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DE Medicaid - Income Eligibility

Income Eligibility for Delaware Medicaid coverage differs depending on which Medicaid Covered Group you are enrolled in. Not only are the Medicaid Income Limits different for different groups, but also the definitions for Countable Income differ.

In some cases, if you become ineligible in your currently enrolled covered group, you will still be eligible under another covered group.

We provide the income-eligibility details in the topics about many of the covered groups. As an overview, however, we can say the following about each of the four types of covered groups:

SSI-Related Covered Groups

Income-eligibility for Medicaid in SSI-Related Covered Groups is entirely dependent on the rules for determining income-eligibility for Supplemental Security Income (SSI). If you become ineligible for SSI benefits because your unearned income is at least equal to the SSI Federal Benefit Rate (FBR) plus $20, then you would lose your Medicaid eligibility under these groups.

If you lose your SSI cash benefit because of earned income (or a combination of earned and unearned income), then you may remain income-eligible unless your earned income exceeds the Delaware SSI State Threshold (see State 1619(b) Threshold Amounts for current and historical state threshold amounts).

You could earn even more without losing Medicaid coverage, if you have greater than average medical expenses, or Impairment Related Work Expenses (IRWE), or a Plan for Achieving Self-Support (PASS), and the Social Security Administration establishes an Individualized Threshold for you.

NOTE: In some SSI-Related Covered Groups, the income that is counted in determining Medicaid eligibility is reduced by subtracting various amounts that make you ineligible for SSI. See SSI-Related Countable Income.

Medicare-Related Covered Groups

Income-eligibility for the limited Medicaid benefits in each of the Medicare-Related Covered Groups (i.e., QMB, SLMB, QDWI, or QI-1) is based on your Countable Income in relation to the Federal Poverty Level (FPL). If your income makes you ineligible for one group, you may be eligible for one of the other Medicare-Related groups.

If your countable income exceeds 200% FPL, then you would not be eligible for any of the Medicare-Related Medicaid groups.

AFDC-TANF Related Covered Groups

Each of the AFDC-TANF Related Covered Groups uses a different method to determine income eligibility.

Section 1931: For Low Income Families with Children - Section 1931 group and the other AFDC-TANF Related Covered Groups that follow Section 1931 income-eligibility rules, the rules for Temporary Assistance for Needy Families (TANF) recipients are always used in determining income-eligibility. Gross Income is compared to 185% of the TANF Standard of Need. And Net Income as defined for TANF recipients is compared to the actual Standard.

In Section 1931 groups, all earned income is disregarded for the second and third months of eligibility. Any Diversion Assistance provided does not count as income.

If your earnings cause you or your family to lose Medicaid eligibility under any of the Section 1931 groups you may be eligible for up to 12 months of Transitional Medicaid.

Pregnant Women and Foster Children: These two groups use the TANF Income Eligibility rules without the Section 1931 variations.

Infants Awaiting Adoption: This group uses the TANF Gross Income definition (see TANF - Income Eligibility) and compares the gross income to the TANF Payment Standard, not the Standard of Need. (See TANF Income Limits.) The child's income must be less than the TANF Payment Standard for one.

Exception: 0-17 year-old recipients of General Assistance (GA) are classified as an AFDC-TANF Related Covered Group, but their eligibility is determined using GA Financial Eligibility rules.

Federal Poverty Level (FPL) Related Covered Groups

Income-eligibility for the FPL Related Covered Groups is determined by the relationship between FPL Countable Income and FPL Income Limits.

·      For pregnant women and infants up to age one, countable income cannot exceed 200% FPL;

·      For children from age one through five countable income cannot exceed 133% FPL.

·      For children age six through 18 countable income cannot exceed 100% FPL.

See also:

DE Medicaid - Resource Eligibility

DE Medicaid - Covered Groups

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual (Sects. 15120.2, 15130,15150.1, 15160.1, 15300.2, 15400.3.1)

Back to:

DE Medicaid - Eligibility

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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