Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 40 - Family Support Division › Chapter 2 - Income Maintenance › Section 13 CSR 40-2.200 - Determining Eligibility for Medical Assistance

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates terminology. It also
				  provides that the decision on the factor of disability shall be made by a
				  qualified medical consultant employed by the division except in cases involving
				  disability-based Social Security Income or Retirement, Survivor's and
				  Disability Insurance and establishes the principles used by county staff in
				  determining eligibility for Medical Assistance on the basis of
				  income.
(1) The medical
				diagnosis and other medical information on Medical Assistance (MA),
				Supplemental Nursing Care (SNC), Aid to the Blind (AB) and Blind Pension (BP)
				cases shall be reviewed by a medical consultant employed by the Family Support
				Division, who shall certify eligibility or ineligibility on the basis of
				permanent and total disability or vision, except that this review will not be
				required to certify permanent and total disability when the claimant receives
				Supplemental Security Income (SSI) or Retirement, Survivor's, and Disability
				Insurance (RSDI) based on his/her disability. In these cases, the verification
				of the receipt of disability-based SSI or RSDI benefits will be sufficient to
				establish permanent and total disability.
(2) If a single individual has an adjusted
				gross income per month that does not exceed the income limit and meets the
				other eligibility requirements, s/he will be eligible for MA. If eligibility is
				based on AB provisions, the income limit is one hundred percent (100%) of the
				federal poverty level (FPL). If eligibility is based on MO HealthNet for Aged,
				Blind, and Disabled (MHABD) or Permanent and Total Disability (PTD) provisions,
				the income limit is eighty-five percent (85%) of the FPL. For a married couple
				living together, the adjusted gross income limitation will be one hundred
				percent (100%) of the FPL for two (2) persons, if eligibility is based on AB
				provisions. For a married couple living together, the adjusted gross income
				limitation will be eighty-five percent (85%) of the FPL for two (2) persons, if
				eligibility is based on MHABD or PTD provisions. In determining adjusted gross
				income, the following exemptions will be applied to the gross income:
(A) If the income is earned or unearned, an
				amount of twenty dollars ($20) may be excluded from the gross. Payments for
				premiums for medical insurance, including Supplemental Medical Insurance (SMI)
				premium, may be excluded;
(B) The
				full amount of any SSI payment will be excluded; and
(C) If the income is earned, the
				twenty-dollar ($20) exclusion in subsection (2)(A) will be applied plus the
				first sixty-five dollars ($65) and one-half (1/2) of the remainder of all
				earned income will be excluded. If a person is a student and is under the age
				of twenty-two (22), the amount of the school expense will be excluded from any
				earned income. If eligibility is based on AB provisions, any work-related
				expenses also will be excluded from earned income.