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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2026 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.502 33

M0320.502 ABD RECEIVING MEDICAID WAIVER SERVICES (CBC)

A. Policy 42 CFR 435.217 - The state plan includes the covered group of aged, blind or disabled individuals in the community who • would be eligible for Medicaid if institutionalized; • are authorized to receive Medicaid waiver services and have selected the option to receive Medicaid waiver services in lieu of nursing facility services; • in the absence of the waiver services would require the level of care furnished in a hospital, nursing facility or ICF-MR; and • have income that does not exceed 300% of the SSI individual payment limit (see M0810.002 A. 3).

Do not wait until the individual starts to receive the waiver services to determine eligibility in this covered group. Determine eligibility in this covered group if the individual is authorized (see subchapter M1420) to receive Medicaid waiver services and has selected the option to receive Medicaid waiver services in lieu of nursing facility services. Presume the individual will receive the services and go on to determine financial eligibility using the policy and procedures in C. below. If the individual's eligibility was determined as an institutionalized individual prior to the receipt of waiver services, the EW must verify the receipt of Medicaid CBC services within 180 days of the date of the Notice of Action on Medicaid. If Medicaid CBC services did not start within 180 days of the date of the Notice of Action on Medicaid, the individual's continued eligibility must be re-evaluated as a non-institutionalized individual. B. Financial Eligibility 1. Asset Transfer The individual must meet the asset transfer policy in subchapter M1450. 2. Resources a. Resource Eligibility - Unmarried Individual All of the individual’s resources must be verified, evaluated, and counted together to determine if the individual meets the Medicaid resource requirements in chapter S11 (ABD Resources). Pay close attention to: 1) equity in non-exempt property contiguous to the individual’s

home which exceeds $5,000 and none of the real property exclusions in sections M1130.100, M1130.140, S1130.150, or M1130.160 apply to the property, and 2) ownership of his/her former residence when the individual has been away from his home property for longer than 6 months. Determine if the home property is excluded in M1130.100. DO NOT DEEM any resources from a blind or disabled child’s parent