621.03 HCBC-CFI Medical Assistance (MAM)

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Individuals applying for Choices For Independent (CFI) medical services, a Home and Community-Based Care (HCBC) service, must meet HCBC-CFI medical criteria as well as other financial and sometimes categorical requirements:

• HCBC-CFI applicants are considered financially and categorically eligible for HCBC-CFI services via the MEAD program if the individual meets:

- the MEAD resource limits in Section 407.01, Financial Assistance and Categorically Needy Medical Assistance;

- the MEAD income limits listed in PART 601, Table F, Medicaid for Employed Adults with Disabilities (MEAD); and

- the MEAD categorical requirements as described throughout PART 211, MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD).

 If a MEAD-eligible individual resides with a spouse, the income and resources of the spouse are considered and financial eligibility for HCBC-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 HCBC-CFI services, the HCBC-CFI-eligible individual is opened for HCBC-CFI services as a group size of 1 on New HEIGHTS.

• HCBC-CFI applicants are considered financially eligible for HCBC-CFI services as categorically-needy if the individual meets:

- the non-MEAD categorically-needy resource limits in Section 407.01, Financial Assistance and Categorically Needy Medical Assistance; and

- the “Categorically-Needy MA” income limits for individuals in Independent Living, Residential Care Facility, or Community Residence living arrangements, listed in PART 601, Table A, Income Limits.

• HCBC-CFI applicants are considered financially eligible for HCBC-CFI services as medically-needy if the individual meets:

- the resource limits in Section 407.03, Medically Needy Medical Assistance; and

- the “Medically-Needy MA” income limits for individuals in Independent Living, Residential Care Facility, or Community Residence living arrangements, listed in PART 601, Table A, Income Limits.

• If a non-MEAD individual does not meet the income limits described above, the individual may also be financially eligible for HCBC-CFI medical services via the special income limits listed in PART 601, Table B, Special Income Limits for CFI and HCBC Individuals. Individuals eligible under this income limit must still meet the non-MEAD resource limits in Section 407.01, Financial Assistance and Categorically Needy Medical Assistance.

Except for MEAD-eligible individuals described in the first bullet above, individuals requesting only HCBC-CFI medical assistance 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 a non-MEAD-eligible individual is income-eligible for HCBC-CFI medical services.

Determining Income Eligibility as Categorically-Needy (bullet 2 above)

• 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 “Categorically-Needy MA” income limit in Table A, Income Limits, for the appropriate living arrangement:

- If gross income is equal to or below the limits, the individual is income-eligible for HCBC-CFI services as categorically-needy.

- If gross income exceeds the limits, determine income eligibility as medically-needy.

Determining Income Eligibility as Medically-Needy (bullet 3 above)

• 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), which is the “Medically-Needy MA” income limits listed in Table A, Income Limits, for the appropriate living arrangement:

- If net income is equal to or below the limits, the individual is income-eligible for HCBC-CFI services as medically-needy.

- If net income exceeds the limits, determine income eligibility via the special income limits.

Determining Income Eligibility Via the Special Income Limits (bullet 4 above)

• 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 income limit listed in Table B, Special Income Limits for CFI and HCBC Individuals, which is the Nursing Facility CAP:

- If gross income is equal to or below the Nursing Facility CAP, the individual is income eligible for HCBC-CFI services under the special income limits.

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