Section 360-4.1 Introduction.
(a) To be eligible for MA under section 360-3.3(b) of this Part as a
medically needy person, or to have MA eligibility extended under some provisions of
section 360-3.3(c), a person must meet certain financial requirements. A person who meets
these requirements is financially eligible for MA. This Subpart explains procedures and
principles used to determine financial eligibility.
(b) How the process works.
(1) Except as provided in paragraph
(2) of this subdivision, financial eligibility
will be determined as follows:
(i) The size of the
applicant's/recipient's MA household will be determined.
(ii) All income and
resources available to the applicant/recipient during the period for which eligibility is
being determined will be identified.
(iii) Certain amounts
and types of income and resources will be disregarded. The remainder is the
applicant's/recipient's net available income and resources.
(iv) The
applicant's/recipient's net available income and resources will be compared to the
eligibility standards for his/her MA household size. The applicant/recipient is
financially eligible if the amounts of his/her net available income and resources do not
exceed the appropriate standards. A financially eligible applicant who also meets all
other eligibility requirements will be eligible to receive MA.
(v) An applicant whose
net available resources are above the resource standards will be ineligible for MA until
he/she incurs medical expenses equal to or greater than the excess resources.
(vi) Generally, an
applicant whose net available income is above the income standard for his/her MA household
size will be ineligible for MA until he/she incurs medical expenses equal to or greater
than the excess income.
(2) For a pregnant woman, an infant younger
than one year of age, a child at least one year of age but younger than six years of age
whose household income does not exceed 133 percent of the applicable federal poverty line
set forth in section 360-4.7(b) of this Subpart, or a child born after September 30, 1983
who is at least six years of age but younger than 19 years of age and whose household
income does not exceed 100 percent of the applicable federal poverty line set forth in
section 360-4.7(b) of this Subpart, financial eligibility will be determined as follows:
(i) The size of the
applicant's/recipient's MA household will be determined.
(ii) All income
available to applicant/recipient during the period for which eligibility is being
determined will be identified. All resources available to the applicant's/recipient's MA
household are exempt from consideration.
(iii) Certain amounts
and types of income will be disregarded in accordance with the provisions of section
360-4.6 of this Subpart. The remainder is the applicant's/recipient's net available
income.
(iv) The
applicant's/recipient's net available income will be compared to the eligibility standards
or poverty lines for his/her MA household size. The applicant/recipient is financially
eligible if the amounts of his/her net available income do not exceed the applicable
eligibility standards or poverty lines. A financially eligible applicant who also meets
all other eligibility requirements will be eligible to receive MA.
(c) This Subpart dos not set forth the procedure for calculating the HR
eligibility of persons whose MA eligibility depends on their being eligible for HR. As
more fully explained in section 360-2.2(d)(2) of this Part, the HR eligibility of such
persons generally will be determined according to Parts 352 and 370 of this Title.