622.03 HCBC-IHS Medical Assistance SR 03-28, 05/03 (AAM-A)

Eligibility for HCBC-IHS 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-IHS 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. See PART 210, MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES.

• Categorically and medically needy non-MEAD-eligible individuals must contribute toward their cost of care. Non-MEAD eligible individuals requesting HCBC-IHS medical assistance-only are always considered an assistance group of 1. Do not consider the income or resources of the spouse, even if they reside together.

Use the following steps to determine if the individual is income-eligible as categorically needy or medically needy.

Determining Income Eligibility as Categorically Needy

1. Add countable gross earned income to countable gross unearned income. The result is gross income.

 Exception: Do not include SSI and VA Aid and Attendance in this step.

2. Compare the result obtained in Step 1 to the "CAP" income limit (See Table B, Income Limits for HCBC Individuals). If gross income is at or below the "CAP" income limit, consider the individual to be categorically needy for HCBC-IHS medical assistance and determine the individual’s cost of care (See Section 622.05, Cost of Care: HCBC-IHS Medical Assistance).

Determining Income Eligibility as Medically Needy

If the individual is not categorically needy, determine eligibility as medically needy:

1. Subtract the earned income disregard (EID) from the gross earned income amount determined above to obtain the individual’s net earned income.

2. Add countable gross unearned income to net earned income.

 Exception: Do not include SSI and the VA Aid and Attendance Allowance in this step.

3. Subtract any allowable deductions. See PART 605, Deductions. The result is net income.

 Exception: Do not allow allocated income as a deduction in this step.

4. Compare net income to the monthly cost of HCBC-IHS services. See Form 517-B, Area Agency Information Release to DFA District Office, Home and Community-Based Care Waiver.

- If net income is below the cost of HCBC-IHS services, determine the individual’s cost of care. See Section 622.05, Cost of Care: HCBC-IHS Medical Assistance.

- If net income exceeds the cost of HCBC-IHS services, see PART 625, In and Out Medical Assistance, to determine potential In and Out eligibility.