Adult Medicaid Manual MA-500 CLASSIFICATION

III. SUMMARY OF DIFFERENCES IN CLASSIFICATIONS

A. Application

1. Individuals classified as “C” apply for Medicaid at the Social Security Administration.

2. Individuals classified as “N”, “M”, “Q”, “B” and “E”, or who are covered under MWD apply for Medicaid at the county dss.

B. Income

1. Non-HCWD Individuals

a. Individuals classified as “C” have eligibility determined based on the SSI/Categorically Needy income limit.

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b. Individuals classified as “N” have eligibility determined based on 100% of the Federal Poverty Level (FPL) unless they are HCWD.

c. Individuals classified as “M” have eligibility determined by the medically needy income limit. This limit is 133 1/3% of the State’s AFDC payment standard in July 1996 and is lower than the limits for C and N classifications. (AFDC stands for Aid to Families with Dependent Children. It is the cash assistance program for families with children that was replaced by Work First.)

d. Individuals classified as “Q” have eligibility determined based on 100% of the FPL.

e. Individuals classified as “B” have eligibility determined based on income that falls between 100% and 120% of the FPL.

f. Individuals classified as “E” have eligibility determined based on income that falls between 120% and 135% of the FPL.

g. MWD has eligibility determined based on 200% of the FPL.

2. HCWD Individuals

a. HCWD individuals classified as “N” have eligibility determined based on 150% of FPL, unless eligible for Q or B (see b. and c. below).

b. HCWD individuals classified as “Q” have eligibility determined based on income that falls at or below 100% of FPL and are otherwise eligible for Q class. However, the maintenance amount entered in EIS is 150% of FPL.

c. HCWD individuals classified as “B” have eligibility determined based on income that falls between 100% and at or below 120% of FPL. However, the maintenance amount entered in EIS is 150% of FPL.

C. Resource Limits

1. Non-HCWD Individuals

a. For MAABD individuals classified as “C”, “N”, “M”, Q, and B the resource limit is $2,000 for an individual and $3,000 for a couple.

b. For MQB individuals classified as “Q”, “B” and “E”, resource limit is $6,680 for an individual and $10,020 for a couple.

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2. HCWD Individuals

a. For individuals classified as “N” the resource limit is the minimum community spouse resource standard (See MA-2231, Community Spouse Resource Allowance II.B.)

b. For individuals classified as “B” or “Q” the resource limit is $6,680/10,020.

D. Effective Date of Eligibility Based on Resources

1. “C”, “N”, “Q”, “B”, “E”, and MWD

If an applicant is over the reserve limit as of the first moment of the first day of the month, he is ineligible for the entire month even if he reduces his reserve during the same month.

2. “M”

An applicant is eligible on the day that reserve is reduced to the allowable limit.

E. Deductible

1. Individuals classified as “C”, “N”, “Q”, “B”, and “E” or who are MWD cannot have a deductible. If income exceeds the income limit, the individual is ineligible under that classification.

2. Individuals classified as “M” can become Medicaid eligible by incurring medical expenses that equal a deductible. The deductible is based on income that exceeds the medically needy income limit.

F. Coverage

1. MAABD individuals classified as “C”, “N”, and “M”, or who are dual eligible “Q” or “B” are eligible for full Medicaid benefits.

2. MQB individuals and MWD individuals classified as “Q”, “B” and “E” are eligible for limited Medicare cost sharing benefits except for dual eligible “Q” or “B” which have full benefits.

G. Certification Period

1. Individuals classified as “C” do not have a certification period.

They remain eligible for Medicaid as long as they receive an SSI check.

2. Individuals classified as “N” can have a 6 or 12 month certification period.

3. Individuals classified as “M” must have a 6 month certification period.

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4. Individuals classified as “Q” and “B” have a 12 month certification period unless they are HCWD dual eligibles.

5. Individuals classified as “E” have no set 6/12 month certification period. Once approved, they remain eligible through 12/31 of the current year.

H. Retroactive Medicaid

1. For individuals classified as “C”, the retroactive period is 3 months prior to the SSI date of application.

2. For individuals classified as “N”, “M”, and “B”, the retroactive period is 3 months prior to the Medicaid date of application at the county dss.

3. Individuals classified as “Q” do not have a retroactive period.

4. For individuals classified as “E”, the retroactive period is 3 months prior to the Medicaid date of application at the county dss. However, retroactive coverage can never be authorized earlier than January of the current year.

5. For individuals eligible as MWD, the retroactive period is 3 months prior to the Medicaid date of application.

I. Passalong Protection

Individuals are eligible because Social Security benefits are being excluded under a passalong protection. Refer to MA-2110, Aged Blind And Disabled Passalong.

J. Buy-In

1. For individuals classified as “C”, “N”, “Q”, “B” and “E” and for MWD, the buy-in effective date is the first day of the first month the recipient is authorized for Medicaid.

2. For individuals classified as “M” the buy-in effective date is the first day of the second month following the month of authorization for Medicaid. Refer to MA-2410, Procedures for Medicare Buy-In.

K. Federal Financial Participation (FFP)

1. For individuals classified as “C”, “Q”, and “B” and for MWD, FFP is available for buy-in. This reduces the state and county share of buy-in costs.

2. For individuals classified as “E”, FFP is 100%.

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3. For individuals classified as “N” or “M”, there is no FFP for Medicare buy-in.