Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-25 - MEDICAID ELIGIBILITY › Section 560-X-25-.10 - Income Criteria For Individuals In Institutions And Home And Community-Based Waivers

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The income
			 limit for the institutional Medicaid program and certain home and
			 community-based waiver programs is determined by the Agency and published in
			 the State Plan for Medical Assistance. The income limit is equal to 300 percent
			 of the current SSI benefit amount payable to an individual in his own home who
			 has no income.
(2) The income limit
			 for certain recipients of home and community-based waiver services who are
			 eligible for Medicaid solely because they require and receive services under a
			 home and community-based services waiver is the SSI federal benefit rate plus
			 the $20.00 general disregard.
(3)
			 Rules in 20 C.F.R. 416 Subpart K govern types of countable income and income
			 exclusions except as further limited by §
								36-27-21.1,
Code of
			 Ala. 1975
.
(4) In
			 determining the amount of income an individual has to apply to his cost of care
			 in an institution, the following are deducted:
(a) amounts of income protected for personal
			 needs subject to the limits as set forth in the Agency State Plan, Attachment
			 2.6-A.
(b) amounts of income
			 protected for the maintenance needs of the ineligible spouse and dependents
			 living outside the facility.
(c)
			 amounts of income protected for health insurance premiums that are paid by the
			 applicant/recipient.
(d) amounts of
			 income for incurred necessary medical or remedial care recognized under state
			 law but not covered under the State's Medicaid Plan, nor subject to payment by
			 Medicare or any other third-party health insurance including Medicare premiums,
			 deductibles and coinsurance.
1. The incurred
			 necessary medical or remedial care must be determined to be medically
			 necessary. All verification needed to make the determination of medical
			 necessity and to allow the deduction must be furnished to the agency within six
			 months of the date of the service.
2. A deduction for expenses incurred for
			 medically necessary non-covered medical or remedial care will be allowed based
			 on the lesser of the Medicaid rate, the Medicare rate, or reasonable and
			 customary charges.
3. A deduction
			 for incurred medically necessary non-covered medical or remedial care expenses
			 will be allowed when the bill is incurred during a period which is no more than
			 three months prior to the month of current application.
4. The deduction for medical and remedial
			 care expenses that were incurred as the result of imposition of a transfer of
			 assets penalty period is limited to zero.
5. A deduction for initial or replacement
			 dentures will be allowed for those meeting Agency established medical necessity
			 criteria.
6. A deduction for
			 hearing aids will be allowed for those meeting Agency established medical
			 necessity criteria.
7. A deduction
			 from the individual's income for incurred necessary medical or remedial care is
			 only applicable when the individual has available income to allow for an offset
			 (liability amount to the nursing home is greater than zero).