Source: http://www.townhall.virginia.gov/l/ViewXML.cfm?textid=11685
Timestamp: 2019-05-24 10:21:42
Document Index: 23896961

Matched Legal Cases: ['§ 301', '§ 601', '§ 602', '§ 1396', '§ 1905', '§ 1616', '§ 212', '§ 1619', '§ 435', '§ 134', '§ 1634', '§ 1611', 'art 441', '§ 1915', '§ 1915', '§ 1905', '§ 1902', '§ 1616', '§ 1614', '§ 1504', '§ 2701', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', 'art 435', '§ 1902', '§ 1905', '§ 1902', '§ 1905', '§ 431', '§ 1641', '§ 402', '§ 1612', '§ 403', '§ 1613', '§ 1903', '§ 431', '§ 212', '§ 274', '§ 301', '§ 208', '§ 241', '§ 1806', '§ 1902', '§ 1903', '§ 1137', '§ 1903', '§ 1137', '§ 211', '§ 1903', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1616', '§ 1634', '§ 1902', '§ 1616', '§ 1634', '§ 1902', '§ 1902', '§ 1616', '§ 1634', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1905', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1902', '§ 1931', '§ 1931', '§ 1115']

CH 0030 Modified Adjusted Gross Income (MAGI) Methodology ...
6/1/17 11:54 AM [latest] 6/22/15 9:37 AM 6/9/15 3:03 PM
12VAC30-30-5
12VAC30-30-5. Definitions.
The follows words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Act" means the Social Security Act (42 USC §§ 301 through 1397mm).
"SSP" means state supplementary payment.
"Title IV-A" means Title IV, Part A of the Social Security Act, 42 USC §§ 601 through 619.
"Title IV-A agency" means the agency described in 42 USC § 602(a)(4).
"Title XIX" means Title XIX of the Social Security Act, 42 USC §§ 1396 through 1396w-5.
c. They were in foster care under the responsibility of any state or a federally recognized tribe and were enrolled in Medicaid under the state plan of that state when they turned age 18 years or at the time of aging out of the foster care program.
12. 6. A child born to a woman who is eligible for and receiving Medicaid on the date of the child's birth. The child is deemed to have applied and been found eligible for Medicaid on the date of birth and remains eligible for one year from birth, as long as he remains a resident of the Commonwealth. A redetermination of eligibility must be completed on behalf of the deemed child at age one year and annually thereafter so long as he remains eligible.
13. 7. Aged, blind, and disabled individuals receiving cash assistance.
d. The more restrictive categorical eligibility criteria are described below: (1) See in 12VAC30-30-40.
14. 8. Qualified severely impaired blind and disabled individuals under age 65 years who:
a. For the month preceding the first month of eligibility under the requirements of § 1905(q)(2) of the Act, received SSI, a state supplemental supplementary payment (SSP) under § 1616 of the Act or under § 212 of P.L. 93-66 or benefits under § 1619(a) of the Act and were eligible for Medicaid; or
15. 9. Except in states that apply more restrictive requirements for Medicaid than under SSI, blind or disabled individuals who:
16. 10. Except in states that apply more restrictive eligibility requirements for Medicaid than under SSI, individuals who are ineligible for SSI or optional state supplements (if the agency provides Medicaid under § 435.230 of the Act), because of requirements that do not apply under Title XIX of the Act.
17. 11. Individuals receiving mandatory state supplements.
18. 12. Individuals who in December 1973 were eligible for Medicaid as an essential spouse and who have continued, as spouse, to live with and be essential to the well-being of a recipient of cash assistance. The recipient with whom the essential spouse is living continues to meet the December 1973 eligibility requirements of the state's approved plan for OAA Old Age Assistance, AB Aid to the Blind, APTD Aid to the Permanently and Totally Disabled, or AABD Aid to the Aged, Blind, and Disabled and the spouse continues to meet the December 1973 requirements for have his or her needs included in computing the cash payment.
In December 1973, Medicaid coverage of the essential spouse was limited to: the aged;, the blind;, and the disabled.
19. 13. Institutionalized individuals who were eligible for Medicaid in December 1973 as inpatients of Title XIX medical institutions or residents of Title XIX intermediate care facilities, if, for each consecutive month after December 1973, they:
20. 14. Blind and disabled individuals who:
21. 15. Individuals who would be SSI/SSP eligible except for the increase in OASDI benefits under P.L. 92-336 (July 1, 1972), who were entitled to OASDI in August 1972, and who were receiving cash assistance in August 1972.
22. 16. Individuals who:
23. 17. Disabled widows and widowers who would be eligible for SSI or SSP except for the increase in their OASDI benefits as a result of the elimination of the reduction factor required by § 134 of P.L. 98-21 and who are deemed, for purposes of Title XIX, to be SSI beneficiaries or SSP beneficiaries for individuals who would be eligible for SSP only, under § 1634(b) of the Act.
24. 18. Disabled widows, disabled widowers, and disabled unmarried divorced spouses who had been married to the insured individual for a period of at least 10 years before the divorce became effective, who have attained the age of 50, who are receiving Title II payments, and who because of the receipt of Title II income lost eligibility for SSI or SSP which they received in the month prior to the month in which they began to receive Title II payments, who would be eligible for SSI or SSP if the amount of the Title II benefit were not counted as income, and who are not entitled to Medicare Part A.
25. 19. Qualified Medicare beneficiaries:
26. 20. Qualified disabled and working individuals:
27. 21. Specified low-income Medicare beneficiaries:
28. 22. a. Each person to whom SSI benefits by reason of disability are not payable for any month solely by reason of clause (i) or (v) of § 1611(e)(3)(A) shall be treated, for purposes of Title XIX, as receiving SSI benefits for the month.
The Title IV A IV-A agency determines eligibility for Title XIX services. The following groups are eligible:
2. 1. Individuals who would be eligible for AFDC, SSI or an optional state supplement as specified in 42 CFR 435.230, if they were not in a medical institution.
3. 2. A group or groups of individuals who would be eligible for Medicaid under the plan if they were in a nursing facility (NF) or an ICF/MR intermediate care facility for individuals with intellectual disabilities (ICF/IID), who but for the provision of home and community-based services under a waiver granted under 42 CFR Part 441, Subpart G would require institutionalization, and who will receive home and community-based services under the waiver. The group or groups covered are listed in the waiver request. This option is effective on the effective date of the state's § 1915(c) waiver under which this group is or these groups are covered. In the event an existing § 1915(c) waiver is amended to cover this group or these groups, this option is effective on the effective date of the amendment.
4. 3. Individuals who would be eligible for Medicaid under the plan if they were in a medical institution, who are terminally ill, and who receive hospice care in accordance with a voluntary election described in § 1905(o) of the Act.
5. 4. The state Commonwealth does not cover all individuals who are not described in § 1902(a)(10)(A)(i) of the Act, who meet the income and resource requirements of the AFDC state plan and who are under younger than the age of 21 years. The state Commonwealth does cover reasonable classifications of these individuals as follows:
(1) In foster homes (and are under younger than the age of 21 years).
(2) In private institutions (and are under younger than the age of 21 years).
(3) In addition to the group under subdivisions 5 4 a (1) and 4 a (2) of this section, individuals placed in foster homes or private institutions by private nonprofit agencies (and are under younger than the age of 21 years).
b. Individuals in adoptions subsidized in full or part by a public agency (who are under younger than the age of 21 years).
c. Individuals in NFs (who are under younger than the age of 21 years). NF services are provided under this plan.
d. In addition to the group under subdivision 5 4 c of this section, individuals in ICFs/MR ICF/IIDs (who are under younger than the age of 21 years).
6. 5. A child for whom there is in effect a state adoption assistance agreement (other than under Title IV-E of the Act), who, as determined by the state adoption agency, cannot be placed for adoption without medical assistance because the child has special care needs for medical or rehabilitative care, and who before execution of the agreement:
a. Was was eligible for Medicaid under the state's approved Medicaid plan; or
The state Commonwealth covers individuals under younger than the age of 21 years.
7. 6. Section 1902(f) states and SSI criteria states without agreements under §§ 1616 and 1634 of the Act. The following groups of individuals who receive a state supplementary payment under an approved optional state supplementary payment program that meets the following conditions. The supplement is:
8. 7. Individuals who are in institutions for at least 30 consecutive days and who are eligible under a special income level. Eligibility begins on the first day of the 30-day period. These individuals meet the income standards specified in 12VAC30-40-220.
The state Commonwealth covers all individuals as described above in this subdivision.
9. 8. Individuals who are 65 years of age or older or who are disabled as determined under § 1614(a)(3) of the Act, whose income does not exceed the income level specified in 12VAC30-40-220 for a family of the same size, and whose resources do not exceed the maximum amount allowed under SSI.
10. 9. Individuals required to enroll in cost-effective employer-based group health plans remain eligible for a minimum enrollment period of one month.
11. Women 10. Individuals who have been screened for breast or cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program established under Title XV of the Public Health Service Act in accordance with § 1504 of the Public Health Service Act and need treatment for breast or cervical cancer, including a pre-cancerous condition of the breast or cervix. These women individuals are not otherwise covered under creditable coverage, as defined in § 2701(c) of the Public Health Services Act, are not eligible for Medicaid under any mandatory categorically needy eligibility group, and have not attained age 65.
12. 11. Individuals who may qualify for the Medicaid Buy-In program under § 1902(a)(10)(A)(ii)(XV) of the Social Security Act (Ticket to Work Act) if they meet the requirements for the 80% eligibility group described in 12VAC30-40-220, as well as the requirements described in 12VAC30-40-105 and 12VAC30-110-1500.
12VAC30-30-40
12VAC30-30-40. Reasonable classifications of individuals under younger than the age of 21, 20, 19, and or 18 years.
See The reasonable classifications of individuals younger than the age of 21, 20, 19, or 18 years are set out in subdivision 5 4 of 12VAC30-30-20. See and subdivision 5 of 12VAC30-30-30.
(1) Except as specified under subdivisions 2 a (2) and 2 a (3) of this section, for AFDC-related Title IV-E individuals, meets covered under § 1902(a)(10)(A)(i)(1), meet the nonfinancial eligibility conditions of the AFDC Medicaid program.
(2) For SSI-related individuals, meets meet the nonfinancial criteria of the SSI program or more restrictive SSI-related categorically needy criteria.
(3) For financially eligible parent/caretaker relatives, pregnant women, infants, or children covered under § 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), and 1902(a)(10)(A)(ii)(IX), and 1931 of the Social Security Act (Act), meets meet the nonfinancial criteria of § 1902(l) of the Act.
(4) For financially eligible aged and disabled individuals covered under § 1902(a)(10)(A)(ii)(X) of the Act, meets meet the nonfinancial criteria of § 1902(m) of the Act.
b. For the medically needy, meets meet the nonfinancial eligibility conditions of 42 CFR Part 435.
c. For financially eligible qualified Medicare beneficiaries covered under § 1902(a)(10)(E)(i) of the Act, meets meet the nonfinancial criteria of § 1905(p) of the Act.
d. For financially eligible qualified disabled and working individuals covered under § 1902(a)(10)(E)(ii) of the Act, meets meet the nonfinancial criteria of § 1905(s).
3. Is residing in the United States and: May receive Medicaid eligibility if otherwise eligible. The Commonwealth provides Medicaid to citizens and nationals of the United States and certain noncitizens consistent with requirements of 42 CFR 435.406, including during a reasonable opportunity period pending verification of their citizenship, national status, or satisfactory immigration status. The Commonwealth provides Medicaid eligibility to otherwise eligible individuals:
a. Is a citizen Who are citizens or national nationals of the United States;.
b. Is a Who are qualified alien noncitizens as defined under Public Law 104-193 who arrived in the United States prior to August 22, 1996; in § 431 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) (8 USC § 1641) or whose eligibility is required by § 402(b) of PRWORA (8 USC § 1612(b)) and certain qualified noncitizens whose eligibility is not prohibited by § 403 of PRWORA (8 USC § 1613); and
(1) The Commonwealth requires lawful permanent residents to have 40 qualifying work quarters under Title II of the Social Security Act;
c. Is a qualified alien as defined under Public Law 104-193 who arrived in the United States on or after August 22, 1996, and whose coverage is mandated by Public Law 104-193; Who have declared themselves to be citizens or nationals of the United States, or any individual having satisfactory immigration status, during a reasonable opportunity period pending verification of their citizenship, nationality, or satisfactory immigration status consistent with requirements of §§ 1903(x), 1137(d), and 1902(ee) of the Act and 42 CFR 435.406, and 956.
d. Is an alien Who is a noncitizen, who is not a qualified alien noncitizen, or who is a qualified alien noncitizen who arrived in the United States on or after August 22, 1996, whose coverage is not mandated by Public Law P.L. 104-193 (coverage must be restricted to certain emergency services); or
e. Is an alien Who is a noncitizen who is a pregnant woman or who is a child under younger than the age of 19 years who is legally residing in the United States and whose coverage is authorized under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). CHIPRA provides for coverage of the following individuals:
(1) A qualified alien noncitizen as defined in § 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996;
(2) An alien A noncitizen in nonimmigrant status who has not violated the terms of the status under which he was admitted or to which he has changed after admission;
(3) An alien A noncitizen who has been paroled into the United States pursuant to § 212(d)(5) of the Immigration and Nationality Act (INA) for less than one year, except for an alien a noncitizen paroled for prosecution, for deferred inspection, or pending removal proceedings;
(4) An alien A noncitizen who belongs to one of the following classes:
(c) Aliens Noncitizens who have been granted employment authorization under 8 USC § 274a.12(c)(9), (10), (16), (18), (20), (22), or (24);
(d) Family unity beneficiaries pursuant to § 301 of Public Law P.L. No. 101-649 as amended;
(e) Aliens Noncitizens currently under Deferred Enforced Departure (DED) pursuant to a decision made by the President of the United States;
(f) Aliens Noncitizens currently in deferred action status; and
(g) Aliens Noncitizens whose visa petition has petitions have been approved and who have a pending application for adjustment of status;
(5) A Noncitizens who are pending applicant applicants for asylum under § 208(a) of the INA or for withholding of removal under § 241(b)(3) of the INA or under the Convention against Torture who has been granted employment authorization, and such an applicant under younger than the age of 14 years who has had an application pending for at least 180 days;
(6) An alien A noncitizen who has been granted withholding of removal under the Convention against Torture;
(8) An alien A noncitizen who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 USC § 1806(e); or
(9) An alien A noncitizen who is lawfully present in American Samoa under the immigration laws of American Samoa.
4. Is a resident of the state Commonwealth, regardless of whether or not the individual maintains the residence permanently or maintains the residence as a fixed address. The state has open interstate residency agreements.
b. Shall also cooperate in establishing the paternity of any eligible child and in obtaining medical support and payments for himself or herself and any other person who is eligible for Medicaid and on whose behalf the individual can make an assignment; except that individuals described in § 1902(l)(1)(A) of the Social Security Act (pregnant women and women in the postpartum period) are exempt from these requirements involving paternity and obtaining support. Any individual may be exempt from the cooperation requirements by demonstrating good cause for refusing to cooperate.
7. a. Is required, as a condition of eligibility, to furnish his social security account number (or numbers, if he has more than one number) except for aliens noncitizens seeking medical assistance for the treatment of an emergency medical condition under § 1903(v)(2) of the Social Security Act (§ 1137(f)).
b. Is required, under § 1903(x) to furnish satisfactory documentary evidence of both identity and of U.S. citizenship upon signing the declaration of citizenship required by § 1137(d) unless citizenship and identity has been verified by the Commissioner of Social Security pursuant to § 211 of the Children's Health Insurance Program Reauthorization Act (CHIPRA), or the individual is otherwise exempt from this requirement. Qualified aliens noncitizens signing the declaration of satisfactory immigration status must also present and have verified documents establishing the claimed immigration status. Exception: Nonqualified aliens noncitizens seeking medical assistance for the treatment of an emergency medical condition under § 1903(v)(2).
8. Is not required to apply for AFDC public assistance cash benefits under Title IV-A as a condition of applying for, or receiving Medicaid if the individual is a pregnant women, infant, or child that the state elects to cover under § 1902(a)(10)(A)(i)(IV) and 1902(a)(10)(A)(ii)(IX) of the Act.
10. 9. Is required to apply for coverage under Medicare A, B and/or or D, or any combination of Medicaid A, B, and D, if it is likely that the individual would meet the eligibility criteria for any or all of those programs. The state agrees to pay any applicable premiums and cost-sharing (except those applicable under Part D) for individuals required to apply for Medicare. Application for Medicare is a condition of eligibility unless the state does not pay the Medicare premiums, deductibles or co-insurance (except those applicable under Part D) for persons covered by the Medicaid eligibility group under which the individual is applying.
11. 10. Is required, as a condition of eligibility for Medicaid payment of long-term care services, to disclose at the time of application for or renewal of Medicaid eligibility, a description of any interest the individual or his spouse has in an annuity (or similar financial instrument as may be specified by the Secretary of Health and Human Services). By virtue of the provision of medical assistance, the state shall become a remainder beneficiary for all annuities purchased on or after February 8, 2006.
12. 11. Is ineligible for Medicaid payment of nursing facility or other long-term care services if the individual's equity interest in his home exceeds $500,000. This dollar amount shall be increased beginning with 2011 from year to year based on the percentage increase in the Consumer Price Index for all Urban Consumers rounded to the nearest $1,000.
12VAC30-40-90
Subpart Article 1
A. For individuals who are AFDC or AFDC-related medically needy or SSI recipients, the income and resource levels and methods for determining countable income and resources of the AFDC and SSI program apply, unless the plan provides for more restrictive levels and methods than SSI for SSI recipients under § 1902(f) of the Act, or more liberal methods under § 1902(r)(2) of the Act, as specified below in this section.
B. For individuals who are not AFDC or AFDC-related medically needy or SSI recipients in a non-section 1902(f) State state and those who are deemed to be cash assistance recipients, the financial eligibility requirements specified in this subpart article apply.
C. D. 12VAC30-40-220 specifies the income levels for mandatory and optional categorically needy groups of individuals, including individuals with incomes related to the Federal federal income poverty level--, that is pregnant women and infants or children covered under §§ 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), and 1902(a)(10)(A)(ii)(IX) of the Act and aged and disabled individuals covered under § 1902(a)(10)(A)(ii)(X) of the Act--,and for mandatory groups of qualified Medicare beneficiaries covered under § 1902(a)(10)(E)(i) of the Act.
D. E. 12VAC30-40-230 specifies the resource levels for mandatory and optional categorically needy poverty level related groups, and for medically needy groups.
E. F. 12VAC30-40-260 specifies the income levels for categorically needy aged, blind, and disabled persons who are covered under requirements more restrictive than SSI.
F. G. 12VAC30-40-240 specifies the methods for determining resource eligibility used by States states that have more restrictive methods than SSI, permitted under § 1902(f) of the Act.
G. H. 12VAC30-40-270 specifies the resource standards to be applied for categorically needy individuals in states that have elected to impose more restrictive eligibility requirements than SSI, permitted under § 1902(f) of the Act.
H. I. 12VAC30-40-280 specifies the methods for determining income eligibility used by States states that are more liberal than the methods of the cash assistance programs, permitted under § 1902(r)(2) of the Act.
I. J. 12VAC30-40-290 specifies the methods for determining resource eligibility used by States states that are more liberal than the methods of the cash assistance programs, permitted under § 1902(r)(2) of the Act.
12VAC30-40-100
Subpart Article 2
a. AFDC-related A. Families and Children Medically Needy individuals (except for poverty level related pregnant women, infants, and children).
(1) 1. In determining countable income for AFDC-related Families and Children Medically Needy individuals, the methods under the state's July 16, 1996, approved AFDC Aid to Families with Dependent Children plan and any more liberal methods described in 12VAC30-40-280 are used.
(2) 2. In determining relative financial responsibility, the agency considers only the income of spouses living in the same household as available to children living with parents until the children become 21 years of age.
(3) 3. Agency continues to treat women eligible under the provisions of § 1902(a)(10) of the Act as eligible, without regard to any changes in income of the family of which she is a member, for the 60-day period after her pregnancy ends and any remaining days in the month in which the 60th day falls.
b. E. Aged individuals. In determining countable income for aged individuals, including aged individuals with incomes up to the federal poverty level described in section § 1902(m)(1) of the Act, the following methods are used.
(1) 1. The methods of the SSI program and/or, any more liberal methods described in 12VAC30-40-280, or both apply.
(2) 2. For optional state supplement recipients in § 1902(f) states and SSI criteria states without § 1616 or § 1634 agreements, SSI methods and/or, any more liberal methods than SSI described in 12VAC30-40-280, or both apply.
(3) 3. In determining relative financial responsibility, the agency considers only the income of spouses living in the same household as available to spouses.
c. F. Blind individuals. In determining countable income for blind individuals, only the methods of the SSI program and/or, any more liberal methods described in 12VAC30-40-280, or both apply.
For optional state supplement recipients in § 1902(f) states and SSI criteria states without § 1616 or § 1634 agreements, the SSI methods and/or, any more liberal methods than SSI described in 12VAC30-40-280, or both apply.
d. G. Disabled individuals. In determining countable income of disabled individuals, including disabled individuals with incomes up to the federal poverty level described in § 1902(m) of the Act, the methods of the SSI program and/or, any more liberal methods described in 12VAC30-40-280, or both apply.
For optional state supplement recipients in § 1902(f) of the Act states and SSI criteria states without § 1616 or § 1634 agreements, the SSI methods and/or, any more liberal methods than SSI described in 12VAC30-40-280, or both apply.
e. Poverty level pregnant women, infants, and children. For pregnant women and infants or children covered under the provisions of § 1902(a)(10)(A)(i)(IV), (VI) and (VII), and § 1902(a)(10)(A)(ii)(IX) of the Act:
(1) The methods of the state's approved AFDC plan are used in determining countable income.
(2) In determining relative financial responsibility, the agency considers only the income of spouses living in the same household as available to spouses and the income of parents as available to children living with parents until the children become 21.
(3) The agency continues to treat women eligible under the provisions of § 1902(a)(10) of the Act as eligible, without regard to any changes in income of the family of which she is a member, for the 60-day period after her pregnancy ends and any remaining days in the month in which the 60th day falls.
f. H. Qualified Medicare beneficiaries. In determining countable income for qualified Medicare beneficiaries covered under § 1902(a)(10)(E)(i) of the Act, the methods of the SSI program and/or, more liberal methods described in 12VAC30-40-280, or both are used.
g. I. Qualified disabled and working individuals. In determining countable income for qualified disabled and working individuals covered under § 1902(a)(10)(E)(ii) of the Act, the methods of the SSI program are used.
12VAC30-40-150
a. A. Section 1902(f) States states (except as specified under items c. and d. below) subsections C and D of this section) for aged, blind and disabled individuals: same as SSI resource standards.
The resource standards for other individuals are the same as those in the related cash assistance program.
b. B. Non-1902(f) States states (except as specified under items c. and d. below) subsections C and D of this section).
2. 12VAC30-40-270 specifies for 1902(f) States states the categorically needy resource levels for all covered categorically needy groups.
c. C. The agency does not apply a resource standard for pregnant women and or infants covered under the provisions of section §§ 1902(a)(10)(A)(i)(IV) and 1902(a)(10)(A)(ii)(IX) of the Act.
d. D. The agency does not apply a resource standard for parent/caretaker relatives or children covered under the provisions of § 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(l), or 1931 of the Act.
e. E. For aged and disabled individuals described in § 1902(m)(1) of the Act who are covered under § 1902(a)(10)(A)(ii)(X) of the Act, 12VAC30-40-230 specifies the resource levels for these individuals.
12VAC30-40-220
A. Mandatory Categorically Needy
1. AFDC-related groups other than poverty level pregnant women and infants.
(Increased annually by the increase in the Consumer Price Index)
Table 1 (100%)
Table 2 (90%)
Each person above 10
MAXIMUM REIMBURSABLE PAYMENT $403
MAXIMUM REIMBURSABLE PAYMENT $435
MAXIMUM REIMBURSABLE PAYMENT $518
2. Pregnant women and infants under § 1902(a)(10)(i)(IV) of the Act:. Effective April 1, 1990, January 1, 2014, based on 133% 143% of the official federal income poverty level.
3. Children under § 1902(a)(10)(i)(VI) of the Act (children who have attained age 1 one year but have not attained age 6) six years), the income eligibility level is 133% 143% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.
4. For children under § 1902(a)(10)(i)(VII) of the Act (children who were born after September 30, 1983, and have attained age 6 six years but have not attained age 19 years), the income eligibility level is 100% 143% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.
3. For individuals not receiving Title II income, the revised poverty levels are effective no later than the beginning of the month following the date of publication. C. Qualified Medicare beneficiaries with incomes related to federal poverty level.
The levels for determining income eligibility for groups of qualified Medicare beneficiaries under the provisions of § 1905(p)(2)(A) of the Act are as follows:
1. Section 1902(f) states, which as of January 1, 1987, used income standards more restrictive than SSI., (VA Virginia did not apply a more restrictive income standard as of January 1, 1987.)
Effective Jan. January 1, 1989: 85%
Effective Jan. January 1, 1990: 90% (no more than 100)
Effective Jan. January 1, 1991: 100% (no more than 100)
Effective Jan. January 1, 1992: 100%
E. Income levelsfor medically needy. (Increased annually the increase in the Consumer Price Index but no higher than the level permitted to claim federal financial participation.)
2. The agency has methods for excluding from its claim for FFP federal financial participation payments made on behalf of individuals whose income exceeds these limits.
A. For children covered under §§ 1902(a)(10)(A)(i)(III) and 1905(n) of the Social Security Act (Act), the Commonwealth of Virginia will disregard one dollar plus an amount equal to the difference between 100% of the AFDC payment standard for the same family size and 100% of the federal poverty level for the same family size as updated annually in the Federal Register.
B. A. For ADC-related medically needy cases, both categorically and medically needy, any individual or family applying for or receiving assistance shall be granted an income exemption consistent with the Social Security Act (Act) (§§ 1902(a)(10)(A)(i)(III), (IV), (VI), (VII); §§ 1902(a)(10)(A)(ii)(VIII), (IX); § 1902(a)(10)(C)(i)(III)) and 1902(a)(10)(C)(ii)(I)). Any interest earned on one interest-bearing savings or investment account per assistance unit not to exceed $5,000, if the applicant, applicants, recipient or recipients designate that the account is reserved for purposes related to self-sufficiency, shall be exempt when determining eligibility for medical assistance for so long as the funds and interest remain on deposit in the account. For purposes of this section, "purposes related to self-sufficiency" shall include, but are not limited to, (i) paying for tuition, books, and incidental expenses at any elementary, secondary, or vocational school, or any college or university; (ii) for making down payment on a primary residence; or (iii) for establishment of a commercial operation that is owned by a member of the Medicaid assistance unit.
D. B. For aged, blind, and disabled individuals, both categorically and medically needy, with the exception of the special income level group of institutionalized individuals, the Commonwealth of Virginia shall disregard the value of in-kind support and maintenance when determining eligibility. In-kind support and maintenance means food, clothing, or shelter or any combination of these provided to an individual.
E. C. For all categorically needy and medically needy children covered under the family and children covered groups, (§§ 1902(a)(10)(A)(i)(I), 1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), 1902(a)(10)(A)(ii)(VIII), 1902(a)(10)(C)(ii)(I), and 1905(n) of the Act), the Commonwealth will disregard all earned income of a child under the age of 19 years who is a student.
F. D. For all categorically needy and medically needy individuals covered under the family and children covered groups (§§ 1902(a)(10)(A)(i)(I), 1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), 1902(a)(10)(A)(ii)(VIII), 1902(a)(10)(C)(ii)(I), and 1905(n) of the Act), the Commonwealth will disregard the fair market value of all in-kind support and maintenance as income in determining financial eligibility. In-kind support and maintenance means food, clothing or shelter or any combination of these provided to an individual.
G. E. Working individuals with disabilities eligible for assistance under § 1902(a)(10)(A)(ii)(XV) of the Act who wish to increase their earnings while maintaining eligibility for Medicaid must establish Work Incentive (WIN) accounts (see 12VAC30-40-290).
H. F. For aged, blind and disabled individuals, both categorically and medically needy, with the exception of the special income level group of institutionalized individuals, the Commonwealth of Virginia shall disregard the value of income derived from temporary employment with the United States Census Bureau for a decennial census.
I. G. For all categorically needy and medically needy individuals covered under the family and children covered groups (§§ 1902(a)(10)(A)(i)(I), 1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(V), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), 1902(a)(10)(A)(ii)(VIII), 1902(a)(10)(C)(ii)(I), and 1905(n) of the Act), the Commonwealth will disregard income derived from the temporary employment with the United States U.S. Census Bureau for a decennial census.
A. Resources to meet burial expenses. Resources set aside to meet the burial expenses of an applicant/recipient applicant or recipient or that individual's spouse are excluded from countable assets. In determining eligibility for benefits for individuals, disregarded from countable resources is an amount not in excess of $3,500 for the individual and an amount not in excess of $3,500 for his spouse when such resources have been set aside to meet the burial expenses of the individual or his spouse. The amount disregarded shall be reduced by:
F. Life, retirement, and other related types of insurance policies. Life, retirement, and other related types of insurance policies with face values totaling $1,500 or less on any one person 21 years old and over older are not considered resources. When the face values of such policies of any one person exceeds $1,500, the cash surrender value of the policies is counted as a resource.
I. Resource exemption for Aid to Dependent Children categorically and medically related medically needy (the Act §§ 1902(a)(10)(A)(i)(III), (IV), (VI), (VII); §§ 1902(a)(10)(A)(ii)(VIII), (IX); § 1902(a)(10)(C)(i)(III)) (§ 1902(a)(10)(C) of the Act). For ADC-related cases, both categorically and medically needy cases, any individual or family applying for or receiving assistance may have or establish one interest-bearing savings or investment account per assistance unit not to exceed $5,000 if the applicant, applicants, recipient or recipients designate that the account is reserved for purposes related to self-sufficiency. Any funds deposited in the account shall be exempt when determining eligibility for medical assistance for so long as the funds and interest remain on deposit in the account. Any amounts withdrawn and used for purposes related to self-sufficiency shall be exempt. For purposes of this section, purposes related to self-sufficiency shall include, but are not limited to, (i) paying for tuition, books, and incidental expenses at any elementary, secondary, or vocational school, or any college or university; (ii) for making down payment on a primary residence; or (iii) for establishment of a commercial operation that is owned by a member of the medical assistance unit.
J. Disregard of resources. The Commonwealth of Virginia will disregard all resources for qualified categorically needy children, pregnant women, and caretaker relatives covered under §§ 1902(a)(10)(A)(i)(I), 1902(a)(10)(A)(i)(III), 1902(a)(10)(A)(i)(IV), 1902(a)(10)(A)(i)(VI), 1902(a)(10)(A)(i)(VII), 1902(a)(10)(A)(ii)(IV), 1902(a)(10)(A)(ii)(VIII), 1931, and 1905(n) of the Social Security Act.
12VAC30-40-345
12VAC30-40-345. Eligibility under § 1931 of the Act. (Repealed.)
A. The state covers low-income families and children under § 1931 of the Act as follows:
AFDC children age 18 who are full-time students in a secondary school or in the equivalent level of vocational or technical training.
B. In determining eligibility for Medicaid, the agency uses the AFDC standards and methodologies in effect as of July 16, 1996, with the following modifications.
1. The agency applies higher income standards than those in effect as of July 16, 1996, increased by no more than the percentage increases in the CPI-U since July 16, 1996. The agency increases the July 16, 1996, income standards shown in 12VAC30-40-220 by the annual increase in the CPI beginning July 1, 2001.
2. The agency uses less restrictive income or resource methodologies than those in effect as of July 16, 1996. The agency does not consider resources in determining eligibility. The agency disregards all earned income of a child under the age of 19 who is a student. The agency disregards the fair market value of all in-kind support and maintenance as income in determining financial eligibility for the above referenced group. The agency disregards income earned from temporary employment with the United States Census Bureau for a decennial census.
3. The income or resource methodologies that the less restrictive methodologies replace are as follows:
a. Resources. The family resource limit was $1,000. Additionally, any applicant or recipient may have or establish one savings or investment account not to exceed $5,000 if the applicant or recipient designates that the account is reserved for purposes related to self-sufficiency. Any funds deposited in the account and any interest earned on or appreciation in the value of the funds shall be exempt when determining eligibility for as long as the funds and interest on or appreciation in value of remain in the account. Any amounts withdrawn and used for purposes related to self-sufficiency shall be exempt. For purposes of this section, "purposes related to self-sufficiency" shall include, but is not limited to, paying for tuition, books and incidental expenses at any elementary, secondary or vocational school or any college or university; making down payment on a primary residence; or establishing a commercial operation that is owned by a member of the Medicaid assistance unit.
b. Income. Any interest or appreciation earned on one interest-bearing savings account per medical assistance unit not to exceed $5,000 at a financial institution, if the applicant or recipient designates that the account is reserved for the purpose of paying for tuition, books, and incidental expenses at any elementary, secondary or vocational school or any college or university, or for making down payment on a primary residence or for business incubation, shall be exempt when determining eligibility for medical assistance for as long as the funds and interest remain on deposit in the account. For purposes of this section, "business incubation" means the initial establishment of a commercial operation owned by a member of the Medicaid assistance unit.
c. Income earned by a child under the age of 19 who is a student was counted in determining eligibility in accordance with the AFDC income methodologies that were in effect as of July 16, 1996.
d. The fair market value of in-kind support and maintenance is counted as income when evaluating the financial eligibility of the above-referenced group. In-kind support and maintenance means food, clothing or shelter or any combination of these provided to an individual.
C. The agency continues to apply the following waivers of the provisions of Part A of Title IV in effect as of July 16, 1996, or submitted prior to August 22, 1996, and approved by the secretary on or before July 1, 1997. For individuals who receive TANF benefits and meet the requirements of Virginia's § 1115 waiver for the Virginia Independence Program, the agency continues to apply the following waivers of the provisions of Part A of Title IV in effect as of July 16, 1996, or submitted prior to August 22, 1996, and approved by the secretary on or before July 1, 1997. The waiver contains the following more liberal income disregards:
Earned income will be disregarded so long as the earnings plus the AFDC benefits are equal to or less than 100% of the Federal Income Poverty Guidelines. For any month in which earnings plus the AFDC standard of payment for the family size exceed the Federal Poverty Income Guidelines for a family of the same size, earned income above 100% of the Federal Poverty Income Guidelines shall be counted.
These waivers will apply only to TANF cash assistance recipients. These waivers will be continued only for as long as eligibility for TANF was established under the welfare reform demonstration project for which these waivers were originally approved.