623.03 HCBC-DD Medical Assistance SR 08-18, 10/08 (AAM-A)

Eligibility for HCBC-DD 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-DD 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 needy non-MEAD-eligible individuals must contribute toward their cost of care. Non-MEAD eligible individuals requesting HCBC-DD 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 Nursing Facility CAP income limit (See Table B, Income Limits for CFI and HCBC Individuals). If gross income is at or below the Nursing Facility CAP income limit, consider the individual to be categorically needy for HCBC-DD medical assistance and determine the individual’s cost of care (See Section 623.05,Cost of Care HCBC-DD 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 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 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 HCBC-DD services as medically needy.

- If net income exceeds the PIL, subtract the PIL from the net income to determine the spenddown for In and Out HCBC-DD services. See PART 625, IN AND OUT MEDICAL ASSISTANCE.