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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)) (PDF, 633.58 KB)

MAGI-Based Methodologies (PDF, 97.74 KB)

MAGI-Based Methodologies – Territories (PDF, 87.8 KB)

Non-MAGI Methodologies (PDF, 594.77 KB)

Less Restrictive Income Methodologies under 1902(r)(2) (PDF, 553.15 KB)

Less Restrictive Resource Methodologies under 1902(r)(2) (PDF, 548.93 KB)

More Restrictive Requirements under 1902(f) – (209(b) States) (PDF, 854.55 KB)

Income/Resource Standards

AFDC Income Standards (PDF, 68.86 KB)

Income Standard Entry (PDF, 83.29 KB)

Income Standards – AFDC-related – Territories (PDF, 84.7 KB)

Income Standards – Poverty Level – Territories (PDF, 54.4 KB)

Medically Needy Income Level (PDF, 574.47 KB)

Handling of Excess Income (Spenddown) (PDF, 684.53 KB)

Medically Needy Resource Level (PDF, 552.9 KB)

Mandatory Eligibility Groups

Families and Adults

Infants and Children under Age 19 (PDF, 87.79 KB)

Parents and Other Caretaker Relatives (PDF, 121.99 KB)

Pregnant Women (PDF, 101.77 KB)

Deemed Newborns (PDF, 752.06 KB)

Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care (PDF, 495.86 KB)

Former Foster Care Children (PDF, 74.21 KB)

Transitional Medical Assistance (PDF, 576.62 KB)

Extended Medicaid due to Spousal Support Collections (PDF, 467.53 KB)

Adult Group (PDF, 84.08 KB)

Aged, Blind and Disabled

SSI Beneficiaries (PDF, 360.02 KB)

Individuals in 209(b) States Who Are Age 65 or Older or Who Have Blindness or a Disability (PDF, 655.75 KB)

Closed Eligibility Groups (PDF, 687.26 KB)

Individuals Deemed To Be Receiving SSI (PDF, 550.54 KB)

Working Individuals under 1619(b) (PDF, 490.07 KB)

Qualified Medicare Beneficiaries (PDF, 711.07 KB)

Qualified Disabled and Working Individuals (PDF, 494.82 KB)

Specified Low Income Medicare Beneficiaries (PDF, 636.32 KB)

Qualifying Individuals (PDF, 636.77 KB)

Optional Eligibility Groups

Families and Adults

Optional Coverage of Parents and Other Caretaker Relatives (PDF, 87.52 KB)

Reasonable Classifications of Individuals under Age 21 (PDF, 161.57 KB)

Reasonable Classification of All Children (PDF, 103.08 KB)

New Reasonable Classification of Children (PDF, 101.37 KB)

Children with Non-IV-E Adoption Assistance (PDF, 190.93 KB)

Independent Foster Care Adolescents (PDF, 143.06 KB)

Optional Targeted Low Income Children (PDF, 127.99 KB)

Individuals above 133% FPL under Age 65 (PDF, 118.63 KB)

Individuals Needing Treatment for Breast or Cervical Cancer (PDF, 400.18 KB)

Individuals Eligible for Family Planning Services (PDF, 108.72 KB)

Individuals with Tuberculosis (PDF, 112.66 KB)

Individuals Electing COBRA Continuation Coverage (PDF, 489.94 KB)

Aged, Blind and Disabled

Individuals Eligible for but Not Receiving Cash Assistance (PDF, 665.65 KB)

Individuals Eligible for Cash Except for Institutionalization (PDF, 669.62 KB)

Individuals Receiving Home and Community Based Services under Institutional Rules (PDF, 710.29 KB)

Optional State Supplement Beneficiaries (PDF, 552.27 KB)

Individuals in Institutions Eligible under a Special Income Level (PDF, 642.97 KB)

PACE Participants (PDF, 513.45 KB)

Individuals Receiving Hospice (PDF, 618.25 KB)

Children under Age 19 with a Disability (PDF, 622.48 KB)

Age and Disability-Related Poverty Level (PDF, 645.72 KB)

Work Incentives (PDF, 664.64 KB)

Ticket to Work Basic (PDF, 655.62 KB)

Ticket to Work Medical Improvements (PDF, 660.44 KB)

Family Opportunity Act Children with a Disability (PDF, 650.62 KB)

Individuals Receiving State Plan Home and Community-Based Services (PDF, 745.92 KB)

Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers (PDF, 555.61 KB)

Medically Needy Options for Coverage

Mandatory Medically Needy

Medically Needy Pregnant Women (PDF, 641.68 KB)

Medically Needy Children under Age 18 (PDF, 646.7 KB)

Protected Medically Needy Individuals Who Were Eligible in 1973 (PDF, 400.15 KB)

Optional Medically Needy

Medically Needy Reasonable Classifications of Individuals under Age 21 (PDF, 661.66 KB)

Medically Needy Parents and Other Caretaker Relatives (PDF, 647.63 KB)

Medically Needy Populations Based on Age, Blindness or Disability (PDF, 678.85 KB)

Non-Financial Eligibility

State Residency (PDF, 103.28 KB)

Citizenship and Non-Citizen Eligibility (PDF, 87.02 KB)

Enrollment

Eligibility and Enrollment Processes

Eligibility Process (PDF, 124.01 KB) 

Application (PDF, 101.3 KB)

Presumptive Eligibility

Presumptive Eligibility for Children under Age 19 (PDF, 108.78 KB)

Parents and Other Caretaker Relatives – Presumptive Eligibility (PDF, 89.29 KB)

Presumptive Eligibility for Pregnant Women (PDF, 86.12 KB)

Adult Group – Presumptive Eligibility (PDF, 116.9 KB)

Individuals above 133% FPL under Age 65 – Presumptive Eligibility (PDF, 132.34 KB)

Individuals Eligible for Family Planning Services – Presumptive Eligibility (PDF, 133.48 KB)

Former Foster Care Children – Presumptive Eligibility (PDF, 116.04 KB)

Individuals Needing Treatment for Breast or Cervical Cancer – Presumptive Eligibility (PDF, 710.5 KB)

Presumptive Eligibility by Hospitals (PDF, 293.39 KB)

Administration

Single State Agency

Designation and Authority (PDF, 131.9 KB)

Intergovernmental Cooperation Act Waivers (PDF, 91.11 KB)

Eligibility Determinations and Fair Hearings (PDF, 101.13 KB)

Organization and Administration (PDF, 95.93 KB)

Single State Agency Assurances (PDF, 69.04 KB)

Submission Forms

Submission Summary (PDF, 714.62 KB)

Submission – Medicaid State Plan (PDF, 618.17 KB)

Submission - Public Comment (PDF, 424.43 KB)

Submission - Tribal Input (PDF, 401.83 KB)