Budgeting Procedures for Medically Needy under ACA Medicaid 510-03-90-50
(New 7/1/2014 ML #3404)
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IM 5236 Attachment A
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IM 5221 Attachment C
IM 5221 Attachment D
Pregnant Women and children under age 19, who fail under the ACA Medicaid Categorically Needy Coverage Group, may be eligible under the ACA Medicaid Medically Needy Coverage Group, provided they have a Medical Need as defined in 510-03-35-35, Need.
To determine ACA Medicaid Medically Needy eligibility:
- Determine if the individual has a Medical Need.
- Determine the monthly income for the individual’s household; reduce the amount of the monthly income by the amount of allowable deductions, if any, to arrive at the countable income amount. Subtract the Medically Needy Income Level for the individuals’ household size from the countable ACA Income.
If the individual’s household has a Medical need, eligibility can be determined for ACA Medicaid Medically Needy coverage.
Note: Processing for ACA Medicaid Medically Needy coverage is completed in the Vision System.
- Once ‘need’ has been established, enter the countable ACA income into Vision.
Note: DO NOT enter any expenses on the expense window, as the allowable deductions were used to determine the countable ACA income.
- Since the Vision system will deduct $90 for taxes and $30 work training allowance for each individual who has countable ACA income, create ‘Unearned’ income of ‘Other’ in the amount of $120 (or less if the countable income is less than $120) for each individual who has countable ACA income.
- Using the Medicaid Income Level Chart, determine the 100% Poverty Level for the household size of the individual(s) who needs coverage and multiply that amount by 5%. This represents the 5% standard deduction allowed under ACA Medicaid.
100% Poverty Level and Standard Deduction Chart
Effective 4/1/2014
HH Size 100% of Poverty
Level (PL)
5% of PL (Standard Deduction) 1 $ 973 $ 48.65 2 $1,311 $ 65.55 3 $1,649 $ 82.45 4 $1,988 $ 99.40 5 $2,326 $116.30 6 $2,664 $133.20 7 $3,003 $150.15 8 $3,341 $167.05 9 $3,679 $183.95 10 $4,018 $200.90 +1 $ 338 $ 16.90
- Enter the result from the calculation in #4 above as an expense in Vision under the ‘Type’ of ‘Medical’, ‘Sub-Type’ of ‘Incurred Medical.
- Rerun the Eligibility Process and authorize the month.
For new applications, PRIOR TO processing eligibility for Medically Needy under ACA Medicaid, please contact your Regional Representative.
For ongoing cases, each time a month is authorized, Medicaid Policy MUST be notified to ensure the correct COE is reported.
