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FMAP-Related Limits - Iowa

Financial Eligibility for FMAP-Related Coverage Groups involves both Income Limits and Resource Limits.

FMAP-Related Income Limits

Income must be within FMAP program limits, unless otherwise specified by the coverage group under which the person is applying or eligible. (See the Mothers and Children (MAC) Program Income Limits below.

There are three tests:

Test 1: 185% test. The gross, non-exempt income of the group must be less than 185% of the Standard of Need (also called the "Schedule of Living Costs") for the eligible group. Note that 185% of special needs for guardianship or conservatorship fees and school expenses can also be allowed in addition to the basic needs.

Click on Desk Aid and see the amounts for all three tests.

NOTE: You must have a web browser (such as Internet Explorer or Netscape) installed in order to view the Desk Aid.

If you are connected to the Internet, you can click here to see the Desk Aid on-line.

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Test 2: Standard of Need Eligibility Test (using the Schedule of Living Costs). The standard of need test determines eligibility for the 50% Work Incentive Deduction. The test is applied only to case applications and reapplications. On reapplications, the standard of need test is applied regardless of how much time has passed since the previous period of eligibility. The test is not applied when a new person enters an existing eligible group.

The test compares the Schedule of Living costs with the eligible group’s gross nonexempt income minus a 20% earned income deduction, minus diversions for certain individuals not in the home or in the home but excluded or ineligible, and minus special needs for guardianship or conservatorship fees and school expenses.

When the countable income of the group is less than the Schedule of Living costs, then the group is eligible for the 50% work incentive deduction. When the countable income of the group is more than the Schedule of Living costs, the application is denied.

Test 3: The Payment Standard Test (using the Schedule of Basic Needs). If the first two tests are met, then the Payment Standard Test is applied.

The test compares the Schedule of Basic Needs to the eligible group’s gross nonexempt income minus the deductions listed for Test 2, and minus the 50% work incentive deduction.

If the family’s countable income is less than the Payment Standard, the benefit amount is determined by deducting the family’s countable net income from the Payment Standard for the size eligible group.

For a list of the deductions applicable for each FMAP-Related Program, see FMAP-Related Financial Eligibility - Deductions.

For details on the income tests, see Iowa Dept of Human Services Employees' Manual Title 4 Family Investment Program, Chapter F, Budgeting for Initial Eligibility, Applying Income Tests, pages 6-15. (Note that the FMAP-related policies reference the income tests for the Family Investment Program (FIP).)

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For the Mothers And Children (MAC) coverage group, income limits are based on federal poverty levels:

·           185% of poverty for pregnant women and infants.

·           133% of poverty for children aged 1 through 18.

Click on Desk Aid and see the 185% and 133% amounts.

NOTE: You must have a web browser (such as Internet Explorer or Netscape) installed in order to view the Desk Aid.

If you are connected to the Internet, you can click here to see the Desk Aid on-line.

You must have Adobe Acrobat Reader installed in order to view the on-line version. If you do not have the Reader installed, you can download it free from: www.adobe.com/products/acrobat/readstep.html

FMAP-Related Resource Limits

NOTE: There are no resource limits for a child’s eligibility for some coverage groups. See the chart in "Medicaid Eligibility for Children - Resources" for a list of the coverage groups with and without resource limits.

For FMAP and FMAP-related Medicaid coverage groups, use FMAP resource limits:

·           For a household that is filing an application for FMAP or FMAP-related benefits, the resource limit is $2,000.

·           For a household that is already receiving Medicaid under FMAP or FMAP-related programs, the resource limit is $5,000.

·           $10,000 in liquid resources is the resource limit for the Mothers and Children (MAC) coverage group.

·           $10,000 in liquid resources is the resource limit for FMAP-related Medically Needy.

Apply the $2,000 limit when a person enters a household receiving Medicaid but is not in the same filing unit (that is, the person is filing separately). Once the applicant becomes a recipient, the resource limit increases to $5,000.

Allow the $5,000 resource limit when:

·           A recipient leaves one coverage group to enter another coverage group.

·           A person enters an existing Medicaid-eligible unit.

·           Medicaid eligibility was suspended in the month before the month of application.

See Also:

·           Family Medical Assistance Program (FMAP) Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter E, Income, Income Policies for FMAP-Related Coverage Groups

·                        Chapter F, Coverage Groups

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