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Medicaid Eligibility Manual Table of Contents TABLE OF CONTENTS Preface Explanatory Notes Outline A-0000 Abbreviations/Acronyms/Definition - Outline A-0000
A-100 Abbreviations/Acronyms A-100
A-200 Definitions A-200
B-0000 Introduction - Outline B-0000
B-100 The Medicaid Program B-100
B-200 Goal of the Medicaid ** Program B-100
B-300 Medicaid B-100
B-400 100% State-Funded Medical Assistance B-100
B-500 Single State Agency B-500
B-600 Coordination of Agencies B-500
B-700 Medical Care Advisory Committee B-500
C-0000 Medical Services - Outline C-0000
C-100 General Information C-100
C-200 Service Limits C-200
C-300 Covered Services C-200
D-0000 Persons Eligible - Outline D-0000
D-100 LIFC-Related Groups D-100
D-200 SSI-Related Groups D-200
D-300 Groups Related to Either ** LIFC or SSI D-300
D-400 Groups Not Related to **LIFC or SSI D-400
D-500 State-Funded Groups D-400 Reissued May 1, 1999 1 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
E-0000 Category - Outline E-0000
E-100 General Information E-100
E-200 Categories of Assistance for Which E-100
** BHSF Determines Eligibility
210 Aged (A) E-210
210.1 Verification E-210
210.2 Documentation E-210.1
220 Blind (B) E-220
220.1 Verification E-220
220.2 Documentation E-220
230 ** LIFC (formerly AFDC) E-230
230.1 Specified Age E-230
230.2 Deprivation E-230.1
230.3 Pregnancy E-230.1
231 ** Reserved
240 Disabled (D) E-240
240.1 Verification E-240
240.2 Documentation E-240.2
250 Qualified Medicare Beneficiaries (Q) E-250
250.1 Verification E-250
250.2 Documentation E-250
260 ** Reserved E-260
Reissued May 1, 1999 2 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
E-300 Categories for Which **BHSF Does Not E-300
Have Responsibility for Determining Eligibility
310 Refugees (E) E-300
320 F (06) E-300
330 I (08) E-330
340 O (15) E-330
350 V (22) E-350
F-0000 Medical Programs - Outline F-0000
F-100 Eligibility Determination Responsibility F-100
C-Related Programs F-100
SSI-Related Programs F-100
Programs Related to Both F-100
**LIFC and SSI
Programs Not Related to 2 of F-100
**LIFC or SSI
F-200 Limited Responsibility F-200
C-Related Programs F-200
SSI-Related Programs F-200
Custody-Related Programs F-200
Reissued May 1, 1999 3 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
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G-0000 Application Processing - Outline G-0000
G-100 Introduction G-100
G-200 General Information G-100
G-300 Application Form G-300
G-400 Time Limits for Disposing of Applications G-400
G-500 Parish of Application G-500
510 Applicant Who Moves Out of 2 of G-500
Parish Prior to Certification
G-600 Who Can Make Application for Assistance G-600
G-700 Application Date G-700
G-800 Acceptable Application Forms G-800
810 Applicant Unable to Participate in G-810
the Eligibility Determination Process
G-900 Application Interviews G-900
910 General Information G-900
911 Management G-911
911.1 How to Evaluate G-911
Management
911.2 Sources of Verification G-911.2
911.3 Documentation Requirements G-911.2
911.4 Case Action G-911.2
920 Interviews G-920
930 Interview Sites G-930
940 Required Interview Explanations G-940
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G-1000 Securing Information to Determine G-1000
Eligibility
G-1100 Cooperation G-1100
1110 Cooperation By Physically and G-1110
** Mentally Able Applicants
1120 Cooperation By LTC and Other G-1120
Applicants Unable To Participate
1130 LTC Refusal to Cooperate G-1120
1140 Failure to Cooperate G-1140
1150 Second Contact Situations G-1150
G-1200 Reserved
G-1300 Obvious Ineligibility G-1300
G-1400 Withdrawals G-1400
G-1500 Death of Applicant Before Certification G-1500
G-1600 Securing Disability Decisions for G-1600
(B and D Categories)
1610 Disability Decisions G-1610
1610.1 MEDT Package G-1610
1610.2 MEDT Decision Required G-1610.2
1610.3 MEDT Decision Not G-1610.2
Required
1610.4 MEDT Approval G-1610.4
1610.5 MEDT Denial G-1610.4
1610.6 Reconsideration of G-1610.4
MEDT Denial
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1610.7 Resubmit to MEDT G-1610.7
1610.8 Reapplication after G-1610.7
MEDT Denial
1610.9 Requesting Authorization G-1610.9
For Family Practioner Exam
1610.10 SSA Certifies Applicant G-1610.9
for SSI
1610.11 SSA Denials G-1610.11
1610.12 SSI Appeals G-1610.11
1610.13 Significant Deterioration G-1610.11
in Medical Condition after
SSA Denial
1620 **Reserved
1630 **Reserved
1640 Reserved
1650 **Reserved
G-1700 Reusing The Application Form G-1700
G-1800 MAP Unit Applications G-1800
G-1900 Referrals To SSI G-1900
G-2000 Decision Notices G-1900
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H-0000 Eligibility Determinations - Outline H-0000
H-100 General Information H-100
100.1 Selecting a Program H-100
100.2 Evaluation of 2 of H-100.1
Eligibility In Other Programs
100.3 Assistance/Benefit Unit H-100.3
Optional Exclusions
110 Roll-Down For C-Related Assistance H-110
110.1 C-Related Categorically H-110.1
Needy
110.2 Medically Needy H-110.1
110.3 Documentation H-110.3
110.4 Roll-Down Flowchart- H-110.4
C-Related
H-200 ** Low Income Families with Children H-200
(LIFC)
200.1 General Information H-200.1
200.2 Coverage H-200
210 ** LIFC Assistance/Benefit Unit H-210
210.1 Who Shall Be Included H-210
210.2 Who May Be Included H-210.2
210.3 Separate Assistance Units H-210.3
221 Eligibility Determination Process H-221
221.1 Determine Assistance/ H-221
Benefit Unit
221.2 Establish Categorical H-221
Requirements
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221.3 Establish Non-Financial H-221
Eligibility
221.4 Establish Need H-221.4
221.5 Eligibility Decision H-221.5
221.6 Certification Period H-221.5
221.7 Notice of Decision H-221.5
230 **LIFC Minor Unmarried Parent H-230
230.1 General Information H-230
231 Eligibility Determination Process H-231
231.1 Determine Assistance/ H-231
Benefit Unit
231.2 Establish Categorical H-231.2
Requirements
231.3 Establish Non-Financial H-231.2
Eligibility
231.4 Establish Need H-231.4
231.5 Eligibility Decision H-231.5
231.6 Certification Period H-231.5
231.7 Notice of Decision H-231.5
232 **LIFC Maternity Home H-232
232.1 Who Shall Be Payee H-232
232.2 Income H-232
240 ** PAP H-240
240.1 General Information H-240
240.2 Coverage H-240.1
240.3 PAP Assistance/Benefit Unit H-240.1
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241 Eligibility Determination Process H-241
241.1 Determine Assistance/ H-241
Benefit Unit
241.2 Establish Categorical H-241
Requirements
241.3 Establish Non-Financial H-241
Eligibility
241.4 Establish Need H-241.3
241.5 Eligibility Decision 2 of H-241.4
241.6 Certification Period 2 of H-241.6
241.7 Notice of Decision 2 of H-241.6
H-300 CHAMP H-300
310 General Information H-300
310.1 Presumptive Eligibility (PE) H-310.1
310.2 Pregnant Women (PW) H-310.1
310.3 CHAMP Child H-310.3
311 PAP Exclusions From CHAMP H-311
320 CHAMP Presumptive Eligibility H-320
321 Eligibility Determination Process H-320
322 Application H-321
323 Eligibility Determination H-323
323.1 Pregnancy H-323
323.2 Income Unit H-323
323.3 Income Computation H-323.3
323.4 Resources 2of H-323.3
323.5 Decision H-323.5
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324 Reserved
325 Referral to the ** Appropriate BHSF H-325
Office
325.1 Eligible Pregnant Woman H-325
326 ** BHSF Responsibility H-326
Upon Receipt of PE Packets
326.1 PE Packets Not Received H-326
Within Five Days
326.2 Complete PE Packet H-326
326.3 Review of Net Income H-326.2
326.4 Closure of PE and Denial 2 of H-326.3
of CHAMP Pregnant Woman
326.5 Notices 2 of H-326.5
327-329 Reserved
330 CHAMP Pregnant Woman H-330
331 Eligibility Determination Process H-330
331.1 Determine Assistance/ H-330
Benefit Unit
331.2 Establish Categorical H-330
Requirements
331.3 Establish Non-Financial H-330
Eligibility
331.4 Establish Need H-331.3
331.5 Eligibility Decision H-331.5
331.6 Certification Period H-331.5
331.7 Notice of Decision H-331.5
331.8 Deem Newborn H-331.5
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332-339 Reserved
340 CHAMP Child H-340
341 Eligibility Determination Process H-340
341.1 Determine Assistance/ H-340
Benefit Unit
341.2 Establish Categorical H-340
Requirements
341.3 Establish Non-Financial H-340
Eligibility
341.4 Establish Need H-341.4
341.5 Eligibility Decision H-341.5
341.6 Certification Period H-341.5
341.7 Notice of Decision H-341.5
H-400 Deemed Eligibles H-400
410 General Information H-400
410.1 Coverage H-410.1
421 Eligibility Determination Process H-421
421.1 Determine Assistance/ H-421
Benefit Unit
421.2 Establish Categorical H-421
Requirement
421.3 Establish Non-Financial H-421.3
Eligibility
421.4 Establish Need H-421.3
421.5 Eligibility Decision H-421.5
421.6 Certification Period H-421.5
421.7 Notice of Decision H-421.7
421.8 Third Party Liability H-421.7
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H-500 Reserved
H-600 Extended Medicaid H-600
610 General Information H-600
610.1 Coverage H-600
620 Disabled Adult Children (DAC) H-620
620.1 General Information H-620
621 Eligibility Determination Process H-621
621.1 Determine Assistance/ H-621
Benefit Unit
621.2 Establish Categorical H-621
Requirement
621.3 Establish Non-Financial H-621
Eligibility
621.4 Establish Need H-621.4
621.5 Eligibility Decision H-621.5
621.6 Certification Period H-621.5
621.7 Notice of Decision H-621.5
630 Disabled Widows/Widowers (DW/W) H-630
630.1 General Information H-630
631 Eligibility Determination Process H-631
631.1 Determine Assistance/ H-631
Benefit Unit
631.2 Establish Categorical H-631
Requirement
631.3 Establish Non-Financial H-631
Eligibility
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631.4 Establish Need H-631.4
631.5 Eligibility Decision 4 of H-631.4
631.6 Certification Period 4 of H-631.4
631.7 Notice of Decision 4 of H-631.4
640 Early Widows/Widowers (EW/W) H-640
640.1 General Information H-640
641 Eligibility Determination Process H-641
641.1 Determine Assistance/ H-641
Benefit Unit
641.2 Establish Categorical H-641
Requirement
641.3 Establish Non-Financial H-641
Eligibility
641.4 Establish Need H-641.4
641.5 Eligibility Decision H-641.5
641.6 Certification Period H-641.5
641.7 Notice of Decision H-641.5
650 Pickle H-650
650.1 General Information H-650
651 Eligibility Determination Process H-651
651.1 Determine Assistance/ H-651
Benefit Unit
651.2 Establish Categorical H-651
Requirement
651.3 Establish Non-Financial H-651
Eligibility
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651.4 Establish Need H-651.4
651.5 Eligibility Decision H-651.5
651.6 Certification Period H-651.5
651.7 Notice of Decision H-651.5
660 Disabled Widows/Widowers and H-660
Disabled Surviving Divorced Spouses
Unable to Perform Any Substantial
Gainful Activity (SGA Disabled W/W/DS)
660.1 General Information H-660
661 Eligibility Determination Process H-661
661.1 Determine Assistance/ H-661
Benefit Unit
661.2 Establish Categorical H-661
Requirement
661.3 Establish Non-Financial H-661
Eligibility
661.4 Establish Need H-661.4
661.5 Eligibility Decision H-661.5
661.6 Certification Period H-661.5
661.7 Notice of Decision H-661.5 Reissued May 1, 1999 14 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
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H-700 SSI Retroactive Medicaid H-700
710 General Information H-700
711 Notification of Applicants/ H-700
Recipients For SSI
712 Application For Retroactive Coverage H-712
713 Retroactive Certification H-712
714 Denial For SSI Because of H-712
Disability
715 Income Rejections H-715
716 Medical Card H-715
721 Eligibility Determination Process H-721
721.1 Determine Assistance/ H-721
Benefit Unit
721.2 Establish Categorical H-721
Requirement
721.3 Establish Non-Financial H-721
Eligibility
721.4 Establish Need H-721.4
721.5 Eligibility Decision H-721.5
721.6 Certification Period H-721.5
721.7 Notice of Decision H-721.5
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H-800 Long Term Care (LTC) H-800
810 General Information H-800
810.1 Coverage H-810
810.2 Medical Certification H-810
810.3 Patient Liability H-810.3
810.4 Optional State Supplement H-810.3
810.5 Categories F, V, I, and O H-810.3
820 Long Term Care - C-Related H-820
820.1 General Information H-820
821 Eligibility Determination Process H-821
821.1 Determine Assistance/ H-821
Benefit Unit
821.2 Establish Categorical H-821
Requirement
821.3 Establish Non-Financial H-821.3
Eligibility
821.4 Establish Need H-821.4
821.5 Eligibility Decision H-821.5
821.6 Determine Patient Liability H-821.5
821.7 Certification Period H-821.6
821.8 Notice of Decision H-821.6
821.9 Post Certification H-821.9
821.10 Transfer of Case Record H-821.9
830 Long Term Care - SSI-Related H-830
830.1 General Information H-830
830.2 CAP Rate H-830
830.3 Personal Care Needs H-830
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830.4 SSI Recipients H-830.3
830.5 SSI Recipients H-830.5
Expected to be Institutionalized
for Three Months or Less
831 Eligibility Determination Process H-831
831.1 Determine Assistance/ H-831
Benefit Unit
831.2 Establish Categorical H-831
Requirement
831.3 Establish Non-Financial H-831.3
Eligibility
831.4 Establish Need H-831.4
831.5 Eligibility Decision 4 of H-831.4
831.6 Post Eligibility H-831.6
Determination
831.7 Certification Period 3 of H-831.6
831.8 Notice of Decision 3 of H-831.6
831.9 Post Certification H-831.9
840 Medicaid Coinsurance-Medicare SNF/NF H-840
840.1 General Information H-840
841 Eligibility Determination Process H-841
841.1 Determine Assistance/ H-841
Benefit Unit
841.2 Establish Categorical H-841
Requirement
841.3 Establish Non-Financial H-841.3
Eligibility
841.4 Establish Need H-841.4
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841.5 Eligibility Decision H-841.5
841.6 Certification Period H-841.5
841.7 Notice of Decision H-841.7
H-900 Home and Community Based Services (HCBS) H-900
910 General Information H-900
910.1 Coverage 2 of H-910
910.2 Medical Certification H-910.2
910.3 Cap Rate 2 of H-910.2
910.4 **Recipient Liability 2 of H-910.2
910.5 Maintenance Needs H-910.4
Allowance
910.6 Categories F, V, I, and O H-910.4
921 Eligibility Determination Process H-921
921.1 Determine Assistance/ H-921
Benefit Unit
921.2 Establish Categorical H-921
Requirement
921.3 Establish Non-Financial H-921
Eligibility
921.4 Establish Need H-921.4
921.5 Eligibility Decision 3 of H-921.4
921.6 ** Reserved H-921.6
921.7 Certification Period H-921.7
921.8 Notice of Decision H-921.7
921.9 Post Certification H-921.7
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H-1000 Medically Needy Program (MNP) H-1000
1010 General Information H-1000
1010.1 Categorical Relatedness H-1000
1010.2 MNIES H-1000
1011 Groups H-1011
1011.1 Regular MNP H-1011
1011.2 Spend-down MNP H-1011.2
1011.3 Eligibility Period H-1011.3
1011.4 Limited Certifications H-1011.4
1011.5 Bills Allowed in the H-1011.5
Spend-down Process
1011.6 Bills Not Allowed in the H-1011.6
Spend-down Process
1012 C-Related MNP Caretaker Relative H-1012
1020 Regular and Spend-down Medically H-1020
Needy - C-Related
1021 Eligibility Determination Process H-1020
1021.1 Determine Assistance/ H-1020
Benefit Unit
1021.2 Establish Categorical H-1020
Requirement
1021.3 Establish Non-Financial H-1021.3
1021.4 Establish Need H-1021.3
1021.5 Eligibility Decision H-1021.5
1021.6 Certification Period H-1021.5
1021.7 Notice of Decision H-1021.5
1021.8 Form 110-MNP H-1021.8
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1030 Spend-down Medically Needy H-1030
Non-LTC- SSI-Related
1031 Eligibility Determination Process H-1030
1031.1 Determine Assistance/ H-1030
Benefit Unit
1031.2 Establish Categorical H-1030
Requirement
1031.3 Establish Non-Financial H-1031.3
Eligibility
1031.4 Establish Need H-1031.4
1031.5 Eligibility Decision 4 of H-1031.4
1031.6 Certification Period 4 of H-1031.4
1031.7 Notice of Decision 4 of H-1031.4
1031.8 Form 110-MNP H-1031.8
1040 Spend-down Medically Needy H-1040
Long Term Care - SSI-Related
1041 Eligibility Determination Process H-1040
1041.1 Determine Assistance/ H-1040
Benefit Unit
1041.2 Establish Categorical H-1040
Requirement
1041.3 Establish Non-Financial H-1041.3
Eligibility
1041.4 Establish Need H-1041.4
1041.5 Eligibility Decision H-1041.5
1041.6 Certification Period H-1041.5
1041.7 Notice of Decision H-1041.5
1041.8 Form 110-MNP H-1041.5
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H-1100 Qualified Medicare Beneficiary (QMB) H-1100
1110 General Information H-1100
1110.1 Coverage H-1110
1121 Eligibility Determination Process H-1121
1121.1 Determine Assistance/ H-1121
Benefit Unit
1121.2 Establish Categorical H-1121
Requirement
1121.3 Establish Non-Financial H-1121
Eligibility
1121.4 Establish Need H-1121.4
1121.5 Eligibility Decision H-1121.5
1121.6 Certification Period H-1121.5
1121.7 Notice of Decision H-1121.5
H-1200 Qualified Disabled and Working Individuals H-1200
(QDWI)
1210 General Information H-1200
1210.1 Coverage H-1200
1221 Eligibility Determination Process H-1221
1221.1 Determine Assistance/ H-1221
Benefit Unit
1221.2 Establish Categorical H-1221
Requirement
1221.3 Establish Non-Financial H-1221
Eligibility
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1221.4 Establish Need H-1221.4
1221.5 Eligibility Decision H-1221.5
1221.6 Certification Period H-1221.5
1221.7 Notice of Decision H-1221.5
H-1300 Specified Low-Income Medicare Beneficiary H-
1300
1310 General Information H-1300
1310.1 Coverage H-1310
1321 Eligibility Determination Process H-1321
1321.1 Determination Assistance/ H-1321
Benefit Unit
1321.2 Establish Non-Financial H-1321
Eligibility
1321.3 Establish Need H-1321
1321.4 Eligibility Decision H-1321.4
1321.5 Certification Period H-1321.4
1321.6 Notice of Decision H-1321.4
H-1400 Reserved
H-1500 ** Continued Medicaid for LIFC Recipients H-1500
1510 General Information H-1500
1510.1 Coverage H-1500
1520 Child Support **Continuance H-1523
1521 Eligibility Criteria H-1520
1522 Period of Eligibility H-1520
1523 Reasons for Ineligibility H-1520
1524 Notices H-1523
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1530 Transitional Medicaid ** H-1530
1531 Eligibility Criteria H-1531
1532 Period of Eligibility H-1532
1533 Reporting Requirements for H-1533
Transitional Medicaid
1533.1 Initial Extension H-1533
(Months one through six)
1533.2 Additional Six Month H-1533
Extension
1534 Reasons For Ineligibility H-1534
1535 Notices H-1535
H-1600 ** Reserved
H-1700 Legal Aliens Not Admitted For Permanent H-1700
Residence and Illegal Aliens
1710 General Information H-1700
1721 Eligibility Determination Process H-1721
1721.1 Determine Assistance/ H-1721
Benefit Unit
1721.2 Establish Categorical H-1721
Requirements
1721.3 Establish Non-Financial H-1721
Eligibility
1721.4 Establish Need H-1721.4
1721.5 Eligibility Decision H-1721.4
1721.6 Certification Period H-1721.4
1721.7 Notice of Decision H-1721.7
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H-1800 Retroactive Medical Eligibility (RME) H-1800
1810 General Information H-1800
1810.1 Coverage H-1810
1821 Eligibility Determination Process H-1821
1821.1 Certification Period H-1821
I-0000 Eligibility Factors - Outline I-0000
I-100 Age - C-Related I-0000
110 Requirement I-100
120 Verification I-120
130 Documentation I-120
140 School Attendance I-140
I-200 Assignment of Third Party Rights I-200
210 Requirement I-200
211 Automatic Assignment I-210
211.1 Non-SSI Applicant/ I-210
Beneficiary
211.2 SSI Applicant/Recipient I-210
212 Cooperation I-212
212.1 Good Cause for I-212.1
Non-cooperation
212.2 Informing the Applicant/ I-212.1
Beneficiary of Good
Cause Provisions
212.3 Establishing Good Cause I-212.3
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213 Denial or Termination of Eligibility I-213
220 Verification I-220
230 Documentation I-220
I-300 Citizenship/Alien Status I-300
310 Requirement I-300
311 Citizenship I-311
311.1 Qualified Alien I-311
311.2 Acceptable Documentation I-311.2
Of Qualified Alien Status
311.3 5-Year Ban for Qualified 3 of I-311.2
Aliens
311.4 Determine 5-year I-311.4
Limitation
311.5 Mandatory Eligibility of I-311.5
Certain Qualified Aliens
Living in the United States
Before August 22, 1996
311.6 Mandatory Eligibility of I-311.6
Qualified Aliens Entering
The United States on or
After August 22, 1996
312 Alien Status I-312
312.1 Undocumented Aliens I-312
**
313 ** Reserved
314 American Indian Born in Canada I-314
314.1 Verification I-314
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Medicaid Eligibility Manual Table of Contents
315 ** Reserved
316 ** Reserved
317 Non-Qualified Aliens I-317
Eligible for Emergency Services
318 Ineligible Aliens I-318
319 Reserved
320 Verification I-320
330 Documentation I-320
I-400 Continuity of Stay (LTC Only, Except HCBS) I-400
410 Requirement I-400
420 Verification 2 of I-410
430 Documentation 2 of I-410
I-500 Deprivation I-500
510 Requirement I-500
511 Legally Responsible Parents I-511
512 Deprivation Based on Death of I-512
a Parent
512.1 Sources of Verification I-512
512.2 Documentation I-512 Reissued May 1, 1999 26 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
513 Deprivation Based on Absence I-513
of a Parent
513.1 Locating and Interviewing I-513
the Absent Parent
513.2 Sources of Verification 3 of I-513.1
513.3 Documentation of I-513.2
Continued Absence
514 Deprivation Based on Incapacity I-514
514.1 Action in Incapacity Cases I-514.1
514.2 Local Office Decision I-514.1
514.3 Securing **Medical 2 of I-514.2
Documentation for
MEDT Incapacity Decision
514.4 Action on MEDT Decision I-514.3
514.5 ** Request for Medical I-514.4
Exam
514.6 ** Review of MEDT I-514.4
Decision
514.7 Refusal of Medical Treatment I-514.6
or Rehabilitation
514.8 Resubmitting Form ** MEDT I-514.6
After Appeal Decision
Reissued May 1, 1999 27 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
515 Deprivation Based on Unemployment I-515
of the Parent
515.1 Establish the Principal I-515
Wage Earner (PWE)
515.2 Unemployment of the PWE I-515.2
515.3 Refusal of Employment I-515.3
515.4 Recent Connection With I-515.3
the Labor Force
515.5 Receipt of Unemployment I-515.5
Compensation Benefits (UCB)
515.6 Presumed UCB Eligibility I-515.6
515.7 Work History Requirement I-515.7
515.8 SSA "Quarters of Coverage" I-515.8
515.9 Unemployment Compensation I-515.8
Benefits (UCB)
515.10 Registration With I-515.10
Employment Security
515.11 Employment Registration I-515.10
Exemptions
515.12 Verification of Earned I-515.12
Income
I-600 Enumeration I-600
610 Requirement I-600
620 Verification I-600
630 Documentation I-620
I-700 Reserved
Reissued May 1, 1999 28 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
I-800 Home I-800
810 Requirement I-800
811 Temporary Absence From Home I-800
812 Assistance For Homeless Families I-811
820 Verification I-820
830 Documentation I-820
I-900 Institutionalization I-900
910 Requirement I-900
920 Institutions I-920
930 Inmate Status 2 of I-920
940 End of Inmate Status 3 of I-930
950 Verification I-940
960 Documentation I-960
I-1000 Medical Certification (LTC and HCBS Only) I-1000
1010 Requirement I-1000
1011 Level Two Screening I-1000
1020 Verification I-1000
1030 Documentation I-1000
I-1100 Medicare Ineligibility I-1100
1110 Requirement I-1100
1120 Verification I-1100
1130 Documentation I-1100
Reissued May 1, 1999 29 Replacing August 1, 1994 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
I-1200 Mother's Medicaid Eligibility I-1200
(Deemed Eligible Children Only)
1210 Requirement I-1200
1220 Verification I-1200
1230 Documentation I-1200
I-1300 Reserved
I-1400 Need I-1400
1410 General Information I-1400
1411 Need - Prohibited AFDC I-1411
Provisions (PAP)
1411.1 Alien Sponsor I-1411.1
1411.2 MUM's Parent I-1411.2
1411.3 Siblings I-1411.3
1411.4 Stepparent I-1411.4
1411.5 Caretaker Relative I-1411.5
1420 Need - Deeming I-1420
1421 Definitions for Deeming Purposes I-1421
1422 When Deeming Is Not Applicable I-1422
1423 Deeming of Resource I-1423
1423.1 Resources Excluded From I-1423
Deeming
1423.2 Parent To Child I-1423.2
Resource Deeming Procedure
1423.3 Sponsor To Alien Resource I-1423.2
Deeming Procedure
Reissued May 1, 1999 30 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1424 Deeming of Income I-1424
1424.1 Income Not Included I-1424
In Deeming
1424.2 Income Deeming Procedures I-1424.1
I-1500 Need - Income I-1500
1510 General Information I-1500
1510.1 Income Standards I-1501.1
1510.2 Ownership of Income I-1510.2
1511 Verification I-1511
1512 Documentation I-1511
1520 Need - C-Related Income I-1520
1521 Income Unit I-1520
1522 Reserved
1523 Reserved
1524 Types of Income (C-Related) I-1524
1524.1 Adoption Assistance - I-1524
AFDC-M and AFDC-PAP Only
1524.2 Agent Orange Settlement I-1524
1524.3 Agriculture and Stabilization I-1524
and Conservation (ACSE)
Payments
1524.4 Alien Sponsor's Income I-1524
1524.5 Alimony I-1524.5
1524.6 Cash Contributions I-1524.5
1524.7 Child Care Program I-1524.7
Reissued May 1, 1999 31 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1524.8 Child Support I-1524.7
1524.9 Child's Earned Income I-1524.7
1524.10 Contractual Income I-1524.9
1524.11 Delta Service Corps I-
1524.10
1524.12 Disability Insurance Benefits I-1524.11
1524.13 Disaster Payments I-
1524.11
1524.14 Dividends I-1524.11
1524.15 Domestic Volunteer I-1524.15
Service Act
1524.16 Earned Income Credits I-1524.15
(EIC)
1524.17 Education Assistance I-1524.15
1524.18 Energy Assistance I-1525.17
1524.19 Foster Care Payments I-1524.17
1524.20 Housing and Urban I-1524.17
Development (HUD) Payments
1524.21 Indian and Native Claims I-1524.21
and Lands
1524.22 In-Kind Income I-1524.21
1524.23 Interest I-1524.21
1524.24 Irregular and I-1524.24
Unpredictable Income
1524.25 Job Training Partnership I-1524.25
Act of 1982 (JTPA)
1524.26 Loans 2 of I-1524.25
1524.27 Lump Sum Payments 2 of I-1524.25 Reissued May 1, 1999 32 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1524.28 Military Pay and
Allowance 3 of I-1524.27
1524.29 Minor Unmarried Mother's I-1524.29
(MUM) Income
1524.30 Nutrition Program I-1524.29
1524.31 Oil and Land Lease I-1524.31
1524.32 Pensions and Annuities I-1524.31
1524.33 Potential Income I-1524.31
1524.34 Radiation Exposure I-1524.34
Compensation Payments
1524.35 Railroad Retirement I-1524.34
1524.36 Reimbursements I-1524.34
1524.37 Relocation Assistance I-1524.34
1524.38 Rental Property I-1524.38
1524.39 Resource Granny I-1524.38
1524.40 Retirement I-1524.38
1524.41 Roomers/Boarders I-1524.38
1524.42 Royalties I-1524.42
1524.43 Self-Employment Income I-1524.42
1524.44 Social Security (RSDI) 3 of I-1524.43
1524.45 Stepparent=s Income I-1524.45
1524.46 Summer Youth Employment I-1524.45
Program (SYEP)
1524.47 Supplemental Security I-1524.45
Income (SSI)
1524.48 Tax Refunds I-1524.45
Reissued May 1, 1999 33 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1524.49 Trust Funds I-1524.49
1524.50 Tutorship Funds I-1524.49
1524.51 Unemployment Compensation I-1524.49
Benefits (UCB)
1524.52 Vendor Payments I-1524.49
1524.53 Veteran=s Administration I-1524.53
Benefits
1524.54 Wages, Salaries, and I-1524.53
Commissions
1524.55 Wartime Relocation of I-1524.53
Civilians= Payments
1524.56 Women, Infants and I-1524.56
Children=s (WIC) Program
1524.57 Work Study I-1524.56
1524.58 Workmen=s Compensation I-1524.56
1525 Need - C-Related Treatment I-1525
Of Income
I-1525.1 185% Pretest I-1525.1
I-1525.2 Rounding Procedures I-1525.2
1526 Deductions I-1526
1526.1 Standard Earned Income I-1526
Deduction
1526.2 Earned Income Exemption I-1526.2
(EIC)
1526.3 Dependent Care Deduction I-1526.3
1526.4 Court-ordered Child Support I-1526.3
And/or Alimony to Persons
Outside the Home Reduction
Reissued May 1, 1999 34 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1527 Need - C-Related - Budgeting of I-1527
Income
1527.1 Budgeting in LIFC for I-1527
Stepparent or Spouse of a
Qualified Relative
1527.2 Budgeting Income From the I-1527.2
Parents of a MUM or Pregnant
Unmarried Minor
1527.3 MUM's Parents Budgeting I-1527.3
in **LIFC
1527.4 MUM's Parents Budgeting I-1527.3
in C-MNP and CHAMP
1527.5 Pregnant Minor's Parents I-1527.5
Budgeting in **LIFC,
**PAP, and C-MNP
1527.6 Pregnant Minor's Parents I-1527.5
Budgeting in CHAMP
1528 Allocation of Income in C-Related I-1528
1530 Need - SSI-Related Income I-1530
1531 Income Unit I-1530
1532 Potential Income (Applying for I-1532
Other Benefits)
1533 Reserved
1534 Types of Income (SSI-Related) I-1534
I-1534.1 Agent Orange I-1534
Settlement Payments
Reissued May 1, 1999 35 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1534.2 Adoption Subsidy I-1534
1534.3 Agriculture and Stabilization I-1534.3
And Conservation Payments
1534.4 Alien Sponsor=s Income I-1534.3
1534.5 Alimony I-1534.3
1534.6 Annuity I-1534.6
1534.7 Assistance Based on Need I-1534.6
1534.8 Black Lung Disease Benefits I-1534.6
1534.9 Capital Gains Distribution I-1534.6
1534.10 Cash and In-Kind Replacement I-1534.10
Items
1534.11 Child Care Food Program I-1534.10
Payments
1534.12 Child Support I-1534.10
1534.13 Commissions I-1534.13
1534.14 Community Spouse=s Income I-1534.13
1534.15 Contractual Income I-1534.13
1534.16 Contributions I-1534.13
1534.17 Death Benefits I-1534.13
1534.18 Disability Payments 2 of I-1534.17
1534.19 Disaster Assistance I-1534.19
1534.20 Dividends I-1534.19
1534.21 Domestic Volunteer Service
Act I-1534.21
1534.22 Donations I-1534.21
1534.23 Earned Income Tax Credits I-1534.23
(EITC)
1534.24 Educational Assistance (Grants,I-1534.23
Scholarships, Fellowships) Reissued May 1, 1999 36 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1534.25 Energy Assistance I-1534.23
1534.26 Fellowships I-1534.23
1534.27 Foster Care Payments I-1534.27
1534.28 Grants I-1534.27
1534.29 Home Produce for Personal I-1534.27
Consumption
1534.30 Housing Assistance Payments I-1534.30
1534.31 Income Based on Need I-1534.30
1534.32 Income Tax Refunds and I-1534.30
Credits
1534.33 Indemnity Medical Insurance I-1534.33
Benefits (Income Replacement
Policies)
1534.34 Indian Related Payments I-1534.33
1534.35 Individual and Family Grant I-1534.33
Assistance
1534.36 Inheritance I-1534.36
1534.37 In-Kind Income I-1534.37
1534.38 In-Kind Support and 2 of I-1534.37
Maintenance
1534.39 Insurance Payments I-1534.39
1534.40 Interest I-1534.39
1534.41 Irregular or ** Infrequent I-1534.40
Income
1534.42 Job Training Partnership I-1534.42
Act (JTPA)
Reissued May 1, 1999 37 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1534.43 Lease Arrangements for I-1534.42
Mineral and Surface Rights
1534.44 Life Insurance I-1534.44
1534.45 Loans I-1534.44
1534.46 Lump Sum Payments 2 of I-1534.45
1534.47 Migrant Worker Income I-1534.47
1534.48 Mineral Rights I-1534.47
1534.49 Military Pay and Allowance I-1534.47
1534.50 Mortgages and Promissory I-1534.47
Notes
1534.51 Pensions and Annuities I-1534.52
1534.52 Railroad Retirement Benefits I-1534.52
1534.53 Recoupments I-1534.52
1534.54 Reimbursements I-1534.52
1534.55 Relocation Assistance I-1534.52
1534.56 Rental Property Income I-1534.56
1534.57 Reparation Payments 2 of I-1534.56
1534.58 Restitution Payments I-1534.58
1534.59 Retirement Benefits I-1534.58
1534.60 Royalties I-1534.58
1534.61 Salaries I-1534.58
1534.62 Scholarships I-1534.58
1534.63 Self-Employment Earnings I-1534.63 Reissued May 1, 1999 38 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1534.64 Senior Community 4 of I-1534.63
Service Employment
Program (SCSEP)
1534.65 Sheltered Workshop 4 of I-1534.63
Earnings
1534.66 Sick Pay 4 of I-1534.63
1534.67 Social Security I-1534.66
Retirement, Survivors and
Disability Insurance Benefits
(RSDI)
1534.68 Spousal Impoverishment I-1534.68
Allocated Income
1534.69 Student Earnings I-1534.68
1534.70 Supplemental Security I-1534.68
Income (SSI)
1534.71 Trust Income and I-1534.70
Tutorship Funds
1534.72 Undivided Estate Income I-1534.72
1534.73 Unemployment Compensation I-1534.72
Benefits (UCB)
1534.74 Vendor Payments I-1534.72 Reissued May 1, 1999 39 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1534.75 Veteran=s Administration I-1534.75
(VA) Benefits
1534.76 Victim=s Compensation I-1534.76
1534.77 Wages, Salaries and I-1534.76
Commissions
1534.78 Worker=s Compensation I-1534.76
1535 Need - SSI-Related - Treatment I-1535
of Income
1536 Deductions I-1535
1537 Spousal Impoverishment Income I-1537
Provisions
1537.1 General Information I-1537
1537.2 Ownership of Income I-1537.2
1537.3 Patient Liability I-1537.2
Determination (Post
Eligibility Determination)
1537.4 Verification I-1537.4
1537.5 Documentation I-1537.4
1540 Need - Income - Programs Not I-1540
Related to AFDC or SSI Reissued May 1, 1999 40 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1541 Qualified Medicare Beneficiary (QMB) I-1541
1541.1 Income Unit I-1541
1541.2 Types of Income I-1541
1541.3 Deductions I-1541
1542 Qualified Disabled and I-1542
Working Individuals (QDWI)
1542.1 Income Unit I-1542
1542.2 Types of Income I-1542
1542.3 Deductions I-1542 1543 Specified Low-Income Medicare I-1543
Beneficiary (SLMB)
1543.1 Income Unit I-1543
1543.2 Type of Income I-1543
1543.3 Deductions I-1543
I-1600 Need - Resources I-1600
1610 General Information I-1600
1610.1 Resource Standards I-1600
1610.2 Determining Countable Value I-1610.2
1610.3 Conversion of a Resource I-1610.3
1611 Verification I-1610.2
1612 Documentation I-1612
1620 Need - C-Related Resources I-1620 Reissued May 1, 1999 41 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1621 Requirement I-1620
1622 Resource Unit I-1620
1623 Reserved
1624 Types of Resources (C-Related) I-1620
1624.1 Agent Orange Settlement I-1624
Payments
1624.2 Burial Insurance I-1624
1624.3 Burial Plot I-1624
1624.4 Certificates of Deposit I-1624
1624.5 Crops In Storage I-1624.5
1624.6 Disaster Payments I-1624.5
1624.7 Earned Income Tax Credit I-1624.5
1624.8 Energy Assistance Payments I-1624.5
1624.9 Escrow Accounts I-1624.5
1624.10 Home I-1624.10
1624.11 Housing and Urban I-1624.11
Development (HUD) Benefits
1624.12 Inaccessible Resources I-1624.11
1624.13 Income I-1624.11
1624.14 Income-Producing Property I-1624.11
1624.15 Indian and Native Claims I-1624.11
and Lands
1624.16 Individual Retirement I-1624.16
Accounts (IRA)
Reissued May 1, 1999 42 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1624.17 Jointly Owned Resources I-1624.16
1624.18 Joint Accounts I-1624.18
1624.19 Keogh Plans I-1624.19
1624.20 Life Insurance I-1624.19
1624.21 Livestock I-1624.19
1624.22 Lump Sum Payments I-1624.22
1624.23 Personal Property I-1624.23
1624.24 Real Estate Other Than I-1624.23
Home
1624.25 Relocation Assistance I-1624.25
1624.26 Retirement Plan I-1624.25
1624.27 Trust Funds I-1624.25
1624.28 Tutorship Funds I-1624.28
1624.29 Vehicles I-1624.28
1624.30 Wartime Relocation of I-1624.30
Civillians Payments
1624.31 Women, Infants, and I-1624.30
Children (WIC) Program
1625 Transferring Resources I-1625
1630 Need - SSI-Related Resources I-1630
1631 Requirement I-1630
1632 Resource Unit I-1630
1633 General Information I-1633
1634 Types of Resources (SSI-Related) I-1634
1634.1 Agent Orange Settlement I-1634
Payments
1634.2 Annuities I-1634
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Medicaid Eligibility Manual Table of Contents
1634.3 Bank Accounts I-1634
1634.4 Bonds I-1634.4
1634.5 Burial Contracts I-1634.5
1634.6 Burial Funds I-1634.5
1634.7 Burial Spaces I-1634.7
1634.8 Cash 2 of I-1634.7
1634.9 Certificates of Deposit 2 of I-1634.7
1634.10 Crops in Storage I-1634.10
1634.11 Death Benefits I-1634.10
1634.12 Disaster Assistance I-1634.10
1634.13 Escrow Accounts I-1634.13
1634.14 Estate I-1634.13
1634.15 Home Property I-1634.13
1634.16 Inheritances I-1634.13
1634.17 Jointly Owned Resources I-1634.17
1634.18 Life Insurance I-1634.17
1634.19 Livestock I-1634.19
1634.20 Loans I-
1634.19
1634.21 Lump Sum Payments I-1634.19
1634.22 Mortgages and Promissory I-1634.22
Notes
1634.23 Mutual Fund Shares I-1634.23
1634.24 NOW Accounts I-1634.23
1634.25 Patient Fund Accounts I-1634.23
1634.26 Pension Funds I-1634.23
1634.27 Promissory Notes I-1634.23
1634.28 Property I-1634.28
Reissued May 1, 1999 44 Replacing April 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
1634.29 Recreational Vehicles (Boats, I-1634.29
Motors, and Campers)
1634.30 Relocation Assistance I-1634.29
1634.31 Reparation Payments I-1634.29
1634.32 Restitution Payments I-1634.32
1634.33 Retirement Funds I-1634.32
1634.34 Safety Deposit Boxes I-1634.34
1634.35 Savings Bonds I-1634.34
1634.36 Savings Certificates I-1634.34
1634.37 Stocks I-1634.37
1634.38 Time Deposits 2 of I-1634.37
1634.39 Trusts I-1634.39
1634.40 Vehicles I-1634.40
1634.41 Victims= Compensation 2 of I-1634.40
Payments
1660 Spousal Impoverishment Resource I-1660
Provisions (LTC/HCBS)
1661 General Information I-1660
1662 Definitions I-1662
1663 Spousal Resources Assessment I-1663
1664 Resource Assessment Procedures 2 of I-1663
1665 Transfer to Community Spouse I-1665
1666 Transfer of Resources by I-1666
Community Spouse
1667 Revisions to Allocated Resources I-1667
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Medicaid Eligibility Manual Table of Contents
1668 Undue Hardship I-1667
1669 Notification I-1669
1670 Transfer of Resources for Less I-1670
Than Fair Market Value
1671 General Information I-1670
1672 Transfers Prior to July 1, 1988 I-1672
1673 Transfer On or After July 1, 1988 I-1673
1674 Transfers On or After August 11, 1993 I-1674
1675 Uncompensated Value I-1675
1676 Effect of Uncompensated Value I-1676
on Eligibility
1677 Receipt of Additional Compensation 5 of I-1676
1678 Return of Transferred Resources I-1678
1679 Rebuttal of Presumed Value I-1679
1680 Need - Resources - Programs I-1680
Not Related to AFDC or SSI
1681 Qualified Medicare I-1681
Beneficiary (QMB)
1681.1 Requirement I-1681
1681.2 Resource Unit I-1681
1681.3 General Information I-1681
1681.4 Types of Resources I-1681
1682 Qualified Disabled and Working I-1682
Individuals (QDWI)
1682.1 Requirement I-1682
1682.2 Resource Unit I-1682
1682.3 General Information I-1682
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Medicaid Eligibility Manual Table of Contents
1682.4 Types of Resources I-1682
1683 Specified Low-Income Medicare I-1683
Beneficiary (SLMB)
1683.1 Requirement I-1683
1683.2 Resource Unit I-1683
1683.3 General Information I-1683
1683.4 Types of Resources I-1683
I-1700 Medicaid Qualifying Trusts I-1710
1710 Medicaid Qualifying Trusts I-1710
1720 Treatment of Trusts Created on Or I-1720
After August 11, 1993
I-1800 Relationship I-1800
1810 Requirement I-1800
1820 Verification I-1820
1820.1 Temporary Certification I-1820
Pending Verification of
Relationship
1820.2 Sources of Verification I-1820
1820.3 Selection of a Collateral I-1820.2
Source
1820.4 Confidentiality I-1820.2
1820.5 Evaluation of Collateral I-1820.4
Information
1820.6 Responsibility for Obtaining I-1820.4
Verification
1820.7 Worker Responsibility I-1820.7
1820.8 Sources for Verification I-1820.7
1830 Documentation I-1820.8
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Medicaid Eligibility Manual Table of Contents
I-1900 Residence I-1900
1910 Requirement I-1900
1910.1 Individuals Under Age 21 I-1910
1910.2 Individuals Age 21 and Over I-1910.1
1911 Change in Residency I-1911
1912 Temporary Visits Out of State I-1912
1913 Interstate Residency Agreements I-1912
1914 Interstate Compact on Adoption I-1914
and Medical Assistance (ICAMA)
1915 Inquiries Concerning Residence I-1915
1920 Verification I-1915
1930 Documentation I-1915
I-2000 Support Enforcement Services I-2000
2010 Requirement I-2000
2010.1 Pregnant Woman Only I-2000
2010.2 Pregnant Woman With I-2010.2
Minor Child
2011 Notification I-2011
2012 Automatic Assignment of Medical I-2011
Support
2013 Cooperation I-2013
2013.1 Requirement to Cooperate I-2013
With SES (Other Than
Pregnant Woman)
2013.2 Good Cause Claim I-2013.2
2014 Referrals to SES I-2014
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Medicaid Eligibility Manual Table of Contents
2015 Non-Cooperation I-2015
2015.1 Penalties for 2 of I-2015
Non-Cooperation With SES
2020 Verification I-2020
2030 Documentation I-2020
I-2100 Supplemental Security Income (SSI) I-2100
Eligibility
2100.1 General Information I-2100
2110 SSI Eligibility Requirement I-2110
2110.1 Verification I-2110
2110.2 Documentation I-2110
2120 Loss of SSI or MSS Requirement I-2120
2120.1 Verification I-2120
2120.2 Documentation I-2120
2130 Concurrent Eligibility for I-2130
and Receipt of SSI or MSS and
RSDI Requirement
2130.1 Verification I-2130.1
2130.2 Documentation I-2130.1
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Medicaid Eligibility Manual Table of Contents
J-0000 Issuing Medical Eligibility Cards (MECS) and J-0000
Optional State Supplement (OSS) Checks - Outline
J-100 General Information J-100
J-200 Medical Eligibility Cards (MECs) J-200
210 State Office Issuance J-200
211 Fiscal Intermediary Issuance J-211
212 Local Office Issuance J-212
212.1 Initial Issuance J-212.1
212.2 Prior Period Eligibility J-212.1
212.3 Lock-In J-212.1
212.4 Replacement J-212.4
212.5 Procedures For Issuing J-212.5
MECs
213 When To Retrieve A MEC J-213
214-229 Reserved
230 Messages on MECs J-230
240-249 Reserved
250 Medical Insurance Codes J-250
260 Third Party Payee (C-Related Only) J-260
260.1 Standards of Selection J-260
260.2 Locating a Third Party Payee J-260.2
260.3 Third Party Payee J-260.2
Responsibilities
260.4 Qualified Relative J-260.2
Responsibilities
260.5 Confidentiality J-260.2
J-300 Optional State Supplement (OSS) Checks J-300
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Medicaid Eligibility Manual Table of Contents K-0000 Redeterminations - Outline K-0000
K-100 Requirement K-100
K-200 Redetermination Listing K-200
K-300 Processing Redeterminations K-200
K-400 Incomplete Redeterminations K-300
K-500 Incapacity or Disability K-300
Decision
L-0000 Changes - Outline L-0000
L-100 Requirement L-100
L-200 Changes That Must Be Reported L-200
L-300-400 Reserved
L-500 Action on Changes L-500
L-600 Adequate Notice L-600
L-700 Advance Notice L-700
L-800 Mass Changes L-700
L-900 Appeal Requests L-900
M-0000 Transfers - Outline M-0000
M-100 General Information M-100
M-200 Active Cases M-200
M-300 Pending Applications M-300
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Medicaid Eligibility Manual Table of Contents
N-0000 Special Processing - Outline N-0000
N-100 EPSDT/KIDMED N-100
110 General Information N-100
120 Coverage N-100
130 Information Requirements N-130
130.1 Initial Information N-130
140 KIDMED Responsibilities N-140
150 Qualified Provider Responsibilities N-140
160 OCS/OYD Responsibilities N-140
N-200 Lock-In N-200
210 Definition N-200
220 Exclusions N-220
230 Who May Be Placed in Lock-In N-220
240 DHH Responsibilities in Placing N-240
the Recipient in Lock-In
241 OFS/BHSF Responsibilities in N-241
Placing the Recipient in Lock-In
N-300 Mandatory State Supplement (MSS) N-300
310 General Information N-300
320 Minimum Income Level (MIL) N-320
330 Reserved
340 Special Needs N-340
340.1 Essential Person N-340.1
340.2 Housekeeping Services N-340.2
340.3 Room and Board/Change N-340.2
In Living Arrangement
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Medicaid Eligibility Manual Table of Contents
340.4 Shelter N-340.2
340.5 Special Care Needs N-340.5
340.6 Transportation and N-340.5
Dependent Care
350 Computing the Special Needs N-350
Budget
360 Redetermination Period 2 of N-350
N-400 Out-of-State Medical Care N-400
410 General Information N-400
420 Services N-400
430 Head Injuries/Traumatic Brain N-430
Injuries/Rehabilitative Care
N-500 Reserved
N-600 Supplemental Security Income (SSI) - Medicaid N-600
610 Introduction N-600
620 Certification Process N-600
630 OCS Children N-620
O-0000 Prior Authorization - Outline O-0000
O-100 Introduction O-100
O-200 Prior Authorization for Medical Equipment, O-200
Appliances, and Supplies
201 General Information O-200
201.1 Requirements for O-200
Approval
201.2 Medicare Part B Recipients O-201.2
201.3 Time Limits O-201.3
201.4 Purchase vs. Rental O-201.3
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Medicaid Eligibility Manual Table of Contents
201.5 Freedom of Choice O-201.3
201.6 Coverage for EPSDT Eligibles O-201.6
201.7 Nursing Home Responsibilities O-201.6
For DME and Medical Supplies
202 Requests O-202
202.1 Emergency Requests O-202.1
203 Delivery Arrangements O-203
204 Items Requiring PAU Authorization O-204
204.1 Abdominal Binder and O-204
Supports
204.2 Adaptive ** Hygiene O-204
Equipment
204.3 Aerosol Compressor O-204
Nebulizers
204.4 Air Filters O-204.4
204.5 Alternating Pressure Beds O-204.4
204.6 Apnea Monitor O-204.6
204.7 Artificial Eyes 2 of O-204.6
204.8 Artificial Larynxes 2 of O-204.6
204.9 Augmentative Communication O-204.9
Devices
204.10 Batteries 2 of O-204.9
204.11 Bilirubin Lamps O-204.11
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Medicaid Eligibility Manual Table of Contents
204.12 Breast or Mammary ProsthesesO-204.11
204.13 Burn Garments and O-204.13
Stockings
204.14 Canes and Crutches O-204.13
204.15 Catheters O-204.13
204.16 Commode Chairs O-204.13
204.17 Continuous Positive O-204.17
Airway Pressure (CPAP)
Devices
204.18 Dialysis Equipment and O-204.18
Supplies
204.19 Egg-Crate Type Mattresses O-204.18
204.20 Glucose Monitors O-204.20
204.21 Hearing Aids (**Medicaid O-204.20
Eligibles Under Age 21 Only)
204.22 Hearing Aid Batteries and O-204.21
Repairs
204.23 Hospital Beds, Mattresses, O-204.21
Rails (Standard Types)
204.24 Hospital Beds (Electric) O-204.23
204.25 Hyperalimentation Therapy O-204.23
Aids (Parental and Enteral)
204.26 Irrigation Equipment 4 of O-204.25 Reissued May 1, 1999 55 Replacing June 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
204.27 IV Therapy Pumps and 4 of O-204.25
Administrator Supplies
204.28 Lifts ** O-204.28
204.29 Mechanical Percussors O-204.28
204.30 Orthopedic Shoes and O-204.28
Corrections
204.31 Orthotic Devices O-204.30
204.32 Ostomy Equipment O-204.32
204.33 Oxygen Concentrators O-204.32
204.34 Prosthetic Devices 2 of O-204.33
204.35 Repairs O-204.35
204.36 Seat Cushions for Wheelchairs O-204.35
204.37 Sheepskins O-204.35
204.38 Side Rails for Beds Othe r O-204.35
Than Hospital Beds
204.39 Suction Machines O-204.35
204.40 Support Hose O-204.39
204.41 Surgical Dressings or BandagesO-204.39
(Gauze, Tape, Sponges, Cement,
And Disposable Gloves)
204.42 Surgical Mastectomy Bras O-204.39 Reissued May 1, 1999 56 Replacing June 1, 1992 Table of Contents "**" Text Deleted "ITALICS" Text Revised
Medicaid Eligibility Manual Table of Contents
204.43 Traction Equipment O-204.43
204.44 Trapeze Bars O-204.43
204.45 Urinals (Hospital Type) and O-204.43
Bed Pans
204.46 Ventilators (Mechanical O-204.43
Breathing Machines) and
Required Accessories
204.47 Walkers O-204.47
204.48 Wheelchairs and Strollers O-204.47
205 New Eyes For The Needy, Inc. O-205
O-300 Medical Transportation O-300
301 General Information O-300
302 Who Is Eligible O-300
302.1 Children in State Custody O-302.1
302.2 Applicants O-302.1
303 Applicant's/Recipient's Trade O-303
Area
304 Ambulance Transportation O-304
305 Non-Ambulance, Non-Emergency O-304
Medical Transportation (NEMT)
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305.1 Services For Which NEMT O-305.1
Transportation Can Be
Provided
305.2 NEMT Transportation O-305.2
Providers
305.3 Transportation Provider's O-305.3
Service Area
306 NEMT Requests O-306
307 Verification of Eligibility for O-306
Transportation Services
308 Exploring Transportation O-308
Alternatives
308.1 Recipient and Community O-308
Resources
308.2 Title 20 Funds O-308.2
309 Selecting a Provider O-309
309.1 City/Public Transportation O-309
309.2 Contract Providers O-309.2
309.3 Freedom of Choice O-309.2
310 Use of Attendants O-310
311 Choice of Vehicle O-311
312 Verification Required O-311
313 Authorizing NEMT O-313
313.1 Rescheduling O-313
314 PAU Authorization O-314
315 Documentation O-315
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Medicaid Eligibility Manual Table of Contents 316 Transportation Provider O-316
Responsibilities
317 Responsibilities After O-317
Transportation Services Are Provided
318 Claim Forms O-318
318.1 Review of Claim Forms O-318
P-0000 Third Party Liability (TPL) - Outline P-0000
P-100 General Information P-100
P-200 Indicators of Potential Third Party P-200
Resources
P-300 Assignment/Cooperation 2 of P-200
P-400 Local Office/BHSF Responsibilities P-400
410 Health Insurance Resource Form P-400
411 Railroad Retirement Medicare P-411
Entitlement
420 TPL Carrier Update Form CF-1 P-411
430 Accident/Injury Reports P-430
440 Request for Accident/Injury P-440
Report Form Disposition
P-500 Buy-In Program P-500
510 General Purpose P-500
520 Part A Buy-In P-500
530 Part B Buy-In P-500
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Medicaid Eligibility Manual Table of Contents Q-0000 Inquiries and Complaints - Outline Q-0000
Q-100 Agency Responsibility Q-100
110 Billing 2 of Q-100
120 Third Party Resource File Q-120
Other Than Medicare
130 Long Term Care Q-130
Q-200 Referrals Q-200
210 Referrals to BHSF Q-200
220 Referrals to Fiscal Intermediary Q-220
R-0000 Authorized Representation R-0000
R-100 Authorized Representation R-100
S-0000 Verification and Documentation - Outline S-0000
S-100 Verification S-100
110 Questionable Information S-110
120 Documentary Evidence S-120
130 Collaterals S-120
S-200 Documentation S-200
T-0000 Fair Hearings - Outline T-0000
T-100 General Information T-100
U-0000 Fraud and Recovery - Outline
U-100 Fraud U-100
110 Suspected Recipient Fraud U-100
120 Suspected Provider Fraud U-100
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U-200 Recovery U-200
210 Agency Responsibility U-210
220 Recovery Report U-220
230 Amount of Ineligible Payment U-230
and Amount of Recovery
V-0000 Reserved
W-0000 Reserved
X-0000 Reserved
Y-0000 Reserved
Z-0000 Charts - Outline Z-0000
Z-100 Reserved
Z-200 Federal Poverty Income Guidelines Z-200
Z-300 Medically Needy Eligibility Z-300
Standards (MNIES) Urban Areas
Z-300 Medically Needy Eligibility 2 of Z-300
Standards (MNIES) Rural Areas
Z-400 Federal Benefit Rate (FBR) Z-400
Z-500 QMB Income Limits Z-400
Z-600 QDWI Income Limits Z-600
Z-700 LTC/HCBS/Psychiatric Hospital - CAP Z-700
Rate, Resource Limits, and Personal
Care Needs Allowance
Z-800 Spousal Impoverishment Maintenance Needs Z-800
and Resource Standards
Z-900 Resource Limits by Program Z-900
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Z-1000 Maximum Resource Limits as of 12-73 for Z-1000
Grandfathered/Converted Recipients
Z-1100 Maximum Grants for MSS Categories A, B, Z-1100
and D Prior to Conversion to SSI
Z-1200 Life Expectancy Tables - Males Z-1200
Z-1200 Life Expectancy Tables - Females 2 of Z-1200
Z-1300 Usufruct and Remainder Interest Tables Z-1300
Z-1400 Social Security Cost of Living Z-1400
Adjustment (COLAS) Extended Medicaid Only
Z-1500 Deeming Allowances Z-1500
Z-1600 SLMB Income Limits Z-1600
Z-1700 AFDC Need Standard and Flat Grants - Z-1700
Urban Areas
Z-1700 AFDC Need Standard and Flat Grants - 2 of Z-1700
Rural Areas
Z-1800 SSI Disability Denial Codes Z-1800
Z-1900 CHAMP Income Limits Z-1900
Z-2000 Qualified Individuals Z-2000
Index
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