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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 40. Eligibility Conditions and Requirements
11/21/2024

12VAC30-40-130. Handling of excess income; spend-down.

Handling of excess income - Spend-down for the medically needy in all states and the categorically needy in 1902(f) states only.

a. Medically Needy

(1) Income in excess of MNIL is considered as available for payment of medical care and services. The Medicaid agency measures available income for periods of either 1 or 6 month(s) (not to exceed 6 months) to determine the amount of excess countable income applicable to the cost of medical care and services.

(2) If countable income exceeds the MNIL standard, the agency deducts the following incurred expenses in the following order:

(a) Health insurance premiums, deductibles, and coinsurance charges.

(b) Expenses for necessary medical and remedial care not included in the plan.

(c) Expenses for necessary medical and remedial care included in the plan.

Incurred expenses that are subject to payment by a third party are not deducted unless the expenses are subject to payment by a third party that is a publicly funded program (other than Medicaid) of a State or local government.

b. Categorically Needy - § 1902(f) states:

The agency applies the following policy under the provisions of § 1902(f) of the Act. The following amounts are deducted from income to determine the individual's countable income:

(1) Any SSI benefit received.

(2) Any State supplement received that is within the scope of an agreement described in § 1616 or 1634 of the Act, or a State supplement within the scope of § 1902(a)(10)(A)(ii)(XI) of the Act.

(3) Increases in OASDI that are deducted under §§ 435.134 and 435.135 for individuals specified in that section, in the manner elected by the State under than section.

(4) Incurred expenses for necessary medical and remedial services recognized under State law.

Incurred expenses that are subject to payment by a third party are not deducted unless the expenses are subject to payment by a third party that is a publicly funded program (other than Medicaid) of a State or local government.

NOTE: FFP will be reduced to the extent a State is paid a spenddown payment by the individual.

Statutory Authority

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

Historical Notes

Derived from VR460-02-2.6100 C, eff. June 16, 1993.

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