Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 20 - Medicaid Eligibility › Section 907 KAR 20:005 - Medicaid technical eligibility requirements not related to a modified adjusted gross income standard or to former foster care individuals

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520, 205.6481-205.6497,
				341.360,
				42 C.F.R. 435, 403,
				45 C.F.R.
				233.100,
				8
				U.S.C. 1101,
				1153(a)(7),
				1157,
				1158,
				1182(d)(5),
				1231(b)(3),
				1253(h),
				1522,
				1612,
				1613,
				1622,
				1641, 38 U.S.C. 101,
				107,
				1101,
				1301,
				1304,
				5303A,
				42 U.S.C.
				402,
				416,
				423,
				1382c,
				1383c,
				1395i,
				1396a
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the technical
				eligibility requirements of the Medicaid Program except for individuals whose
				Medicaid eligibility standard is a modified adjusted gross income or for former
				foster care individuals between the ages of nineteen (19) and twenty-six (26)
				who aged out of foster care while receiving Medicaid coverage. Individuals to
				whom the technical eligibility requirements in this administrative regulation
				apply include children in foster care; aged, blind, or disabled individuals;
				and individuals who receive supplemental security income benefits.
Section 1. The Categorically Needy.
(1) An individual receiving Title IV-E
			 benefits, SSI benefits, or an optional or a mandatory state supplement shall be
			 eligible for Medicaid as a categorically-needy individual.
(2) The following classifications of persons
			 shall be considered categorically needy and eligible for Medicaid participation
			 as categorically needy:
(a) A child in a
			 foster family home or private child-caring facility dependent on a governmental
			 or private agency;
(b) A child in a
			 psychiatric hospital, psychiatric residential treatment facility, or
			 intermediate care facility for individuals with an intellectual disability
			 beginning with day thirty-one (31) of the child's stay in the psychiatric
			 hospital, psychiatric residential treatment facility, or intermediate care
			 facility for individuals with an intellectual disability;
(c) A child in a subsidized adoption
			 dependent on a governmental agency;
(d) A qualified severely impaired individual
			 as specified in
			 42 U.S.C.
			 1396a(a)(10)(A)(i)(II) and
			 1396d(q),
			 to the extent the coverage is mandatory in this state;
(e) An individual who loses SSI benefit
			 eligibility but would be eligible for SSI benefits except for entitlement to or
			 an increase in his or her child's insurance benefits based on disability as
			 specified in
			 42
			 U.S.C. 1383c;
(f) An individual specified in
			 42
			 U.S.C. 1383c who:
1. Loses SSI benefits or state supplement
			 payments as a result of receipt of benefits pursuant to
			 42 U.S.C.
			 402(e) or (f);
2. Would be eligible for SSI benefits or
			 state supplement payments except for these benefits; and
3. Is not entitled to Medicare Part A
			 benefits;
(g) A disabled
			 widow, widower, or disabled surviving divorced spouse, who would be eligible
			 for SSI benefits except for entitlement to an OASDI benefit resulting from a
			 change in the definition of disability;
(h) A child who:
1. Was receiving SSI benefits on August 22,
			 1996; and
2. Except for the change
			 in definition of childhood disability would continue to receive SSI benefits;
			 or
(i) A person with
			 hemophilia who would be eligible for SSI benefits except that the individual
			 received a settlement in a class action lawsuit entitled "Factor VIII or IX
			 Concentrate Blood Products Litigation".
(3) The classifications of persons listed in
			 this subsection shall be considered categorically-needy and eligible for
			 Medicaid participation as limited by the provisions of this subsection.
(a) A family which correctly received
			 Medicaid for three (3) of the last six (6) calendar months, and would have been
			 terminated from receipt of AFDC using AFDC methodologies in effect on July 16,
			 1996 as a result of new or increased collection of child or spousal support,
			 shall be eligible for extended Medicaid coverage for four (4) consecutive
			 calendar months beginning with the first month the family would have been
			 ineligible for AFDC.
(b) A family
			 which would have been terminated from AFDC assistance using the AFDC
			 methodologies in effect on July 16, 1996 because of increased earnings, hours
			 of employment, or loss of earnings disregards shall be eligible for up to four
			 (4) months of extended Medicaid.
(c)
1.
			 Except as provided in subparagraph 3 of this paragraph, an individual in an
			 institution meeting appropriate patient status criteria who, if not
			 institutionalized, would not be eligible for SSI benefits or optional state
			 supplement benefits due to income shall be eligible under a special income
			 level which is set at 300 percent of the SSI benefit amount payable for an
			 individual with no income.
2.
			 Except as provided in subparagraph 3 of this paragraph, eligibility for a
			 similar hospice participant or similar participant in a 1915(c) home and
			 community based waiver program for individuals with an intellectual disability
			 or the aged, blind, or disabled shall be determined using the method
			 established in subparagraph 1 of this subsection.
3. Eligibility of an individual in an
			 intermediate care facility for individuals with an intellectual disability (ICF
			 IID) or supports for community living for an individual with an intellectual
			 disability or a developmental disability waiver meeting appropriate patient
			 status criteria whose gross income exceeds 300 percent of the SSI benefit
			 amount shall be determined by comparing the cost of the individual's care to
			 the individual's income.