Mont. Admin. R. 37.82.1101 - INDIVIDUALS COVERED, NON-INSTITUTIONALIZED MEDICALLY NEEDY
(1) Medicaid under this subchapter will be
provided to the following individuals who would be receiving FAIM financial
assistance if their income had not exceeded the income standards found in ARM
37.78.420 provided they are also
eligible under ARM
37.82.1102,
37.82.1106,
37.82.1107 and
37.82.1110:
(a) pregnant women whose pregnancy has been
verified;
(b) individuals who are
under the age of 18 or are age 18 and a full-time student in a secondary school
and can reasonably be expected to obtain a secondary school diploma or its
equivalent in or before the month of their 19th birthday;
(c) a child born on or after October 1, 1983,
through the month of their 19th birthday whose family income and resources meet
the requirements listed in ARM
37.78.401 and
37.82.1106;
(d) individuals under
age 19 who are ineligible for medicaid under ARM
37.82.701; and
(e) individuals in a FAIM financial
assistance lump sum period of ineligibility.
(2) This group does not include individuals
whose cash assistance is terminated solely because of increased income from
employment and who, under ARM 37.82.701, are receiving continued medicaid
coverage. However, this group may be eligible when the medicaid coverage
terminates.
(3) This group does not
include coverage for the caretaker relative, as defined in ARM
46.10.403.
(4) Medicaid under this
subchapter will also be provided to the following groups of
non-institutionalized SSI-related individuals and couples:
(a) Individuals who would be receiving SSI if
their income had not exceeded the current SSI income standards.
(i) This group does not include aged, blind
or disabled individuals or couples receiving mandatory state supplements or
only a state supplementary payment (but no SSI payment) under the optional
state supplementary program established in ARM
37.43.101 through
37.43.104. Under subchapter 9,
these individuals are eligible for medicaid on the basis of income standards
higher than the current SSI income standards. However, this group does include
such individuals when increased income causes ineligibility for such
supplementary payments. At this juncture, for the purposes of medicaid under
the present subchapter, any income used to meet needs previously met by the
supplementary payment is not excluded from income.
(ii) This group does not include individuals
who are currently ineligible for SSI or only a state supplementary payment
under the optional state supplementary program because the increase in OASDI
benefits they received on July 1, 1972, raised individual or couple income over
the current SSI or optional state supplementary program income standards. These
individuals, under ARM
37.82.901(2) (b) and (3)
(a) and
37.82.903(2) and
(3), have their July 1, 1972, increase in
OASDI benefits excluded from unearned income and are determined eligible for
medicaid under subchapter 9. However, this group does include such individuals
when, after excluding the July 1, 1972 increase in OASDI benefits, other income
causes ineligibility for medicaid under subchapter 9. At this juncture, for the
purposes of medicaid under the present subchapter, the July 1, 1972, increase
in OASDI benefits is no longer excluded from but is counted as unearned
income.
(iii) This group does not
include individuals who are currently ineligible for SSI or only a state
supplementary payment under the optional state supplementary program solely due
to a cost-of-living increase in OASDI paid under section 215 (i) of the Social
Security Act after April, 1977. These individuals, under ARM
37.82.901(2) (c) and (3)
(b) and
37.82.903(2) and
(3), have such increases excluded from
unearned income and are determined eligible for medicaid under subchapter 9.
However, this group does include such individuals when, after excluding such
increases, other income causes ineligibility for medicaid under Chapter 85,
subchapter 20. At this juncture, for the purposes of medicaid under the present
subchapter, cost-of-living increases in OASDI paid under section 215(i) of the
Social Security Act after April, 1977, are no longer excluded from but are
counted as unearned income.
(iv)
This group does not include individuals who in December, 1973, were eligible
for medicaid as an essential spouse of a recipient of OAA, AB, APTD, or AABD.
These individuals are eligible for medicaid under subchapter 9 if the
provisions of ARM
37.82.901(4) (a),
37.82.902(4), and
37.82.903(4) are
met. When medicaid under subchapter 9 is lost, such individuals must qualify
for medicaid under the present subchapter in their own right. Medicaid under
the present subchapter does not provide for coverage of an essential
person.
(v) This group does not
include individuals who would be eligible for SSI had they applied. These
individuals are not relevant to medicaid under this subchapter.
Notes
Sec. 53-6-113, MCA; IMP, Sec. 53-6-131, MCA;
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