MEDICAID ELIGIBILITY MANUAL (MEM)

Table of Contents

Preface/Explanatory Notes

A-0000  Abbreviations/Acronyms/Definitions - Outline

A-100  Abbreviations and Acronyms

A-200  Definitions

B-0000  Introduction

C-0000  Medical Services

D-0000  Persons Eligible

E-0000  Category

F-0000  Medical Programs

G-0000  Application Processing

H-0000  Eligibility Determinations - Outline

H-100  General Information H-200  Low Income Families with Children (LIFC)           H-230  LIFC Minor Unmarried Parent           H-232  LIFC - Maternity Home           H-240  PAP H-300  CHAMP General Information           H-320  Presumptive Eligibility (PE)           H-330  Pregnant Woman (PW)           H-340  CHAMP Child H-400  Deemed Eligibles H-500  LaCHIP           H-550  Phase IV LaCHIP H-600  Extended Medicaid H-700  SSI Retroactive Medicaid H-800  Long Term Care General Information           H-820  Long Term Care - C-Related           H-830  Long Term Care - SSI-Related           H-840  Medicaid Coinsurance - Medicare SNF/NF           H-850  Hospice Services Provided in Nursing Facilities           H-860  Undue Hardship and Undue Hardship Exception H-900  Home and Community Based Services (HCBS) H-1000  Medically Needy Program (MNP) H-1100  Qualified Medicare Beneficiary (QMB) H-1200  Qualified Disabled and Working Individuals (QDWI) H-1300  Specified Low-Income Medicare Beneficiary (SLMB) H-1400  Breast and Cervical Cancer Program H-1500  Continued Medicaid H-1600  Tuberculosis Infected (TB) H-1700  Disability Medicaid H-1800  Retroactive Medicaid Eligibility (RME) H-1900  Twelve (12) Months Continuous Eligibility H-2000  Qualified Individuals Program (QI) H-2100  Medicaid Purchase Plan (MPP) H-2200  Take Charge - Family Planning Medicaid Program H-2300  Family Opportunity Act Medicaid Program H-2400  Refugee Medical Assistance H-2500  Youth Aging Out of Foster Care

I-0000  Eligibility Factors - Outline

I-100  Age - C-Related I-200  Assignment of Third Party Rights I-300  Citizenship/Alien Status I-400  Continuity of Stay (LTC Only, Except HCBS) I-500  Deprivation I-600  Enumeration I-700  Reserved I-800  Home I-900  Institutionalization I-1000  Medical Certification (LTC and HCBS Only) I-1100  Medicare Ineligibility I-1200  Mother's Medicaid Eligibility (Deemed Eligible Children Only) I-1300  Reserved I-1400  Need - General Information I-1500  Need - Income           I-1520  Need - C-Related Income           I-1530  Need - SSI-Related Income           I-1540  Need - Income, Programs Not Related to AFDC or SSI I-1600  Need - Resources           I-1620  Reserved           I-1630  Need - SSI-Related Resources           I-1660  Spousal Impoverishment Resource Provisions (LTC/HCBS)           I-1670  Transfer of Resources For Less Than Fair Market Value           I-1680  Need - Resources, Programs Not Related to AFDC or SSI I-1700  Trusts I-1800  Relationship I-1900  Residence I-2000  Support Enforcement Services I-2100  Supplemental Security Income (SSI) Eligibility I-2200  Creditable Health Insurance

J-0000  Issuing Medical Eligibility Cards (MECS) and Optional State Supplement (OSS) Checks

K-0000  Renewals

L-0000  Changes

M-0000  Transfers

N-0000  Special Processing

O-0000  Prior Authorization

P-0000  Third Party Liability (TPL)

Q-0000  Inquiries and Complaints

R-0000  Authorized Representation

S-0000  Verification and Documentation

T-0000  Fair Hearings

U-0000  Fraud and Recovery

V-0000  Reserved

W-0000  Reserved

X-0000  Retirees

Y-0000  Reserved

Z-Charts

Z-0000  Charts Z-100  Maximum SSI Student Child Earned Income Exclusion Amounts Z-200  Federal Poverty Income Guidelines Z-300  Medically Needy Income Eligibility Standards (MNIES) Z-400  Federal Benefit Rate (FBR) Z-500  QMB Income Limits Z-600  QDWI Income Limits Z-700  LTC/HCBS CAP Rate, Resource Limits and Personal Care Needs Allowance Z-800  Spousal Impoverishment Maintenance Needs and Resource Standards Z-900  Resource Limits by Program Z-1000  Maximum Resource Limits as of 12-73 for Grandfathered/Converted SSI Recipients Z-1100  Maximum Grants for MMS Categories A, B, and D Prior to Conversion to SSI Z-1200  Life Expectancy Tables Z-1300  Usufruct and Remainder Interest Tables Z-1400  Social Security Cost of Living Adjustment (COLA) Extended Medicaid Only Z-1500  Deeming Allowances Z-1600  SLMB Income Limits Z-1700  7/16/96 AFDC Need Standard and Flat Grants Z-1800  SSI Disability Denial Codes Z-1900  CHAMP Income Limits Z-2000  Qualified Individuals - Group One Income Limits Z-2100  CHAMP Pregnant Woman(LaMOMS) - Income Limits

Index