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
the F-8 Kansas Medical Assistance
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 F-8 Kansas Medical Assistance
Standards in the Non-MAGI 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 F-8 Kansas Medical Assistance
Standards in the Working Healthy Program.
5.
Standards for Long Term Care – To
be Medicaid eligible for long term care coverage (Institutional, HCBS,
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. 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 F-8 Kansas Medical Assistance
Standards in Long Term Care/HSBC
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 F-8 Kansas Medical Assistance
Standards In MediKan Program.
7440 Reserved