Medicaid Programs

Pro Bono Attorneys Deskbook

Summary of Medicaid Programs

The charts below provide quick, easy-to-read summaries of a number of Medicaid programs. You can view each summary individually by clicking on the link to a program you are interested in, or you can view all of the charts by simply scrolling down the page. Footnotes * through ***, along with other helpful information on Medicaid programs, are found below after the last chart. Click here to view this information.

The charts below were revised on February 20, 2007, by Lee A. Waer, Turnbull Law Office, P.C.

List of Medicaid Programs:

Medical Assistance (Non-Vendor)
Medical Assistance for Disabled Children
Missouri Children with Developmental Disabilities Waiver (Sara Lopez waiver)
Medical Assistance -- Home and Community Based (HCB) Waiver
Vendor Nursing Care (including ICF-MR)
Supplemental Nursing Care
Blind Pension
Supplemental Aid to the Blind
Qualified Medicare Beneficiary
Specified Low Income Medicare Beneficiary
QI - 1 Qualifying Individual
Medical Assistance (Section 1619 of the Social Security Act)
Qualified Disabled Working Individual
Breast or Cervical Cancer Treatment Medical Assistance Program
MC+ for Pregnant Women
MC+ for Newborns
Medical Assistance for Families
MC+ for Kids
MC+ for Kids (Children's Health Initiative Program)
Transitional Medical Assistance
Medical Assistance for Child Support Closings
Extended Women's Health Services
Refugee Assistance
Temporary Medicaid During Pregnancy (TEMP)
Presumptive Medicaid for Children
Medicaid Assistance for Ineligible Aliens

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance (Non-Vendor)

Medicaid

$695* single person; $935* married couple. These amounts are 85% of the current Federal Poverty Level ($817 for a single person and $1,100 for a married couple). These income guidelines are set by state appropriation not to be less than the federal Supplemental Security Income (SSI) maximum (currently $623 for a single person and $934 for a married couple).

If income exceeds limits, person must reduce (spend down) income on medical expenses or pay the state a monthly premium that equals the spend down amount.

If client meets definition of blindness, income guideline is $817* for a single person.

$999.99 for a single individual; $2,000 for a married couple. **

Be permanently and totally disabled (PTD) as determined by the Missouri Family Support Division, be blind, or be at least age 65; or receiving Supplemental Security Income (SSI) or Social Security Disability Insurance benefits (SSDI)

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance for Disabled Children

Medicaid

$695* This amount is 85% of the FPL (currently $817 for a single person). The income guideline is set by state appropriation not to be less than the SSI maximum (currently $623 for a single person). If income exceeds limits, child must reduce (spend down) income on medical expenses or pay the state a monthly premium that equals the spend down amount. Net parental income is counted using SSI methodology.

$999.99; Resources of the child and parents are counted. **

● Be under age 18

● Be PTD or receiving SSI

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

Missouri Children with Developmental Disabilities Waiver program (Sara Lopez waiver)

Medicaid

$1,088*; The parents’ income is not deemed toward the child.

$999.99; No resources belonging to the parents are deemed toward the child. **

● Be under age 18

● Transfers of property within 60 months of the application may cause ineligibility***

● Be PTD or gets SSI

● Determined by the Department of Mental Health (DMH) to need Intermediate Care Facility/Mental Retardation level of care and be authorized to receive waiver services

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance -- Home and Community Based (HCB) waiver

Medicaid

$1,088* for person needing HCB services. For a married couple, income of the non-HCB spouse is not counted toward the spouse who needs nursing level services.

$999.99 for an individual; $2,000 for a married couple when both require HCB services. **

When a spouse needs HCB services, an assessment of assets occurs. See Resource Limits under Vendor Nursing Care below for details.

● Be at least age 63

● Transfers of property within 60 months of the application may cause ineligibility***

● Unless age 65 or older, person must be PTD or blind, or receives SSI or SSDI.

● Determined by the Department of Health and Senior Services (DHSS) to need nursing facility level of care and be authorized to receive HCB waiver services.

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Vendor nursing care (including ICF-MR)

Medicaid to include direct payments to a Medicaid certified nursing facility above the amount the resident is expected to pay

A $30 personal needs standard, the cost of the person’s private medical insurance to include the Medicare premium, and when appropriate an allotment to a community spouse or dependent are deducted. The remaining income or surplus amount becomes the patient’s required monthly contribution to the nursing facility.

The claimant’s spouse’s income is not counted to determine the institutionalized spouse’s monthly payment to the nursing facility. The community spouse’s income is considered when determining the monthly amount the institutionalized spouse can send to the community spouse.

$999.99 for an individual; $2,000 for a married couple when both require nursing level care. **

For a married couple, an assessment of assets occurs to establish the community spouse resource allowance (CSRA). The amount of assets protected for the community spouse is 50% of non-exempt assets subject to the $20,328* minimum and $101,640* maximum. If need for income higher than minimum monthly needs allowance is established, an administrative hearing or court can set a higher CSRA. The hearing would first look to institutionalized spouse’s income before setting a higher CSRA. The CSRA is disregarded from the total non-exempt assets to determine the institutionalized spouse’s resource eligibility.

· Transfers of property within 60 months of the application may cause ineligibility.*** To determine the number of months of ineligibility from the date of the transfer, the amount transferred is divided by $2,943*.

· Unless age 65 or older, person must be PTD or blind, or receives SSI or SSDI.

· Determined by DHSS to need nursing facility level of care

· Be in a Medicaid certified nursing care bed for 30 days

· Be prescreened for mental illness, mental retardation, and developmental disabilities.

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Supplemental Nursing Care

Medicaid. SNC pays a monthly cash grant, a monthly $25 personal needs allowance, and the Medicare premium. The maximum grants are:
$156 for Residential Care Facility I; $292 for RCF-II; $390 for non-Medicaid nursing facility (ICF/Skilled)

The client’s gross income must be less than the facility’s monthly basic rate. If the client is otherwise eligible, the state pays the difference between the facility’s rate and the client’s gross income up to the maximum grant.

$999.99 for a single person and $2,000 for a married couple **

● Unless age 65 or older, person must be PTD, blind, or receives SSI or SSDI.

● Determined by DHSS to need nursing facility level of care if in an ICF/SNF

● Be at least age 21

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Blind Pension

State funded Medicaid and a $541* monthly grant

No income maximum

$20,000 total property; The home is exempt. If a person leaves their home to enter a nursing facility, the homestead exemption continues.

· Meet the state’s definition of blindness

· Lifetime penalty period for transferring property to become eligible

· Cannot receive or be eligible for SSI

· Be 18 or older

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Supplemental Aid to the Blind

Medicaid and a monthly cash grant of $541* less any SSI received

$673

$2,000 for a single person, $4,000
for a married
couple. **

● Meet the state’s definition of blindness

● Must apply for SSI

● Be 18 or older

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Qualified Medicare Beneficiary

Pays Medicare Part B premiums and in some cases Part A. Pays co-payments and deductibles for Medicare approved services.

$817* for a single person; $1,100* for a two person household

$4,000 for a single person; $6,000
for a married couple **

Must receive Part A Medicare

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Specified Low Income Medicare Beneficiary

Pays Medicare Part B premium

$980* for a single person; $1,320* for a couple

$4,000 for a
single person, $6,000 for a married couple **

Must receive Part A Medicare

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

QI – 1 Qualifying Individual

Pays Medicare Part B premium

$1,103* for a single person; $1,485 for a couple

$4,000 for a single person; $6,000
for a married couple **

● Must receive Part A Medicare

● Cannot receive Medicaid

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance (Section 1619 of the Social Security Act)

Medicaid

$2,320*

$2,000 for a
single person; $3,000 for a married couple **

● Must have lost SSI due to employment as determined by the Social Security Administration

● Received Medicaid in the month immediately preceding the month of receiving 1619 status

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Qualified Disabled Working Individual

Pays Medicare Part A premium

$1,634*

$4,000 for a
single person; $6,000 for a married couple **

● Be under 65

● Be qualified for Medicare due to a disability

● Lost or is losing Medicare due to employment

● Must be ineligible for Medicaid

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Breast or Cervical Cancer Treatment Medical Assistance Program

Medicaid

$1,634*

None

● Be screened by a Breast and Cervical Cancer Control Project Medicaid provider

● Need treatment for breast or cervical cancer

● Be uninsured or have health insurance that does not cover breast and cervical cancer treatment

● Women must be under age 65

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

MC+ for Pregnant Women

MC+ (Medicaid) during the pregnancy plus 2 months of coverage following the month the pregnancy ends

185% of the federal poverty level (FPL)* for the household size including the unborn child; e. g., $2,035 for an expectant mother with no children or spouse

None

Pregnancy must be verified

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

MC+ for newborns

MC+ (Medicaid) for the child through age 1

See other requirements in this row

See other requirements this row

● Child’s mother was eligible for and received Medicaid when the child was born.

● Newborn remains with the mother

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance for Families

MC+ (Medicaid) for children and their parents

Temporary Assistance standard for the household size; e. g., $292 for a three-person family*

None

● Eligible child under 19 in the home

● Cooperate in obtaining medical support for the children

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

MC+ for Kids

MC+ (Medicaid) for children only

● 185% of FPL* for children under age 1; e. g., $2,560 for a three-person family

● 133% of FPL* for ages 1 – 5; e. g., $1,840 for a three-person family

● 100% of FPL* for ages 6 -18; e. g., $1,384 for a three-person household

If income exceeds these limits, see "Income Limits" in next chart below

None

● Child must be under age 19

● Parent cooperates in obtaining medical support

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

MC+ for Kids (Children’s Health Initiative Program)

MC+ (Medicaid) for children only

300% of FPL* for the household size; e. g., $4,150 for a three-person household

The family’s net worth must be less than $250,000.

● Children must be uninsured

● With income over 150% of FPL, children cannot have access to affordable health insurance and the family must pay a monthly premium to the state from $11 up to $282.

● Children must be uninsured for six months if health insurance is dropped without good cause.

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Transitional Medical Assistance

MC+ (Medicaid) coverage for the family for up to one year

185% of the FPL* for the second 6 months

None

● Received Medical Assistance for Families in 3 of the last 6 months preceding ineligibility

● Became ineligible due to employment, increased wages, or loss of earned income disregards

● Return quarterly reports

● Have a child under 19 in the home

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance for Child Support Closings

MC+ (Medicaid) for the family for 4 months

None

● Received Medical Assistance for Families in 3 of the last 6 months preceding ineligibility

● Became ineligible due to the receipt of or increased income from child support or alimony

PROGRAM

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Extended Women’s Health Services

Provides coverage for family planning, and testing and treatment of sexually transmitted diseases for women who lose MC+ coverage two months after the pregnancy ends. Coverage is limited to 12 months.

None

● Received MC+ coverage due to pregnancy

● Be uninsured

PROGRAMS

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Refugee Assistance

Medicaid for 8 months

None

● Do not meet eligibility guidelines in any of the above programs e. g., Medical Assistance or Medical Assistance for Families

● Must meet a certain alien status

PROGRAMS	BENEFITS	INCOME LIMITS	RESOURCE LIMITS	OTHER REQUIREMENTS
Temporary Medicaid During Pregnancy (TEMP)	Medicaid covered ambulatory prenatal care services through a Medicaid provider. Coverage ends the last day of the month following the month the expectant mother was determined presumptive eligible.	185% FPL	None	Determined eligible by a qualified provider such as a participating health department

PROGRAMS

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Presumptive Eligibility for Children

Medicaid coverage ends the month following the month of application.

150% FPL

None

● Child has not received presumptive eligibility within the last 12 months.

● Determined eligible by a qualified entity such as a participating children’s hospitals

PROGRAMS

BENEFITS

INCOME LIMITS

RESOURCE LIMITS

OTHER REQUIREMENTS

Medical Assistance for Ineligible Aliens

Medicaid coverage for emergency care only

See Other Requirements in this row

● Individual does not meet the definition of a qualified alien.

● Individual must meet all of the guidelines for a program e. g., Medical Assistance or Medical Assistance for Families except for the citizenship or qualified alien status.

FOOTNOTES:

*COST OF LIVING ADJUSTMENTS:

Amounts are effective as of January 16, 2007. Amounts are subject to periodic adjustments e. g., programs based on the FPL are adjusted annually. Some program amounts are set by appropriations each year by the legislature e.g., the Medical Assistance (non-vendor) program for persons who are at least age 65 or who are permanently and totally disabled.

The Medical Assistance for Families program uses the Temporary Assistance program’s maximum monthly grant amounts for the income guidelines. The payment amounts are set by appropriation. The following chart provides the maximums for families from one to six persons for fiscal year ending June 30, 2007:

Number of Person	Maximum Payment
1	$136
2	$234
3	$292
4	$342
5	$388
6	$431

** RESOURCE LIMITS:

Resources include but are not limited to checking accounts, savings accounts, certificates of deposit, Individual Retirement Accounts, promissory notes, cash value of life insurance policies above a $1,500 exemption, recreational vehicles, and a second home.

A person’s car is not a resource that is being used to go to work, get medical care, and used for other transportation needs. Any additional vehicles may be considered to be a resource.

A person’s place of residence, the adjoining land, and the home’s furnishings are exempt. The homestead exemption continues if a person leaves his or her home to enter a RCF-II, ICF, skilled nursing facility or Medicaid certified bed, or if a spouse resides in the home. If none of these exemptions occur, the home becomes a resource in 24 months from the time the person leaves the home to reside in senior citizen housing, live with a relative, or be in some other living arrangement. This 24 month rule does not apply to QWDI, QMB, SLMB and QI-1 claimants who express the intent to return to their home. Claimants who have more than $500,000 in home equity are not eligible for Medicaid vendor nursing care or HCB.

***TRANSFER OF PROPERTY

The Deficit Reduction Act of 2005 enacted a number of changes for nursing care applications for transfers that occur on or after February 8, 2006:

Made the look back period 60 months;
Requires the transfer penalty period to begin in the month of application if the client is otherwise eligible except for the transfer;
Requires the states to total multiple transfers within 60 months of the application to determine the amount transferred;
Imposes days of ineligibility for transfer amounts which are less than the state’s penalty transfer divisor determined by dividing the remainder by $96.75.

Transfers that occurred before February 8, 2005:

Are subject to a 36 month look back period (60 months for trust transfers);
Begin the penalty in the month of the transfer;
A separate penalty is established for each monthly transfer rather than accumulating them;
No transfer penalty is imposed when the quotient is less than .50 after dividing the amount transferred by the state’s transfer divisor amount. The amount is then rounded down or up to the nearest whole number.

ADDITIONAL MEDICAID INFORMATION:

APPLICATION REQUIREMENTS:

Persons must verify their Social Security Numbers, be living in the State of Missouri, and be a U. S. citizen or eligible legal immigrant. There are additional eligibility requirements in some of the above listed programs. Medicaid claimants must provide documentary evidence of citizenship and identity.

MANAGED CARE:

Claimants in family based programs such as MAF and MC+ receive their health care coverage through a managed care plan in some counties.

PROGRAMS OTHER THAN MEDICAID IN FSD:

FSD also has a Rehabilitation Services for Blind unit that assists the visually impaired. FSD also administers the Food Stamp, Temporary Assistance, and Low Income Home Energy Assistance programs.

PROGRAMS OFFERED BY OTHER AGENCIES:

Other assistance may be available through different state agencies:

The Department of Social Services, Children’s Division, has such programs as foster and alternative care. DSS administers the Missouri RX Plan which coordinates prescription drug coverage with the Medicare Part D program.
The Department of Mental Health has programs that provide long-term care in the community and in facilities for persons with developmental disabilities, mental retardation, and mental illness.
The Department of Health and Senior Services administers such programs as the Missouri Senior Rx program to help the elderly obtain prescription medications and the home and community based services that provide personal care, homemaker/chore help, nursing services, counseling, respite care, and case management.
The Missouri Division of Vocational Rehabilitation operates an independent living waiver that provides self-directed home and community based services for disabled persons ages 18 – 64. The Personal Care Assistance program will be moved to DHSS.
The Missouri Kidney Program through the University of Missouri at Columbia helps eligible patients with kidney diseases obtain medical care.

A good source of finding services and programs for disabled persons throughout the state is the Governor’s Council on Disability or Phone: 573-751-2600, Information Hotline 1-800-877-8249, Fax: 573-526-4109.