reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-10 - Mandatory coverage: categorically needy and other required special groups

Current through Register Vol. 40, No. 24, July 15, 2024
The Title IV-A agency or the Department of Medical Assistance
				  Services Central Processing Unit determines eligibility for Title XIX services.
				  The following groups shall be eligible for medical assistance as
				  specified:
1. Parents and other
				caretaker relatives of dependent children with household income at or below a
				standard established by the Commonwealth in
				12VAC30-40-100
				consistent with
				42 CFR
				435.110 and §§ 1902(a)(10)(A)(i)(l)
				and 1931(b) of the Social Security Act. Individuals qualifying under this
				eligibility group shall meet the following criteria:
a. Parents, other caretaker relatives
				(defined at
				42 CFR
				435.4) including pregnant women, or dependent
				children (defined at
				42 CFR
				435.4) younger than 18 years of age. This
				group includes individuals who are parents or other caretaker relatives of
				children who are 18 years of age provided the children are full-time students
				in a secondary school or the equivalent level of vocational or technical
				training and are expected to complete such school or training before their 19th
				birthday.
b. Spouses of parents and
				other caretaker relatives shall include other relatives of the child based on
				blood (including those of half-blood), adoption, or marriage. Other relatives
				of a specified degree of the dependent child shall include any blood relative
				(including those of half-blood) and including (i) first cousins; (ii) nephews
				or nieces; (iii) persons of preceding generations as denoted by prefixes of
				grand, great, or great-great; (iv) stepbrother; (v) stepsister; (vi) a relative
				by adoption following entry of the interlocutory or final order, whichever is
				first; (vii) the same relatives by adoption as listed in this subdivision 1 b;
				and (viii) spouses of any persons named in this subdivision 1 b even after the
				marriage is terminated by death or divorce.
MAGI-based income methodologies in
				  12VAC30-40-100
				  shall be used in calculating household income.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-20 - Optional groups other than the medically needy

Current through Register Vol. 40, No. 24, July 15, 2024
The Title IV-A agency determines eligibility for Title XIX
				  services. The following groups are eligible:
1. Individuals who would be eligible for SSI
				or an optional state supplement as specified in
				42 CFR
				435.230 if they were not in a medical
				institution.
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 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.
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.
4. The 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 state plan and who are younger
				than the age of 21 years. The Commonwealth does cover reasonable
				classifications of these individuals as follows:
a. Individuals for whom public agencies are
				assuming full or partial financial responsibility and who are:
(1) In foster homes (and are younger than the
				age of 21 years).
(2) In private
				institutions (and are younger than the age of 21 years).
(3) In addition to the group under
				subdivisions 4 a (1) and 4 a (2) of this section, individuals placed in foster
				homes or private institutions by private nonprofit agencies (and are younger
				than the age of 21 years).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-30 - Optional coverage of the medically needy

Current through Register Vol. 40, No. 24, July 15, 2024
The Title IV A Agency determines eligibility for Title XIX
				  services.
This plan includes the medically needy:
1. Pregnant women who, except for income
				and/or resources, would be eligible as categorically needy under Title XIX of
				the Act.
2. Women who, while
				pregnant, were eligible for and have applied for Medicaid and receive Medicaid
				as medically needy under the approved State plan on the date the pregnancy
				ends. These women continue to be eligible, as though they were pregnant, for
				all pregnancy-related and postpartum services under the plan for a 60-day
				period after the pregnancy ends, and any remaining days in the month in which
				the 60th day falls.
3. Individuals
				under age 18 who, but for income and/or resources, would be eligible under
				§ 1902(a)(10)(A)(i) of the Act.
4. Newborn children born on or after October
				1, 1984, to a woman who is eligible as medically needy and is 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 so long as the woman remains eligible and the child is a member of
				the woman's household.
5.
				Reasonable classification of financially eligible individuals under the ages of
				21, 20, 19, or 18 as specified below:
(1)
				Individuals for whom public agencies are assuming full or partial financial
				responsibility and who are:
(a) In foster
				homes (and are under the age of 21).
(b) In private institutions (and are under
				the age of 21).
(c) In addition to
				the group under (1)(a) and (b), individuals placed in foster homes or private
				institutions by private, nonprofit agencies (and are under the age of
				21).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-40 - Reasonable classifications of individuals younger than the age of 21, 20, 19, or 18 years

Current through Register Vol. 40, No. 24, July 15, 2024
The reasonable classifications of individuals younger than
				  the age of 21, 20, 19, or 18 years are set out in subdivision 4 of
				  12VAC30-30-20 and subdivision 5 of
				  12VAC30-30-30.
Statutory Authority: §
											32.1-325 of the Code of
					 Virginia; 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-50 - More restrictive categorical eligibility criteria

Current through Register Vol. 40, No. 24, July 15, 2024
More restrictive categorical eligibility criteria:
1. Presumptively eligible SSI recipients are
				not covered.
2. Presumptively
				disabled or blind SSI recipients are not covered.
3. Conditionally eligible SSI recipients are
				not covered.
(See
				  12VAC30-40-10 through
				  12VAC30-40-30 for the more
				  restrictive financial eligibility criteria)
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-60 - Requirements relating to determining eligibility for Medicare Prescription Drug Low-Income Subsidy

Current through Register Vol. 40, No. 24, July 15, 2024
The agency provides for making Medicare Prescription Drug
				  Low-Income Subsidy determinations under § 1935(a) of the Social Security
				  Act;
1. The agency makes
				determinations of eligibility for premium and cost-sharing subsidies under and
				in accordance with § 1860 D 14 of the Social Security Act;
a. The Social Security Administration's
				subsidy application (SSA-1020) will be used as the official application form
				for individuals to request that the state determine eligibility for the
				Low-Income Subsidy.
b. The
				application must be filed at the local department of social services in the
				city or county where the applicant resides. A face-to-face interview is not
				required.
c. The applicant may be
				represented by an individual who is authorized to act on behalf of the
				applicant; if the applicant is incapacitated or incompetent, someone acting
				responsibly on his behalf; or an individual of the applicant's choice who is
				requested by the applicant to act as his representative in the application
				process. The person acting responsibly on behalf of, or acting as the
				representative of the applicant is required to attest to the accuracy of the
				information on the application.
d.
				Applications must be acted on within 45 days from the date the application is
				received by the local department of social services. A determination of
				eligibility or ineligibility must be made and the applicant must be sent
				written notice of his approval or denial of assistance under the Low-Income
				Subsidy program as well as the reasons for such findings.
e. Redeterminations of eligibility must be
				made in the same manner and frequency as redeterminations are required under
				the state's Medicaid State Plan.
f.
				Family size. The following persons are counted in the family size: the
				applicant; the applicant's spouse, if living with the applicant; and any
				persons who are related by blood, marriage or adoption, who are living with the
				applicant and spouse and who are dependent on the applicant or spouse for at
				least one-half of their financial support.
g. Financial requirements. Regulations at 20
				CFR Part 416 Subparts K and L are used to evaluate income and resources for
				subsidy eligibility. Current SSI policy can be found in the online Program
				Operations Manual System (POMS) at
http://policy.ssa.gov/poms.nsf/aboutpoms
.
				Less restrictive rules the state uses for Medicaid determinations are not used
				for the Low-Income Subsidy determination.
h. The subsidy applicant may appeal his
				Low-Income Subsidy determination according to the appeal procedures found in
				the state's Medicaid State Plan.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 30 - GROUPS COVERED AND AGENCIES RESPONSIBLE FOR ELIGIBILITY DETERMINATION › Section 12VAC30-30-70 - Hospital presumptive eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
A. Qualified hospitals shall administer
				presumptive eligibility in accordance with the provisions of this section. A
				qualified hospital is a hospital that meets the requirements of
				42 CFR
				435.1110(b) and that:
1. Has entered into a valid provider
				agreement with the Department of Medical Assistance Services (DMAS),
				participates as a Virginia Medicaid provider, notifies DMAS of its election to
				make presumptive eligibility determinations, and agrees to make presumptive
				eligibility determinations consistent with DMAS policies and procedures;
				and
2. Has not been disqualified by
				DMAS for failure to make presumptive eligibility determinations in accordance
				with applicable state policies and procedures as defined in subsections C, D,
				and E of this section or for failure to meet any standards established by the
				Medicaid agency.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part I - General Conditions of Eligibility › Section 12VAC30-40-10 - General conditions of eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
Each individual covered under the plan:
1. Is financially eligible (using the methods
				  and standards described in Parts II (12VAC30-40-20 through 12VAC30-40-80) and
				  III (12VAC30-40-90 through 12VAC30-40-210) of this chapter) to receive
				  services.
2. Meets the applicable
				  nonfinancial eligibility conditions.
a. For
				  the categorically needy:
(1) Except as
				  specified under subdivisions 2 a (2) and 2 a (3) of this section, for Title
				  IV-E individuals covered under § 1902(a)(10)(A)(i)(1), meet the
				  nonfinancial eligibility conditions of the Medicaid program.
(2) For SSI-related individuals, 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), 1902(a)(10)(A)(ii)(IX), and 1931 of the Social Security
				  Act (Act), 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, meet the nonfinancial criteria of § 1902(m) of the Act.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-20 - Post-eligibility treatment of institutionalized individuals

Current through Register Vol. 40, No. 24, July 15, 2024
The following amounts are deducted from gross income when
					 computing the application of an individual's or couple's income to the cost of
					 institutional care:
1. Personal needs
				  allowance.
a. Aged, blind, disabled:
Individuals: $40 PLUS *
Couples: $60 PLUS *
For the following individuals with greater need -- * (1)
					 Patients in institutions who participate in work programs as part of treatment.
					 The first $75.00 of earnings plus 1/2 the remainder, up to a maximum of $190.00
					 monthly is allowed to be retained for personal needs. * (2) Patients receiving
					 institutional or home- and community-based waiver services who pay guardianship
					 fees, the actual cost of guardian fees up to a maximum of 5% of gross
					 income.
b. AFDC related:
Children: $40
Adults: $60
c. Individuals under age 21 covered in this
				  plan as specified in Item b.7 of
				  12VAC30-30-20: $40
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-30 - Maintenance needs of non-institutionalized spouse

Current through Register Vol. 40, No. 24, July 15, 2024
For maintenance of the non-institutionalized spouse only.
					 The amount must be based on a reasonable assessment of need but must not exceed
					 the highest of--
SSI level
$_________
SSP level
$_________
Monthly medically needy level
$_________
Other as follows
$_________
See
					 12VAC30-40-80.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-40 - Children

Current through Register Vol. 40, No. 24, July 15, 2024
For children, each family member. (Applies only to children
					 not living with the community spouse.)
AFDC level
$__________
Medically needy level
$ See below*
Other as follows
$__________
For children living with the community spouse, see
					 12VAC30-40-80.
* Group I: $216.67; Group II: $250; Group III: $325. For
					 appropriate family size see
					 12VAC30-40-220.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-50 - Medical expenses

Current through Register Vol. 40, No. 24, July 15, 2024
Amounts for incurred medical expenses not subject to
					 payment by a third party
a. Health
				  insurance premiums, deductibles and co-insurance charges
b. Necessary medical or remedial care not
				  covered under the Medicaid plan
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-60 - Maintenance of residence

Current through Register Vol. 40, No. 24, July 15, 2024
An amount for maintenance of a single individual's home for
					 not longer than 6 months, if a physician has certified he or she is likely to
					 return home within that period.
Amount for maintenance of home:
$ See below*
* Group I: $216.67; Group II: $250; Group III: $325. For
					 appropriate family size see
					 12VAC30-40-220.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-70 - SSI benefits

Current through Register Vol. 40, No. 24, July 15, 2024
SSI benefits paid under § 1611(e)(1)(E) of the Act to
					 individuals who receive care in a hospital or NF.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part II - Post-Eligibility Treatment of Institutionalized Individuals › Section 12VAC30-40-80 - Maintenance standards

Current through Register Vol. 40, No. 24, July 15, 2024
Maintenance standard for community spouse and other
					 dependent family members under § 1924 of the Act.
1. Community spouses: Standard based on
				  formula contained in § 1924(d) is used.
2. Other family members who are dependent:
				  Standard based on the formula contained in § 1924(d)(1)(c) is
				  used.
3. The standards described
				  above are used for individuals receiving home and community based services in
				  lieu of services provided in medical or remedial institutions.
4. The definition of dependency below is used
				  to define dependent children, parents and siblings for purposes of deducting
				  allowances under § 1924.
a. Dependent
				  children -- A child under age 21 and a child age 21 years old and older of
				  either spouse who lives with a community spouse and who may be claimed as a
				  dependent by either member of a couple for tax purposes under the Internal
				  Revenue Services Code.
b. Dependent
				  parents -- Parents of either member of a couple who reside with the community
				  spouse and who may be claimed as dependents by either spouse for tax purposes
				  under the Internal Revenue Services Code.
c. Dependent siblings -- A brother or sister
				  of either member of a couple (including half-brothers and half-sisters and
				  siblings gained through adoption) who reside with the community spouse and who
				  may be claimed by either member of the married couple for tax purposes under
				  the Internal Revenue Services Code.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 2 - Income › Section 12VAC30-40-100 - Methods of determining income

Current through Register Vol. 40, No. 24, July 15, 2024
A. Families and Children Medically Needy
					 individuals.
1. In determining countable
					 income for Families and Children Medically Needy individuals, the methods under
					 the state's July 16, 1996, approved Aid to Families with Dependent Children
					 plan and any more liberal methods described in
					 12VAC30-40-280 are used.
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. 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.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 2 - Income › Section 12VAC30-40-105 - Financial eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
Working Individuals with Disabilities; Basic Coverage
						Group (Ticket to Work and Work Incentive Improvement Act (TWWIIA)).
The following standards and methods shall be applied in
						determining financial eligibility:
1.
					 The agency applies the following income and resource standards to applicants of
					 this program:
a. The individual's total
					 countable income shall not exceed 80% of the current federal poverty income
					 guidelines; and
b. The individual's
					 total countable assets shall not exceed $2,000.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 2 - Income › Section 12VAC30-40-110 - Medicaid qualifying trusts

Current through Register Vol. 40, No. 24, July 15, 2024
In the case of a Medicaid qualifying trust described in
						§ 1902(k)(2) of the Act, the amount from the trust that is deemed
						available to the individual who established the trust (or whose spouse
						established the trust) is the maximum amount that the trustee(s) is permitted
						under the trust to distribute to the individual. This amount is deemed
						available to the individual, whether or not the distribution is actually made.
						This provision does not apply to any trust or initial trust decree established
						before April 7, 1986, solely for the benefit of a mentally retarded individual
						who resides in an intermediate care facility for the mentally retarded.
The policy for qualifying trusts which is effective for
						trusts established or assets disposed of after August 10, 1993, is located in
						12VAC30-40-300.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						  other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 2 - Income › Section 12VAC30-40-120 - Medically needy income levels (MNILs) based on family size

Current through Register Vol. 40, No. 24, July 15, 2024
Medically needy income levels (MNILs) are based on
						family size.
12VAC30-40-220 specifies the MNILs
						for all covered medically needy groups. If the agency chooses more restrictive
						levels under § 1902(f) of the Act,
						12VAC30-40-220 so
						indicates.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						  other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 2 - Income › Section 12VAC30-40-130 - Handling of excess income; spend-down

Current through Register Vol. 40, No. 24, July 15, 2024
Handling of excess income - Spend-down for the medically
						needy in all states and the categorically needy in 1902(f) states only.
a. Medically Needy
(1) Income in excess of MNIL is considered as
					 available for payment of medical care and services. The Medicaid agency
					 measures available income for periods of either 1 or 6 month(s) (not to exceed
					 6 months) to determine the amount of excess countable income applicable to the
					 cost of medical care and services.
(2) If countable income exceeds the MNIL
					 standard, the agency deducts the following incurred expenses in the following
					 order:
(a) Health insurance premiums,
					 deductibles, and coinsurance charges.
(b) Expenses for necessary medical and
					 remedial care not included in the plan.
(c) Expenses for necessary medical and
					 remedial care included in the plan.
Incurred expenses that are subject to payment by a third
						party are not deducted unless the expenses are subject to payment by a third
						party that is a publicly funded program (other than Medicaid) of a State or
						local government.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-140 - Methods for determining resources

Current through Register Vol. 40, No. 24, July 15, 2024
a. AFDC-related individuals (except for
					 poverty level related pregnant women, infants, and children).
(1) In determining countable resources for
					 AFDC-related individuals, the following methods are used:
(a) The methods under the state's approved
					 AFDC plan; and/or
(b) Any more
					 liberal methods described in
					 12VAC30-40-290.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-150 - Resource standard; categorically needy

Current through Register Vol. 40, No. 24, July 15, 2024
A. Section 1902(f) states (except as
					 specified under 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. Non-1902(f) states (except as specified
					 under subsections C and D of this section).
1. The resource standards are the same as
					 those in the related cash assistance program.
2.
												12VAC30-40-270 specifies for
					 1902(f) states the categorically needy resource levels for all covered
					 categorically needy groups.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-160 - Resource standard; medically needy

Current through Register Vol. 40, No. 24, July 15, 2024
a. Resource standards are based on family
					 size.
b. A single standard is
					 employed in determining resource eligibility for all groups.
12VAC30-40-230
						specifies the resource standards for all covered medically needy groups. If the
						agency chooses more restrictive levels under this subsection,
						12VAC30-40-230 so
						indicates.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						  other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-170 - Resource standard; qualified Medicare beneficiaries and specified low-income Medicare beneficiaries

Current through Register Vol. 40, No. 24, July 15, 2024
For qualified Medicare beneficiaries covered under §
						1902(a)(10)(E)(i) of the Act, and specified low-income Medicare beneficiaries
						covered under § 1902(a)(10)(E)(iii) of the Act, the resource standard is
						twice the SSI standard or, effective January 1, 2010, the resource limit set
						for the Medicare Part D Low Income Subsidy Program.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-180 - Qualified disabled and working individuals

Current through Register Vol. 40, No. 24, July 15, 2024
For qualified disabled and working individuals covered
						under 1902(a)(10)(E)(ii) of the Act, the resource standard for an individual or
						a couple (in the case of an individual with a spouse) is twice the SSI
						standard.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						  other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 3 - Resources › Section 12VAC30-40-190 - Excess resources

Current through Register Vol. 40, No. 24, July 15, 2024
a.
					 Categorically Needy, Qualified Medicare Beneficiaries, Qualified Disabled and
					 Working Individuals, and Specified Low-Income Medicare Beneficiaries. Any
					 excess resources make the individual ineligible.
b. Medically Needy. Any excess resources make
					 the individual ineligible.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 4 - Effective Date and Transfer of Resources › Section 12VAC30-40-200 - Effective date of eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
a.
					 Groups Other Than Qualified Medicare Beneficiaries.
(1) For the prospective period. Coverage is
					 available for the full month if aged, blind, disabled or AFDC-related
					 individuals are eligible at any time during the month.
(2) For the retroactive period. Coverage is
					 available for three months before the date of application if aged, blind,
					 disabled or AFDC-related individuals would have been eligible had they
					 applied.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part III - Financial Eligibility › Article 4 - Effective Date and Transfer of Resources › Section 12VAC30-40-210 - Transfer of resources - categorically and medically needy, qualified Medicare beneficiaries, and qualified disabled and working individuals

Current through Register Vol. 40, No. 24, July 15, 2024
The agency complies with the provisions of § 1917 of
						the Act with respect to the transfer of resources.
Disposal of resources at less than fair market value
						affect eligibility for certain services as detailed in
						12VAC30-40-300.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						  other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-220 - Income eligibility levels

Current through Register Vol. 40, No. 24, July 15, 2024
A.
1. Groups I, II, and III income limits are
				  set forth in this subdivision 1.
Group I
Size of assistance unit
Monthly
Yearly
1
$239
$2,868
2
364
4,368
3
464
5,568
4
563
6,756
5
663
7,956
6
748
8,976
7
844
10,128
8
945
11,340
Each additional person
98
1,176
Group II
Size of assistance unit
Monthly
Yearly
1
$313
$3,756
2
449
5,388
3
565
6,780
4
675
8,100
5
794
9,528
6
895
10,740
7
1,002
12,024
8
1,119
13,428
Each additional person
111
1,332
Group III
Size of assistance unit
Monthly
Yearly
1
$472
5,664
2
633
7,596
3
774
9,288
4
909
10,908
5
1,074
12,888
6
1,195
14,340
7
1,330
15,960
8
1,471
17,652
Each additional person
135
1,620
2.
				  Pregnant women and infants under § 1902(a)(10)(i)(IV) of the Act.
				  Effective January 1, 2014, based on 143% of the official federal income poverty
				  level.
3. Children under §
				  1902(a)(10)(i)(VI) of the Act (children who have attained age one year but have
				  not attained age six years), the income eligibility level is 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 six years but have not attained
				  age 19 years), the income eligibility level is 143% of the federal poverty
				  level (as revised annually in the Federal Register) for the size family
				  involved.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-230 - Resource levels

Current through Register Vol. 40, No. 24, July 15, 2024
A. CATEGORICALLY
				  NEEDY GROUPS WITH INCOMES RELATED TO FEDERAL POVERTY LEVEL
Resource levels are not applicable to pregnant women or
					 children.
B. MEDICALLY
				  NEEDY
Applicable to all groups -
Family Size
Resource Level
1
$2,000
2
3,000
3
3,100
4
3,200
5
3,300
6
3,400
7
3,500
8
3,600
9
3,700
10
3,800
For each additional person
$100
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-235 - Reasonable limits on amounts for necessary medical or remedial care not covered under Medicaid

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				  Medicaid agency meets the requirements of
				  42 CFR
				  435.725,
				  42 CFR
				  435.832, and § 1924 of the Social
				  Security Act, in that the agency will deduct amounts for incurred expenses for
				  medical or remedial care that are not subject to payment by a third party,
				  including medically necessary or remedial care recognized under state law but
				  not covered under the state's Medicaid plan, subject to reasonable limits as
				  specified in subsection B of this section.
B. All medical or remedial goods and services
				  not subject to payment by a third party and not covered by Medicaid but
				  recognized under state law must be prescribed by a physician, dentist,
				  podiatrist or other practitioner with prescribing authority pursuant to
				  Virginia law. The maximum amount that may be deducted from the patient's income
				  for nursing facility residents shall be the maximum amount reimbursed by the
				  higher of either Medicare or Medicaid for the same noncovered items or
				  services.
C. If neither Medicaid
				  nor Medicare has an allowed amount for the service rendered, then DMAS will
				  protect from the individual's income:
1. For
				  services, the amount of the provider's usual and customary charge; or
2. For supplies and durable medical
				  equipment, the actual invoice cost plus the lesser of either:
a. The labor charges; or
b. A 30% mark-up from the invoice.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-240 - More restrictive methods of treating resources than those of the SSI program: section 1902(f) states only

Current through Register Vol. 40, No. 24, July 15, 2024
A. The following limitations apply to
				  resources in addition to the resource requirements of the Supplemental Security
				  Income (SSI) program for the aged, blind and disabled.
1. For income-producing property and other
				  nonresidential property, appropriate equity and profit is to be determined by
				  the prorata share owned by an individual in relation to his proportionate share
				  of the equity and profit.
2.
				  Property in the form of an interest in an undivided estate is to be regarded as
				  an asset when the value of the interest plus all other resources exceeds the
				  applicable resource limit unless it is considered unsaleable for reasons other
				  than being an undivided estate. An heir can initiate a court action to
				  partition. If a partition suit is necessary (because at least one other owner
				  of or heir to the property will not agree to sell the property) in order for
				  the individual to liquidate the interest, estimated partition costs may be
				  deducted from the property's value. However, if a partition would not result in
				  the applicant or recipient securing title to property having value
				  substantially in excess of the cost of the court action, the property would not
				  be regarded as an asset.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-250 - Standards for optional state supplementary payments

Current through Register Vol. 40, No. 24, July 15, 2024
Payment Category (Reasonable
							 Classification)
Administered by
Income Level
Income Disregards Employed
Gross
Net
Federal
State
1 person/Couple
2 person/Couple
(1)
(2)
(3)
(4)
(5)
a) Aged, blind, disabled in domiciliary facilities
X
300% of SSI payment limit
Rate of home up to specified maximum of $815 per month
							 for allowance for an individual (effective 11/1/00). Maximum for homes in
							 Planning District 8 Increased by 15%.
Disregards of SSI Program
b) Aged, blind, disabled in approved adult foster care
							 homes
X
300% of SSI payment limit
Approved rate for home up to a maximum of $508.
							 Maximum for homes in Planning District 8 increased by 15%.
Disregards of SSI Program
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-260 - Income levels for 1902(f) states; categorically needy who are covered under requirements more restrictive than SSI

Current through Register Vol. 40, No. 24, July 15, 2024
The SSI income levels for an individual or couple, as
					 appropriate, are used. See
					 12VAC30-40-230.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-270 - Resource standards for 1902(f) states; categorically needy

Current through Register Vol. 40, No. 24, July 15, 2024
The Commonwealth does not apply more restrictive resource
					 standards. See
					 12VAC30-40-230.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-290 - More liberal methods of treating resources under Section 1902(r)(2) of the Act: Section 1902(f) states

Current through Register Vol. 40, No. 24, July 15, 2024
A. Resources to meet burial expenses.
				  Resources set aside to meet the burial expenses of an 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:
1. The face value of
				  life insurance on the life of an individual owned by the individual or his
				  spouse if the cash surrender value of such policies has been excluded from
				  countable resources; and
2. The
				  amount of any other revocable or irrevocable trust, contract, or other
				  arrangement specifically designated for the purpose of meeting the individual's
				  or his spouse's burial expenses.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-300 - Transfer of resources

Current through Register Vol. 40, No. 24, July 15, 2024
The agency provides for the denial of eligibility by reason
					 of disposal of resources for less than fair market value. This section includes
					 procedures applicable to all transfers of resources.
A. Except as noted below, the criteria for
				  determining the period of ineligibility are the same as criteria specified in
				  § 1613(c) of the Social Security Act (Act): Transfer of resources other
				  than the home of an individual who is an inpatient in a medical institution.
1. The agency uses a procedure that provides
				  for a total period of ineligibility greater than 24 months for individuals who
				  have transferred resources for less than fair market value when the
				  uncompensated value of disposed of resources exceeds $12,000. This period bears
				  a reasonable relationship to the uncompensated value of the transfer. The
				  computation of the period and the reasonable relationship of this period to the
				  uncompensated value is described as follows:
This transfer of resources rule includes the transfer of
					 the former residence of an inpatient in a medical institution.
2. The agency has provisions for
				  waiver of denial of eligibility in any instance where the state determines that
				  a denial would work an undue hardship.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-320 - Consideration of Medicaid qualifying trust; undue hardship

Current through Register Vol. 40, No. 24, July 15, 2024
Condition or Requirement
The following criteria will be used to determine whether
					 the agency will not count the funds in a trust as specified in
					 12VAC30-40-110, because it would
					 work an undue hardship for categorically and medically needy
					 individuals:
The Commonwealth does not, at the present time, recognize
					 undue hardships in cases of qualifying trusts.
1. In determining eligibility for Medicaid
				  the maximum amount of payments permitted under the terms of a "Medicaid
				  qualifying trust" to be distributed to the grantor, if the trustee exercised
				  his discretion to the fullest extent possible, shall be considered available in
				  determining the grantor's eligibility for Medicaid.
A "Medicaid qualifying trust" is a trust, or similar legal
					 device, established (other than by will) by an individual (or an individual's
					 spouse) under which the individual may be beneficiary of all or part of the
					 payments from the trust and the distribution of such payments is determined by
					 one or more trustees who are permitted to exercise any discretion with respect
					 to the distribution to the individual.
The requirements of this section shall apply without regard
					 to:
A. Whether or not the Medicaid
				  qualifying trust is irrevocable or is established for purposes other than to
				  enable a grantor to qualify for Medicaid; or
B. Whether or not the trustee(s) exercises
				  his discretion to distribute any payments to the individual.
This provision shall not apply to any trust or initial
					 trust decree established prior to April 7, 1986, solely for the benefit of a
					 mentally retarded individual who resides in an intermediate care facility for
					 the mentally retarded.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-330 - Cost effectiveness methodology for COBRA continuation beneficiaries

Current through Register Vol. 40, No. 24, July 15, 2024
Cost effectiveness methodology for COBRA continuation
					 beneficiaries is not applicable.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-340 - Compliance with section 1924 and OBRA 90

Current through Register Vol. 40, No. 24, July 15, 2024
a. Income and Resource eligibility policies
				  used to determine eligibility for institutionalized spouses who have spouses
				  living in the community are consistent with § 1924.
b. In the determination of resource
				  eligibility the state resource standard is $12,000 adjusted annually in
				  accordance with § 1924(g).
c.
				  An institutionalized spouse who (or whose spouse) has excess resources shall
				  not be found ineligible under Title XIX of the Social Security Act, per §
				  1924(c)(3)(C), where the state determines that denial of eligibility on the
				  basis of having excess resources would work an undue hardship.
d. State community property laws do not apply
				  for purposes of post-eligibility treatment of income.
e. The spousal share is determined at the
				  beginning of the first continuous period of institutionalization (beginning on
				  or after September 30, 1989) of the institutionalized spouse.
Statutory Authority
Social Security Act Title XIX; 42 CFR 430 to end; all
						other applicable Statutory and regulatory sections.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 40 - ELIGIBILITY CONDITIONS AND REQUIREMENTS › Part IV - Eligibility Requirements › Section 12VAC30-40-345

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
												32.1-325 of the Code of
						Virginia; 42 USC §
													1396 et
						seq.