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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 January 2019 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.503 35

• 022 for an aged individual also QMB; • 042 for a blind individual also QMB; • 062 for a disabled individual also QMB; • 025 for an aged individual also SLMB; • 045 for a blind or disabled individual also SLMB.

2. Not QMB or SLMB If the individual is NOT a QMB or SLMB - the individual does NOT have Medicare Part A, OR has countable income over the QMB and SLMB income limits - the AC is: • 020 for an aged individual NOT also QMB or SLMB; • 040 for a blind individual NOT also QMB or SLMB; • 060 for a disabled individual NOT also QMB or SLMB. D. Ineligible In This Covered Group If the individual is not eligible for Medicaid in this covered group because of income, determine the individual’s eligibility as medically needy spenddown. Determine the individual’s eligibility as QMB, SLMB, QDWI or QI if he/she has Medicare Part A.

M0320.503 ABD HOSPICE

A. Policy SMM 3580-3584 - The state plan includes the covered group of aged, blind or disabled individuals who are terminally ill and elect hospice benefits.

The ABD Hospice covered group is for individuals who have a signed a hospice election statement in effect for at least 30 consecutive days, and who are not eligible in any other full-benefit Medicaid covered group. Hospice care is a covered service for individuals in all full-benefit covered groups; individuals who need hospice services but who are eligible in another full-benefit covered group do not meet the Hospice covered group. Individuals receiving hospice services in the ABD Hospice Covered group may also receive services the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, if the services are authorized by the Department of Medical Assistance Services (DMAS) (see M1440.101).

The individual must elect hospice care. Election of hospice care is verified either verbally or in writing from the hospice. If the verification is verbal, document the case record. Eligibility in the Hospice covered group is ongoing as long as the individual continues to receive hospice care, subject to a renewal of eligibility at least once every 12 months. The eligibility worker must verify that the hospice agreement is current at the time of the annual Medicaid renewal. The 30-day requirement begins on the day the hospice care election statement is signed. Once the hospice election has been in effect for 30 consecutive days, the 300% of SSI income limit is used to determine Medicaid eligibility. If the individual’s income is within 300% of SSI, eligibility in the Hospice covered group may be determined beginning with the month in which the hospice election was signed. Individuals who already meet the definition of institutionalization in M1410.010 B.2 at the time of hospice election meet the 30-day requirement, provided there is no break between institutionalization and hospice election.