621.03 HCBC-ECI Medical Assistance SR 08-18, 10/08 (AAM-A)

Eligibility for CFI* medical assistance differs depending upon whether the individual requesting CFI* 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 CFI* 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 CFI or HCBC services, the CFI or HCBC-eligible individual is opened for CFI or 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 CFI* medical assistance-only are always considered an assistance group of 1. See Section 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 Nursing Facility CAP income limit (see Table A: Income Limits).

- If gross income is equal to or below the Nursing Facility CAP, the individual is income-eligible for CFI* services as categorically needy.

- If gross income exceeds the Nursing Facility 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 PART 605, DEDUCTIONS). The result is net assistance group income.

• Compare the assistance group’s net income to the Protected Income Level (PIL) in Table B, Income Limits for CFI and HCBC Individuals:

- If net income is equal to or below the PIL, * the individual is income eligible for CFI* services as medically needy. BEAS staff will determine the individual’s cost of care obligation.

- If net income exceeds the PIL*, subtract the PIL from the net income to determine the individual’s spenddown for In and Out CFI services.*See PART 625 , IN AND OUT MEDICAL ASSISTANCE.