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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2018 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.001 1

M0310.000 GENERAL RULES & PROCEDURES

M0310.001 GENERAL PRINCIPLES OF MEDICAID COVERED GROUPS

A. Introduction An individual who meets all the non-financial eligibility requirements in Chapter M02 and who is not an ineligible person listed in M0210.100, must meet a Medicaid covered group in order to be eligible for Medicaid. Chapter M03 explains in detail each of the Medicaid covered groups and how to determine if an individual meets the covered group requirements. The Medicaid covered groups are divided into two classifications: the categorically needy (CN) and the medically needy (MN). CN individuals meet all Medicaid non-financial requirements (see M02) and the definition for a covered group. MN individuals meet all Medicaid non-financial requirements and resource requirements, but have income in excess of the Medicaid limits. MN individuals may be placed on a spenddown (SD). The covered groups are also divided into Aged, Blind and Disabled (ABD) and Families & Children (F&C) covered groups. Within some covered groups are several definitions of eligible individuals. Some individuals may meet the requirements of more than one group. The agency must verify the individual meets a definition for a covered group and the group’s financial requirements. B. Refugees If the Medicaid applicant is a refugee, first determine if the refugee meets the requirements in a Medicaid covered group using the policy and procedures in this chapter. If the refugee does not meet the requirements of a Medicaid covered group, the refugee is not eligible for Medicaid under a Medicaid covered group. Go to the Refugee Resettlement Program Manual Volume XVIII to determine the refugee's eligibility for assistance under the Refugee Resettlement Program. The requirements for the Refugee Other (Cash Assistance) and Refugee Medicaid Other and Refugee Medicaid Unaccompanied Minors programs are found in another manual: the Refugee Resettlement Program Manual Volume XVIII. C. Covered Group Information This subchapter contains the general principles for determining if the individual meets a definition and covered group(s). • M0310.002 contains the list of Covered Groups; • M0310.100 - M0310.134 contains the Definitions; • M0320 contains the detailed policy and covered group requirements for the Aged, Blind and Disabled Groups; • M0330 contains the detailed policy and covered group requirements for the Families & Children Groups, and includes the Modified Adjusted Gross Income (MAGI) Adults covered group, effective January 1, 2019.