621.03 HCBC-ECI Medical Assistance SR 02-04, 02/02 (AAM-A) |
Eligibility for HCBC-ECI medical assistance differs depending upon whether the individual requesting HCBC services is MEAD-eligible.
. MEAD-eligible individuals are considered categorically needy and do not have a cost of care requirement. If a MEAD-eligible individual resides with a spouse, the income and resources of the spouse are considered, and financial eligibility for HCBC-ECI services is based on a group size of 2. If the couple meets MEAD financial eligibility requirements, and either or both spouses meet the medical criteria for HCBC services, the HCBC-eligible individual is opened for HCBC services as a group size of 1 on New HEIGHTS. See Part 210, MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES.
. Categorically needy non-MEAD-eligible individuals must contribute toward their cost of care. Non-MEAD eligible individuals requesting HCBC-ECI medical assistance-only are always considered an assistance group of 1. See Part 231.03 , HCBC-ECI Medical Assistance. Do not consider the income or resources of the spouse even if they reside togeher.
Use the following steps to determine if a non-MEAD-eligible individual is income-eligible as categorically or medically needy.
Determining Income Eligibility as Categorically Needy
. Add the individual's countable gross earned income to countable gross unearned income.
Exception: Do not include VA Aid and Attendance or SSI in this step.
. Gross income must be equal to or below the CAP income limit (see Table A ).
- If gross income is equal to or below the CAP, the individual is income-eligible for HCBC-ECI services as categorically needy.*
- If gross income exceeds the CAP, determine income eligibility as medically needy.
Determining Income Eligibility as Medically Needy
. Subtract the earned income disregard (EID) from countable gross earned income to obtain net earned income.
. Add countable gross unearned income to net earned income.
. Subtract any allowable deductions (See AAM 605 , Deductions). The result is net assistance group income.
. Compare net assistance group income to the HCBC medically needy income limit.
- If net income is equal to or below the medically needy income limit in Table B , the individual is income eligible for HCBC-ECI services as medically needy. DEAS staff will determine the individual's cost of care obligation.
- If net income exceeds the income limit, deny the application for HCBC-ECI services. See Part 625 , In and Out Medical Assistance, to determine potential In and Out eligibility.