Adult Medicaid Manual MA-500 CLASSIFICATION

IV. DETERMINATION OF THE CORRECT CLASSIFICATION

In order to determine the correct classification code, (see V. below) you must look to income and resources unless the individual receives SSI.

A. Evaluate Under Categorically Needy Criteria

1. In General

a. When the individual receives SSI, he is categorically needy (C). He automatically receives Medicaid.

b. When the individual does not receive SSI, his income and resources must meet the categorically needy criteria.

2. Non-HCWD Individuals

a. Income must be equal to or less than 100% of the poverty level to be evaluated as “N.”

b. Compare the income of the individual and all financially responsible persons to 100% of the poverty level:

(1) When the income is equal to or less than 100% of the poverty level, continue to evaluate as “N”.

(2) When the income is above the poverty level, the individual cannot be classified as “N.” Refer to B., below to evaluate as Medically Needy.

NOTE: Always advise an applicant to apply for SSI when his countable income is equal to or less than the SSI income limit. Refer to the DMA-5179, MAABD Eligibility Overview Chart.

c. When the income is below the federal poverty level, determine countable reserve based on categorically needy methodology:

(1) When income is equal to or less than 100% of the poverty level and countable reserve is equal to or less than $2,000/3,000, the individual’s classification is “N.”

REISSUED 11/01/11 – CHANGE NO. 17-11

(IV.A.2.c.)

(2) If he has income equal to or less than the poverty level but has excess resources which he reduces to become eligible during the month, he is Medically Needy through the month resources are reduced to the resource limit. He is Categorically Needy - No Money Payment (N) the following month.

(3) When the countable income or reserve, do not meet the categorically needy criteria, the individual cannot be classified as “N.” Refer to IV.B. to evaluate using Medically Needy criteria.

3. HCWD Individual

a. Income must be equal to or less than 150% of the poverty level.

b. Resources must be equal to or less than the minimum community spouse resource allowance (see MA-2231, Community Spouse Resource Protection).

c. When income is equal to or less than 150% of the poverty level and countable reserve is equal to or less than the minimum community spouse resource allowance, the individual’s classification is “N” unless they are eligible as “Q” or “B.”

B. Evaluate Under Medically Needy Criteria

1. When an individual does not meet the “N” criteria, evaluate as Medically Needy (HCWD individuals cannot be Medically Needy). Determine eligibility based on the Medically Needy income level and resource methodologies.

2. Compare the income of the individual and all financially responsible persons to the Medically Needy income limit.

a. When the countable income exceeds the Medically Needy income limit, the individual has a deductible based on the income in excess of the Medically Needy income limit.

b. The individual must incur medical expenses equal to the deductible before he can be authorized for Medicaid.

3. Determine the countable reserve based on Medically Needy criteria:

a. When both countable income and reserve meet the medically needy criteria, the classification is “M.”

REISSUED 11/01/11 – CHANGE NO. 17-11

(IV.B.3.)

b. When the countable reserve exceeds the reserve limit, refer to MA-2304, Processing the Application, and MA-2230, Financial Resources, to determine if the individual can reduce, exclude, or rebut his reserve.

C. Evaluate Under MQB-Q or MQB-B Criteria

When the individual is enrolled in Medicare, always evaluate for MQB-Q and MQB-B and dual eligibility.

1. Compare the countable income to the MQB-Q and MQB-B income limits to determine if the individual meets the income limit for either program.

a. When the income is equal to or below 100% of poverty the individual’s classification is “Q.”

b. When the income is between 100% and 120% of poverty, the individual’s classification is “B.”

2. Determine countable reserve:

a. Reserve is determined using categorically needy reserve methodologies.

b. The reserve limit for MQB-Q or B is twice the reserve limit of categorically needy.

D. Evaluate Under MQB-E Criteria

When the individual is enrolled in Medicare and is ineligible in any other aid program/category above, always evaluate for MQB-E.

1. Compare the countable income to the MQB-E income limits to determine if the individual meets the income limit.

2. Determine countable reserve:

a. Reserve is determined using categorically needy reserve methodologies.

b. The reserve limit for MQB-E is twice the reserve limit of categorically needy.

ISSUED 11/01/11 – CHANGE NO. 17-11