7430 Program Standards - For the Medicaid poverty level, CHIP, QMB, LMB, QWD, and Working Healthy programs, standards have been established based on a percentage of the federal poverty level. If countable income does not exceed these standards, there is eligibility. A premium may be applicable for Working Healthy coverage. For the Medically Needy programs, standards have been established which are the amounts of monthly income protected from medical expenses to allow applicants/recipients to meet their maintenance needs. If countable income does not exceed these standards, there is eligibility. If countable income exceeds the standards, a person can "spenddown" the excess and become eligible.
 

The Special Needs provisions of 7412 do not apply to any medical program.

 

  1. Standards in the QMB, LMB and QWD Programs - For QMB, total countable income must not exceed the monthly 100% poverty level standard.

    To be eligible for LMB, total countable income must not exceed either the monthly 120% or 135% poverty level standard as noted in 2672.

    To be eligible for QWD, total countable income must not exceed the monthly 200% poverty level standard.

    See Appendix, Item F-8 - Standards in the QMB, LMB, and QWD Programs.
     

  2. Standards in the Medically Needy Programs - The protected income budgeted is the independent living standard for the number of persons in the plan and any legally responsible persons in the family group.

    An SSI recipient shall not, however, be included in determining the protected income level.

  3. For persons moving from a long term care arrangement in a Medicaid approved institution to independent living, the independent living standard shall also be budgeted beginning with the month following the month of discharge for persons for whom the provisions of 8144.2 have been applied or the month of discharge for all others. (See 7530 (3).)
     

    An applicant and/or recipient entering a medical institution (including a general medical hospital or a state institution even if no FFP is available) from an independent living situation for a temporary stay as defined in 8113 may be budgeted for independent living for a period not to exceed the two calendar months following the month of admission to allow for maintaining previous living arrangements. This would not be applicable if the provisions of 8144.2 are used.

    See Appendix - F-8 - Standards in the Medical Assistance Programs.
     

  4. Standards in the Working Healthy Program - To be eligible, the total countable income must not exceed the monthly poverty level standards based on the number of individuals in the assistance plan.

    See Appendix F-8 - Standards in the Working Healthy Program.


  5. Standards for Long Term Care – To be Medicaid eligible for long term care coverage (Institutional, HCBS. MFP, PACE), an individual must have countable income before deductions at or below 300% of the SSI standard for a single person.

    If income does not exceed 300% of the SSI standard, the monthly standard for institutional is $62 and $727 for HCBS and MFP. The PACE standard is $727 when receiving HCBS services and $62 when institutionalized.

    If income is in excess of 300%, but passes the cost of care test, eligibility may be determined under Medically Needy (MN)using the $62 and $727 monthly standards. See 8160, 8260 and 8320.1.

    See Appendix, Item F-8 – Standards for Long Term Care/HCBS.

  6.  Standards for MediKan – To be eligible for MediKan, monthly countable income must not exceed $250 for a single individual or $325 for a married couple living together.

    See Appendix, Item F-8 – Standards in the MediKan Program.

 

7440  Reserved