Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 40. Eligibility Conditions and Requirements
7/13/2020

12VAC30-40-220. Income Eligibility Levels.

Part IV
Eligibility Requirements

A. 1. Groups I, II, and III income limits are set forth in this subdivision 1.

Group I

Size of assistance unit

Monthly

Yearly

1

$239

$2,868

2

364

4,368

3

464

5,568

4

563

6,756

5

663

7,956

6

748

8,976

7

844

10,128

8

945

11,340

Each additional person

98

1,176

Group II

Size of assistance unit

Monthly

Yearly

1

$313

$3,756

2

449

5,388

3

565

6,780

4

675

8,100

5

794

9,528

6

895

10,740

7

1,002

12,024

8

1,119

13,428

Each additional person

111

1,332

Group III

Size of assistance unit

Monthly

Yearly

1

$472

5,664

2

633

7,596

3

774

9,288

4

909

10,908

5

1,074

12,888

6

1,195

14,340

7

1,330

15,960

8

1,471

17,652

Each additional person

135

1,620

2. Pregnant women and infants under § 1902(a)(10)(i)(IV) of the Act. Effective January 1, 2014, based on 143% of the official federal income poverty level.

3. Children under § 1902(a)(10)(i)(VI) of the Act (children who have attained age one year but have not attained age six years), the income eligibility level is 143% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.

4. For children under § 1902(a)(10)(i)(VII) of the Act (children who were born after September 30, 1983, and have attained age six years but have not attained age years), the income eligibility level is 143% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.

B. Treatment of cost of living adjustment (COLA) for groups with income related to federal poverty level.

1. If an individual receives a Title II benefit, any amount attributable to the most recent increase in the monthly insurance benefit as a result of a Title II COLA is not counted as income during a "transition period" beginning with January, when the Title II benefit for December is received, and ending with the last day of the month following the month of publication of the revised annual federal poverty level.

2. For individuals with Title II income, the revised poverty levels are not effective until the first day of the month following the end of the transition period.

3. For individuals not receiving Title II income, the revised poverty levels are effective no later than the beginning of the month following the date of publication.

C. Qualified Medicare beneficiaries with incomes related to federal poverty level. The levels for determining income eligibility for groups of qualified Medicare beneficiaries under the provisions of § 1905(p)(2)(A) of the Act are as follows:

Section 1902(f) states, which as of January 1, 1987, used income standards more restrictive than SSI, Virginia did not apply a more restrictive income standard as of January 1, 1987.

Based on the following percentage of the official federal income poverty level:

Effective January 1, 1989: 85%

Effective January 1, 1990: 90% (no more than 100)

Effective January 1, 1991: 100% (no more than 100)

Effective January 1, 1992: 100%

D. Aged and disabled individuals described in § 1902(m)(1) of the Act; Level for determining income eligibility for aged and disabled persons described in § 1902(m)(1) of the Act is 80% of the official federal income poverty level (as revised annually in the Federal Register) for the size family involved.

E. Income levels - for medically needy. (Increased annually the increase in the Consumer Price Index but no higher than the level permitted to claim federal financial participation.

1. The following income levels are applicable to all groups, urban and rural.

2. The agency has methods for excluding from its claim for federal financial participation payments made on behalf of individuals whose income exceeds these limits.

(1)

(2)

(3)

Family Size

Net income level protected for maintenance for 12 months

Amount by which Column 2 exceeds limits specified in 42 CFR 435.10071

Group I

Group II

Group III

1

$2,691.00

$3,105.00

$4,036.50

$0

2

$3,519.00

$3,824.00

$4,867.00

$0

3

$4,036.50

$4,450.50

$5,485.50

$0

4

$4,554.00

$4,968.00

$6,003.00

$0

5

$5,071.50

$5,485.50

$6,520.50

$0

6

$5,589.00

$6,003.00

$7,038.00

$0

7

$6,106.50

$6,520.50

$7,555.50

$0

8

$6,727.50

$7,141.50

$8,073.00

$0

9

$7,348.50

$7,762.50

$8,797.50

$0

10

$8,073.00

$8,487.00

$9,418.50

$0

For each additional person, add:

$695.52

$695.52

$695.52

$0

1As authorized in § 4718 of OBRA '90.

GROUPING OF LOCALITIES

GROUP I: Counties

Accomack

King and Queen

Alleghany

King William

Amelia

Lancaster

Amherst

Lee

Appomattox

Louisa

Bath

Lunenburg

Bedford

Madison

Bland

Matthews

Botetourt

Mecklenburg

Brunswick

Middlesex

Buchanan

Nelson

Buckingham

New Kent

Campbell

Northampton

Caroline

Northumberland

Carroll

Nottoway

Charles City

Orange

Charlotte

Page

Clarke

Patrick

Craig

Pittsylvania

Culpeper

Powhatan

Cumberland

Prince Edward

Dickenson

Prince George

Dinwiddie

Pulaski

Essex

Rappahannock

Fauquier

Richmond

Floyd

Rockbridge

Fluvanna

Russell

Franklin

Scott

Frederick

Shenandoah

Giles

Smyth

Gloucester

Southampton

Goochland

Spotsylvania

Grayson

Stafford

Greene

Surry

Greensville

Sussex

Halifax

Tazewell

Hanover

Washington

Henry

Westmoreland

Highland

Wise

Isle of Wight

Wythe

James City

York

King George

GROUP I: Cities

Bristol

Franklin

Buena Vista

Galax

Danville

Norton

Emporia

Suffolk

GROUP II: Counties

Albemarle

Loudoun

Augusta

Roanoke

Chesterfield

Rockingham

Henrico

Warren

GROUP II: Cities

Chesapeake

Petersburg

Covington

Portsmouth

Harrisonburg

Radford

Hopewell

Richmond

Lexington

Roanoke

Lynchburg

Staunton

Martinsville

Virginia Beach

Newport News

Williamsburg

Norfolk

Winchester

GROUP III: Counties

Arlington

Montgomery

Fairfax

Prince William

GROUP III: Cities

Alexandria

Fredericksburg

Charlottesville

Hampton

Colonial Heights

Manassas

Fairfax

Manassas Park

Falls Church

Waynesboro

Statutory Authority

§ 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Historical Notes

Derived from VR460-03-2.6101:1, eff. June 30, 1994; amended, Volume 11, Issue 10, eff. March 9, 1995; Volume 11, Issue 24, eff. October 1, 1995; Volume 17, Issue 18, eff. July 1, 2001; Errata, 17:21 VA.R. 3124 July 2, 2001; amended, Virginia Register Volume 18, Issue 07, eff. January 16, 2002; Volume 18, Issue 18, eff. July 1, 2002; Volume 33, Issue 21, eff. July 27, 2017.

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