624.03 HCBC-ABD Medical Assistance (MAM)

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Individuals applying for HCBC-ABD medical services must meet HCBC-ABD medical criteria as well as other financial and sometimes categorical requirements.

• HCBC-ABD applicants are considered financially and categorically eligible for HCBC-ABD 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-ABD 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.

• HCBC-ABD applicants are considered financially eligible for HCBC-ABD 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-ABD applicants are considered financially eligible for HCBC-ABD 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-ABD 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-ABD services are always considered a group size 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-ABD services.

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

1. Add the individual’s 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 “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-ABD 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)

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 add the VA Aid and Attendance Allowance or SSI in this step.

3. Subtract any allowable deductions. See PART 605, DEDUCTIONS. The result is net case 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), 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 PIL, the individual is income eligible for HCBC-ABD services as medically-needy.

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

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

1. Add the individual’s 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. Gross income must be equal to or below the income limit 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-ABD services under the special income limits.

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