Current through Register Vol. 46, No. 39, September 25, 2024
(a) To be eligible
for MA under section
360-3.3(b)
of this Part as a medically needy person, or to have MA eligibility extended
under some provisions of section
360-3.3(c)
of this Part, a person must meet certain financial requirements. A person who
meets these requirements is financially eligible for MA. This Subpart explains
procedures and principles used to determine financial eligibility.
(b) How the process works.
(1) Except as provided in paragraph (2) of
this subdivision, financial eligibility will be determined as follows:
(i) The size of the applicant's/recipient's
MA household will be determined.
(ii) All income and resources available to
the applicant/recipient during the period for which eligibility is being
determined will be identified.
(iii) Certain amounts and types of income and
resources will be disregarded. The remainder is the applicant's/recipient's net
available income and resources.
(iv) The applicant's/recipient's net
available income and resources will be compared to the eligibility standards
for his/her MA household size. The applicant/recipient is financially eligible
if the amounts of his/her net available income and resources do not exceed the
appropriate standards. A financially eligible applicant who also meets all
other eligibility requirements will be eligible to receive MA.
(v) An applicant whose net available
resources are above the resource standards will be ineligible for MA until
he/she incurs medical expenses equal to or greater than the excess
resources.
(vi) Generally, an
applicant whose net available income is above the income standard for his/her
MA household size will be ineligible for MA until he/she incurs medical
expenses equal to or greater than the excess income.
(2) For a pregnant woman, an infant younger
than one year of age, a child at least one year of age but younger than six
years of age whose household income does not exceed 133 percent of the
applicable Federal poverty line set forth in section
360-4.7(b)
of this Subpart, or a child born after September 30, 1983 who is at least six
years of age but younger than 19 years of age and whose household income does
not exceed 100 percent of the applicable Federal poverty line set forth in
section
360-4.7(b)
of this Subpart, financial eligibility will be determined as follows:
(i) The size of the applicant's/recipient's
MA household will be determined.
(ii) All income available to the
applicant/recipient during the period for which eligibility is being determined
will be identified. All resources available to the applicant's/recipient's MA
household are exempt from consideration.
(iii) Certain amounts and types of income
will be disregarded in accordance with the provisions of section
360-4.6
of this Subpart. The remainder is the applicant's/recipient's net available
income.
(iv) The
applicant's/recipient's net available income will be compared to the
eligibility standards or poverty lines for his/her MA household size. The
applicant/recipient is financially eligible if the amounts of his/her net
available income do not exceed the applicable eligibility standards or poverty
lines. A financially eligible applicant who also meets all other eligibility
requirements will be eligible to receive MA.
(c) This Subpart does not set forth the
procedure for calculating the HR eligibility of persons whose MA eligibility
depends on their being eligible for HR. As more fully explained in section
360-2.2(d)(2)
of this Part, the HR eligibility of such persons generally will be determined
according to Parts 352 and 370 of this Title.
