Clarifying information

This program is used for individuals who have countable income over the CNIL and living in a licensed, department contracted alternate living facility (ALF).

Noninstitutional Medicaid in an ALF has the same program rules as SSI-related Medicaid, but with a higher income standard.

The ACES medical coverage group (MCG) is G03 for MPC, and G95, G99 for private pay clients.

CFC clients under group C and D are in MCG L52.

For SSI-related individuals who are eligible to receive CN coverage because they are on SSI (S01) or are SSI-related with income at or below the CNIL (S02), the higher standard used for non institutional Medicaid in an ALF is not needed because they already meet CN eligibility. MPC clients in an ALF will remain on the S01 or S02 program.

The G03/G95/G99 medical coverage group is used for eligibility when an individual resides in an alternate living facility. The daily rate is what drives the eligibility. The difference in eligibility between the SSI related series (S02, S95, S99) and non institutional in an ALF (G03, G95, G99) is the income standard. The standard is the daily rate x 31 days plus the ABD cash standard of $38.84.

For individuals receiving Home and Community Services (HCS), Developmental Disabilities Administration (DDA), or behavioral health organization/mental health (BHO) services with income at or below the Medicaid Special Income Level (SIL) use the state daily rate authorized for that individual.

For private pay individuals in a state contracted/licensed facility, use the private daily rate the individual is billed by the facility.