8.06 Medically-needy coverage group

In general. An individual who would be a member of a categorically-needy coverage group, as described in § 8.05, may qualify for MABD as medically needy even if their income or resources exceed coverage group limits. Income standard. An otherwise-qualifying individual is eligible for this coverage group if their MABD income for the individual’s financial responsibility group (as defined in § 29.03) is at or below the PIL for the individual’s Medicaid group (as defined in § 29.04), or, as described in paragraph (d) of this subsection, they incur enough non-covered medical expenses to reduce their income to that level. Resource standard. To qualify for this coverage group, an individual must have MABD resources for the individual’s financial responsibility group that are at or below the SSI/AABD maximum for the individual’s Medicaid group, or, as described in paragraph (d) of this subsection, they incur enough expenses to reduce their resources to that level. Spenddown rules. The rules in § 30.00 specify how an individual may use non-covered medical expenses to “spend down” their income or resources to the applicable limits.