Only those persons with a medical need are eligible for Medicaid and not all persons needing help receive Medicaid. In Georgia, medical eligibility determinations for nursing home facility care are performed by the facility using Form DMA-59. Determinations for CCSP (HCBS) are made by the CCSP RN Care coordinator. 2240 – Level of Care As […]

With few exceptions (such as the existence of an interstate compact), a Medicaid applicant must be a resident of the State where benefits are provided. 42 CFR § 435.403. [Note 10]. The “duration” of residence cannot be a condition of eligibility. See 42 CFR § 435.403(j)(1); Shapiro v. Thompson, 394 U.S. 618 (1969). HCFA 64 […]

An applicant must be a U.S. Citizen or a legally admitted alien to receive Medicaid. 42 CFR § 435.406. In that regard, HCFA 64 provides as follows: 3210.1 General Requirements.–The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) significantly changed Medicaid eligibility for individuals who are not citizens of the United States. […]

In addition, to establish technical eligibility for nursing home Medicaid, an applicant must be (i) a U.S. Citizen or lawfully admitted alien, (ii) a resident of the State where benefits are sought and (iii) have been treated for a continuous period of 30 days in a medical facility. 42 C.F.R. § 435.211. [Note 7]. By […]

Individuals who are aged (age 65 or older), blind or disabled may be entitled to Medicaid if they are medically eligible and financially needy. In Georgia and Tennessee, SSI recipients are immediately eligible. See 42 U.S.C. § 1396a(a)(10)(A)(i)(II). Although the focus here is on long term care Medicaid, other classes of assistance make Medicaid available […]

The Rule 42 U.S. Code § 1382c(a)(3)(A) states: “an individual shall be considered to be disabled for purposes of this subchapter if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or […]

The remainder of this book focuses on long-term care Medicaid. Long-term care refers to a wide range of supportive and health services for persons who have lost the capacity for self-care due to illness, frailty, or a disabling condition. It differs from acute care in that the goal of long-term care is not to cure […]

States may extend Medicaid to certain individuals with incomes too high to qualify for SSI, and who are eligible for nursing facility or other institutional care. Under the special income rule, also referred to as “the 300 percent rule,” such persons must (1) require care provided by a nursing home or other medical institution for […]

The enactment of the Omnibus Budget Reconciliation Act of 1986 (OBRA 86) offered States an option for covering persons whose income exceeds SSI or 209(b) levels. (CRS Report, How Medicaid Works: Program Basics, January 4, 2006). This option allows States to cover aged and disabled individuals with incomes up to 100 percent of FPL. In […]

Many States provide SSP benefits with State-only dollars on a monthly basis. These payments are intended to cover such items as food, shelter, clothing, utilities, and other daily necessities. The amount of the benefit is determined by the individual States. States may provide supplemental payments to all persons who receive SSI, and/or to individuals who […]

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