7430 Medical
Program Standards - For the Medicaid poverty level, Title 21,
QMB, LMB, QWD, and Working Healthy programs, standards have been established
based on a percentage of the federal poverty level. If countable income
does not exceed these standards, there is eligibility. A premium may be
applicable for Working Healthy coverage. For the Medically Needy programs,
standards have been established which are the amounts of monthly income
protected from medical expenses to allow applicants/recipients to meet
their maintenance needs. If countable income does not exceed these standards,
there is eligibility. If countable income exceeds the standards, a person
can "spenddown" the excess and become eligible.
The Special Needs provisions of 7412
do not apply to any medical program.
To be eligible for LMB, total countable income must
not exceed either the monthly 120% or 135% poverty level standard
as noted in 2672.
To be eligible for QWD, total countable income must not exceed the
monthly 200% poverty level standard.
See Appendix,
Item F-8 - Standards in the QMB, LMB, and QWD Programs.
Standards in the MA and MS Programs -
The protected income budgeted is the independent living standard for
the number of persons in the plan and any legally responsible persons
in the family group.
An SSI recipient shall not, however, be included in determining the
protected income level.
For persons moving from a long term care arrangement
in a Medicaid approved institution to independent living, the independent
living standard shall also be budgeted beginning with the month following
the month of discharge for persons for whom the provisions of 8144.2
have been applied or the month of discharge for all others. (See 7530 (3).)
An applicant and/or recipient entering a medical institution
(including a general medical hospital or a state institution even
if no FFP is available) from an independent living situation for a
temporary stay as defined in 8113
may be budgeted for independent living for a period not to exceed
the two calendar months following the month of admission to allow
for maintaining previous living arrangements. This would not be applicable
if the provisions of 8144.2 are
used.
See Appendix
- F-8 - Standards in the MA and MS Programs.
Standards
in the Working Healthy Program - To be eligible, the total
countable income must not exceed the monthly poverty level standards
based on the number of individuals in the assistance plan.
See Appendix
F-8 - Standards in the Working Healthy Program.
7440 Child Care Standards - To be eligible, the total countable gross income must not exceed 185% of the current federal poverty guidelines based on the household size. If gross countable income does not exceed these standards, there is financial eligibility. A monthly family share deduction shall be assessed to EM clients with income at or over 70% of the federal poverty level. See the Family Share Deduction Schedule in the Appendix (F-1).