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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2024 Subchapter Subject Page ending with Page M0320.000 AGED, BLIND & DISABLED GROUPS M0320.503 37

D. Enrollment Eligible individuals must be enrolled in the appropriate AC. If the individual is aged, blind, or disabled as defined in M0310, he is enrolled under the AC for that covered group. AC (054) is used for “deemed-disabled” individuals only. Use the appropriate Hospice AC when the individual is also authorized to receive CCC Plus waiver services.

For individuals who are ABD and entitled/enrolled in Medicare Part A, income must be recalculated (allowing appropriate disregards) to determine if the individual is dually eligible as a QMB or SLMB. 1. ABD Individual

a. Dual-eligible As QMB or SLMB If the individual is also a Qualified Medicare Beneficiary (QMB) or Special Low Income Medicare Beneficiary (SLMB) - the individual has Medicare Part A and has countable income within the QMB or SLMB income limits - the AC is: • 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.

b. Not QMB or SLMB If the individual is NOT a Qualified Medicare Beneficiary (QMB) the individual does NOT have Medicare Part A, OR has countable income over the QMB income limit – 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.

2. “Deemed” Disabled Individual An individual who is “deemed” disabled based on the hospice election is enrolled using AC 054. Individuals in this AC who have also been approved to receive services under the EDCD Waiver do not need a disability determination.

E. Post-eligibility Requirements (Patient Pay) A patient pay must be calculated for individuals who receive hospice services in a nursing facility (see subchapter M1470). Individuals who receive hospice services outside of a nursing facility do not have a patient pay. Individuals who have elected hospice services and who also receive services available under the CCC Plus Waiver must have a patient pay calculation for the CCC Plus services (see subchapter M1470). F. Ineligible In This Covered Group There is no corresponding medically needy hospice covered group. If the individual is aged or has been determined blind or disabled, the individual must be evaluated in a medically needy covered group for medically needy spenddown.