Medicaid Policy
The policies in section 400 apply to all non-MAGI-based Medicaid groups and the Medicare Cost Sharing programs. Some specific sections may include information for MAGI-based groups for clarity, or may reference 450-2 for treatment of income for MAGI-based groups.
The budgeting section in 435 has been modified to apply to both the non-MAGI-based and the MAGI-based coverage groups.
See 450 for policy about how to determine income for MAGI based programs.
A. General Content
A client's income must be considered to determine eligibility for medical assistance. The income from a spouse, a parent of a minor child, or a sponsor of an alien may also have to count as income to the client for non-MAGI-based programs.
This section includes the following information.
1. The rules for deciding what amount of a client's income (or income of a client's spouse, parents, or sponsor) must be counted to decide eligibility for the client for non-MAGI based programs.
2. Explanations about what income is countable, what is exempt, how to count income from a parent, a spouse, or an alien's sponsor, and what income deductions are allowed.
3. The rules for budgeting income and change reporting.
4. The rules for calculating how much the client must pay to receive Medicaid, if the client does not qualify for Medicaid coverage without cost. Some programs do not allow a person to pay to receive coverage.
B. Worker Requirements
The Department prohibits employees of the Departments of Human Services, Workforce Services, or Health from advising or encouraging applicants for, or recipients of, public assistance programs to terminate employment or otherwise reduce income to qualify for an assistance program. This does not mean employees cannot tell applicants or recipients about the Medicaid spenddown program and the ways to reduce or meet the medical excess with medical bills to receive Medicaid coverage.
Workers can explain eligibility policies, tell clients how we decide if someone is eligible for Medicaid, explain what income deductions a client receives, and answer questions a client asks about policies. (See 461-5 for rules on medical bills.)
If the client has expenses and not enough income to cover the expenses, the client must verify how they are meeting their expenses (731-1).