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Eligibility & Administration SPA Implementation Guides

Eligibility

Income/Resource Methodologies

Eligibility Determinations of Individuals Age 65 or Older or Who Have Blindness or a Disability (1634/SSI Criteria/209(b))

MAGI-Based Methodologies

MAGI-Based Methodologies – Territories

Non-MAGI Methodologies

Less Restrictive Income Methodologies under 1902(r)(2)

Less Restrictive Resource Methodologies under 1902(r)(2)

More Restrictive Requirements under 1902(f) – (209(b) States)

Income/Resource Standards

AFDC Income Standards

Income Standard Entry

Income Standards – AFDC-related – Territories

Income Standards – Poverty Level – Territories

Medically Needy Income Level

Handling of Excess Income (Spenddown)

Medically Needy Resource Level

Mandatory Eligibility Groups

Families and Adults

Infants and Children under Age 19

Parents and Other Caretaker Relatives

Pregnant Women

Deemed Newborns

Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care

Former Foster Care Children

Transitional Medical Assistance

Extended Medicaid due to Spousal Support Collections

Adult Group

Aged, Blind and Disabled

SSI Beneficiaries

Individuals in 209(b) States Who Are Age 65 or Older or Who Have Blindness or a Disability

Closed Eligibility Groups

Individuals Deemed To Be Receiving SSI

Working Individuals under 1619(b)

Qualified Medicare Beneficiaries

Qualified Disabled and Working Individuals

Specified Low Income Medicare Beneficiaries

Qualifying Individuals

Optional Eligibility Groups

Families and Adults

Optional Coverage of Parents and Other Caretaker Relatives

Reasonable Classifications of Individuals under Age 21

Reasonable Classification of All Children

New Reasonable Classification of Children

Children with Non-IV-E Adoption Assistance

Independent Foster Care Adolescents

Optional Targeted Low Income Children

Individuals above 133% FPL under Age 65

Individuals Needing Treatment for Breast or Cervical Cancer

Individuals Eligible for Family Planning Services

Individuals with Tuberculosis

Individuals Electing COBRA Continuation Coverage

Aged, Blind and Disabled

Individuals Eligible for but Not Receiving Cash Assistance

Individuals Eligible for Cash Except for Institutionalization

Individuals Receiving Home and Community Based Services under Institutional Rules

Optional State Supplement Beneficiaries

Individuals in Institutions Eligible under a Special Income Level

PACE Participants

Individuals Receiving Hospice

Children under Age 19 with a Disability

Age and Disability-Related Poverty Level

Work Incentives

Ticket to Work Basic

Ticket to Work Medical Improvements

Family Opportunity Act Children with a Disability

Individuals Receiving State Plan Home and Community-Based Services

Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers

Medically Needy Options for Coverage

Mandatory Medically Needy

Medically Needy Pregnant Women

Medically Needy Children under Age 18

Protected Medically Needy Individuals Who Were Eligible in 1973

Optional Medically Needy

Medically Needy Reasonable Classifications of Individuals under Age 21

Medically Needy Parents and Other Caretaker Relatives

Medically Needy Populations Based on Age, Blindness or Disability

Non-Financial Eligibility

State Residency

Citizenship and Non-Citizen Eligibility

Enrollment

Eligibility and Enrollment Processes

Continuous Eligibility for Children

Eligibility Process 

Application

Presumptive Eligibility

Presumptive Eligibility for Children under Age 19

Parents and Other Caretaker Relatives – Presumptive Eligibility

Presumptive Eligibility for Pregnant Women

Adult Group – Presumptive Eligibility

Individuals above 133% FPL under Age 65 – Presumptive Eligibility

Individuals Eligible for Family Planning Services – Presumptive Eligibility

Former Foster Care Children – Presumptive Eligibility

Individuals Needing Treatment for Breast or Cervical Cancer – Presumptive Eligibility

Presumptive Eligibility by Hospitals

Administration

Single State Agency

Designation and Authority

Intergovernmental Cooperation Act Waivers

Eligibility Determinations and Fair Hearings

Organization and Administration

Single State Agency Assurances

Submission Forms

Submission Summary

Submission – Medicaid State Plan

Submission - Public Comment

Submission - Tribal Input