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VA Medicaid Income Limits

The Income Limits for Medicaid eligibility are defined differently depending upon the Medicaid Covered Group to which your Assistance Unit belongs or for which you are applying.

In some cases the income limits are defined in terms of the Federal Poverty Level (FPL); in some cases in terms of the SSI individual payment limit and in some cases, in terms of the Virginia Standards of Assistance. (See the topic, Medicaid Covered Groups for a listing of, or link to, the income limits that apply to each group.)

In most cases the various income limits are compared to Countable Income. Gross Income, however, is used in determining eligibility for Medicaid Waivers and Medicaid for ABD (Aged, Blind or Disabled) individuals in Medical Institutions. To be income eligible in those groups, the Gross Income must not exceed 300% of the SSI Individual Payment Limit (the Federal Benefit Rate).

Gross Income is also used in the first step of the two-step process for determining income eligibility for Low Income Families with Children (LIFC).

SSI-Related Medicaid

If you receive SSI then you are assumed to be income-eligible for Medicaid. If your earned income causes your SSI cash benefit to stop, then you are still eligible for Medicaid under a work incentive called "1619(b)" unless:

·             Your earned income exceeds the Virginia State Threshold (or an Individualized Threshold if SSA establishes one for you); or

NOTE: See Supplemental Security Income (SSI) for links to more information about 1619(b) and the thresholds.

·             You have resources that exceed the resource limits using Virginia's more restrictive resource definitions.

NOTE: The more restrictive resource definitions are not used for former Old Age Assistance (OAA), Aid to the Blind (AB), or Aid to the Permanently and Totally Disabled (APTD) money payment recipients who currently receive Supplemental Security Income (SSI) or Auxiliary Grants (AG).

Applying for SSI

If you are applying for SSI, then your initial eligibility depends on two tests.

·             If your total income does not exceed the amount that allows you to receive at least $1 of SSI cash benefit, then you have passed the first test.

·             If your earned income does not exceed the Significant Gainful Activity (SGA) amount, then you have passed the second test.

Each of these tests, however, have different rules related to Impairment Related Work Expenses (IRWEs), Blind Work Expenses (BWEs), Plans for Achieving Self Support (PASSes), and Subsidies.

NOTE: When you tell WorkWORLD that you don't get SSI but you would like to receive SSI benefits if you were financially eligible, WorkWORLD will calculate whether or not you are income-eligible for SSI taking into account IRWEs, BWEs, PASSes, and Subsidies.

If you are income-eligible for SSI, then you are also income-eligible for Medicaid.

NOTE: You must also be resource-eligible for Medicaid. See VA Medicaid Resource Limits.

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source:

Information for this topic was drawn from Chapters M07 and S08 of the Department of Social Services (DSS) Medicaid Manual.

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