Alabama Administrative Code › Title 560 - ALABAMA MEDICAID AGENCY › Chapter 560-X-25 - MEDICAID ELIGIBILITY › Section 560-X-25-.03 - Coverage Groups

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 following are the general groups of individuals designated as categorically
			 eligible under the State Plan for Medical Assistance, and who as a result are
			 Medicaid eligible:
(a) Aged, blind or disabled
			 persons who receive Supplemental Security Income (SSI) under Title
			 XVI;
(b) Persons who are residents
			 of Title XIX institutions but who are not eligible for SSI, Optional
			 Supplementation or AFDC because their income exceeds $50.00 per month but is
			 not more than 300 percent of the current SSI benefit amount payable to an
			 individual in his own home who has no income;
(c) Persons who would be eligible for SSI or
			 Optional Supplementation but for the fact that they are residents of a Title
			 XIX institution;
(d) All aged,
			 blind and disabled persons who were residents of a Title XIX institution as of
			 December 31, 1973 and who were converted from the former State program (OAP,
			 APTD, AB). If ineligible under current eligibility rules these individuals are
			 entitled to use the rules for determining eligibility which were in effect
			 under the State's Plan for Medical Assistance in December 1973;
(e) Persons who:
1. are currently receiving Old Age Survivors
			 Disability Insurance (OASDI);
2.
			 are ineligible for SSI due to income;
3. were contemporaneously eligible for both
			 OASDI and SSI in the same month after April 1977; and
4. would be eligible for SSI but for OASDI
			 cost-of-1iving increases received since the last month of contemporaneous OASDI
			 and SSI eligibility.
(f)
			 Individuals receiving mandatory or optional State Supplementation
			 payments;
(g) Individuals who would
			 be eligible for SSI, except for the increase in OASDI benefits under Pub. L.
			 92-336 (July 1, 1972), who were entitled to OASDI in August 1972, and who were
			 receiving cash assistance in August 1972 or who were eligible for such cash
			 assistance but for the fact that they were residents of a medical institution
			 or intermediate care facility;
(h)
			 Medicaid for Low Income Families: Individuals eligible for Medicaid through the
			 Medicaid for Low Income Families Program or who meet the eligibility criteria
			 for Medicaid for Low Income Families based on policies in effect for the AFDC
			 program as it existed on July 16, 1996 based on Section 1931 of the Social
			 Security Act.
The following individuals are deemed to be eligible for
				Medicaid for Low Income Families:
1.
			 AFDC qualified pregnant women whose family income and resources fall within the
			 standards for Medicaid for Low Income Families.
2. Individuals under age 18 who would qualify
			 for Medicaid for Low Income Families but do not qualify as dependent children,
			 since they are children for whom public agencies have assumed full or partial
			 financial responsibility and who are in foster homes or private
			 institutions.
(i) All
			 individuals receiving assistance under Title IV-E of the Act, including
			 children for whom adoption assistance or foster care payments are made in
			 Alabama or out of state;
(j)
			 Individuals who are eligible for Medicaid solely because they require and
			 receive services under CMS approved home and community-based services waiver.
			 See Appendix C of the waiver document for a complete description of eligibility
			 groups served by a specific waiver.