Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 30. Groups Covered and Agencies Responsible for Eligibility Determination

12VAC30-30-30. Optional coverage of the medically needy.

The Title IV A Agency determines eligibility for Title XIX services.

This plan includes the medically needy:

1. Pregnant women who, except for income and/or resources, would be eligible as categorically needy under Title XIX of the Act.

2. Women who, while pregnant, were eligible for and have applied for Medicaid and receive Medicaid as medically needy under the approved State plan on the date the pregnancy ends. These women continue to be eligible, as though they were pregnant, for all pregnancy-related and postpartum services under the plan for a 60-day period after the pregnancy ends, and any remaining days in the month in which the 60th day falls.

3. Individuals under age 18 who, but for income and/or resources, would be eligible under § 1902(a)(10)(A)(i) of the Act.

4. Newborn children born on or after October 1, 1984, to a woman who is eligible as medically needy and is receiving Medicaid on the date of the child's birth. The child is deemed to have applied and been found eligible for Medicaid on the date of birth and remains eligible for one year so long as the woman remains eligible and the child is a member of the woman's household.

5. Reasonable classification of financially eligible individuals under the ages of 21, 20, 19, or 18 as specified below:

(1) Individuals for whom public agencies are assuming full or partial financial responsibility and who are:

(a) In foster homes (and are under the age of 21).

(b) In private institutions (and are under the age of 21).

(c) In addition to the group under (1)(a) and (b), individuals placed in foster homes or private institutions by private, nonprofit agencies (and are under the age of 21).

(2) Individuals in adoptions subsidized in full or part by the public agency (who are under the age of 21).

(3) Individuals in NFs (who are under the age of 21). NF services are provided under this plan.

(4) In addition to the group under (3), individuals in ICFs/MR (who are under the age of 21).

6. Aged Individuals.

7. Blind Individuals.

8. Disabled Individuals.

9. Blind and disabled individuals who:

a. Meet all current requirements for Medicaid eligibility except the blindness or disability criteria;

b. Were eligible as medically needy in December 1973 as blind or disabled; and

c. For each consecutive month after December 1973 continue to meet the December 1973 eligibility criteria.

10. Individuals required to enroll in cost-effective employer-based group health plans remain eligible for a minimum enrollment period of one month.

Statutory Authority

Social Security Act Title XIX; 42 CFR Part 430 to end; all other applicable statutory and regulatory sections.

Historical Notes

Derived from VR460-02-2.2100:1, eff. June 16, 1993; amended, Virginia Register Volume 11, Issue 10, eff. March 9, 1995.

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