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VA Medically Needy

The Medicaid Medically Needy covered group is known primarily for its "Spenddown". (See Spenddown below for a brief explanation, or Medically Needy Income Levels for details.)

This group consists of individuals who meet all Medicaid requirements for certain covered groups except that they have Countable Income or resources greater than the income limits or resource limits specified for their covered group.

The covered groups for which this applies are:

·             Those involving the Aged, Blind and Disabled (ABD) categories;

·             Pregnant women and Infants;

·             Children under 18; and

·             Children under 21 who are in foster care, who receive adoption assistance, who are sponsored in independent living situations, nursing homes, or intermediate care facilities for the mentally retarded (ICFs/MR).

See Medicaid Covered Groups for brief descriptions of the various covered groups.

NOTE: WorkWORLD calculates Medically Needy eligibility and spenddown only for the Disabled Medically Needy category.

Spenddown

In order to be covered by Medicaid in this way, this group must first spend on medical expenses the difference between their income and the VA Medically Needy Income Level for their family size and geographic area.

This is called a "spenddown". The spenddown is counted within a six-month period. That is, individuals who are categorized as Medically Needy must spend down to the income level within a six-month period. For the remainder of that six months, they are covered by Medicaid. Then they start all over again for the next six-month period. (See Medically Needy Income Level for details and numbers used in the calculations. WorkWORLD will calculate the spenddown, if any, for you if you choose Medically Needy as the covered group.)

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 Chapter M03.30 and M13 of the Department of Social Services (DSS) Medicaid Manual.

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