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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2013 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.503 36
Individuals who meet the Hospice covered group may have their eligibility determined using the same financial requirements as institutionalized individuals. B. Financial Eligibility 1. Asset Transfer The individual in the hospice covered group must meet the asset transfer policy in subchapter M1450. 2. Resources The hospice services recipient is an assistance unit of 1 person. All of the individual’s resources must be verified, evaluated, and counted together to determine if the individual meets the Medicaid resource requirements.
If current resources are within the limit, go on to determine income eligibility.
If current resources are NOT within the limit, the individual is NOT eligible for Medicaid in this covered group. He/she may be eligible in an MSP covered group (which has more liberal resource methods and standards).
a. Unmarried Individual If the individual is unmarried or is married and has no community spouse, use the resource policy in chapter S11 and subchapter M1460.
b. Married Individuals If the individual is married and has a community spouse, use the resource policy in chapter S11 and subchapter M1480.
3. Income To determine if an individual has income within the 300% of SSI limit, use gross income, not countable income. Determine what is income according to chapter S08 and subchapter M1460. DO NOT subtract the $20 general exclusion or any other income exclusions. The individual is an assistance unit of 1 person. DO NOT DEEM any income from the individual’s spouse or parent.
Compare the total gross income to the 300% of SSI limit (see M0810.002 A. 3). If countable income is equal to or less than this limit, the individual is eligible for Medicaid in this covered group. If the total gross income exceeds this limit, the individual is not eligible for Medicaid in this covered group. Evaluate his/her eligibility as medically needy. C. Entitlement Eligible individuals in this group are entitled to full Medicaid coverage beginning the first day of the month in which all eligibility requirements are met. Retroactive coverage is applicable to this covered group. If the individual has Medicare Part A, re-calculate the individual’s income, applying the appropriate exclusions. Compare the countable income to the QMB and SLMB limits.