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West Virginia Income Maintenance Manual Chapter 23

West Virginia Income Maintenance Manual Page 16 Chapter 23 Specific Medicaid Requirements

23.9 RELATIONSHIP BETWEEN COVERAGE GROUPS All Medicaid coverage groups are assigned to one of two categories: Categorically Needy and Medically Needy. • Categorically Needy Medicaid clients are families and children; aged, blind, or disabled individuals; and pregnant women who are eligible to receive Medicaid because they fall into a certain category and meet financial criteria. The federal government mandates West Virginia to cover some Categorically Needy coverage groups; other coverage groups are optional. • Medically Needy Medicaid clients are those who would be eligible for Categorically Needy benefits except that their income and/or assets are too high. Even though their resources are too high for Categorically Needy Medicaid eligibility, they have high medical needs and cannot afford to pay their medical bills. These individuals are allowed to “spenddown” their excess income to the Medically Needy Income Level (MNIL) by incurring medical expenses. The spenddown process is explained in Chapter 4. The following tables show the relationship between the categories and coverage groups. Medicaid Categorically Needy Mandatory (Federal Requirement) Optional (State Option with Federal Approval) Adults, Families, and Children Coverage Groups * Administered by Office of Social Services Parents/Caretaker Relatives Adoption Assistance other than IV-E* Children Under Age 19 Foster Care other than IV-E* Pregnant Women Children with Disabilities Community Services Program (CDCSP) Adult Group Former Foster Children

Continuously Eligible Newborn (CEN) Children (Parent is Categorical) Extended Medicaid IV-E Adoption Assistance* IV-E Foster Care* Transitional Medicaid Non-qualified Noncitizens – Emergency