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Revision 09-4; Effective December 1, 2009
A special income limit is used to determine income eligibility for a person in an institutional setting who is not already eligible for Medicaid or for a person who becomes ineligible for Medicaid because of the move to an institutional setting.
The special income limit for a person is equal to or less than 300% of the full individual Supplemental Security Income (SSI) federal benefit rate.
The special income limit for a couple is twice the special income limit for an individual.
To qualify for the special income limit, a person or couple must:
- have countable income that exceeds the reduced SSI federal benefit rate; and
- reside in a Medicaid-certified long-term care facility for 30 consecutive days;
- receive a level of care or medical necessity determination that qualifies the person or couple for Medicaid; or
- be approved by a Texas health and human services agency to receive services under a Home and Community-Based Services waiver program and receive the services within one month after approval.
Note: The special income limit is used if the person is 65 years of age or older and in a Medicaid-certified institution for mental diseases for 30 consecutive days.
G-6210 Thirty Consecutive Days and the Special Income Limit
Revision 09-4; Effective December 1, 2009
Eligibility under the special income limit is not effective until the person has been in an institutional setting for a period of 30 consecutive days. Once the person has been in the institutional setting for the 30 consecutive days, use the special income limit retroactively for the month in which the person started the 30 consecutive days period.
Note: When a full Medicaid-eligible recipient moves into an institutional setting, the recipient does not have to meet the 30 consecutive days requirement to be eligible for Medicaid in an institutional setting.
The 30 consecutive days are not disrupted if the person:
- makes a three-day therapeutic home visit with a planned return to the facility;
- is admitted to a hospital with a planned return to the facility;
- moves from a Medicaid-certified facility to another Medicaid-certified facility; or
- moves to a Home and Community-Based Services waiver program.
If a person dies before meeting the 30 consecutive days requirement without moving to a non-institutional setting, the person is considered to have met the requirement for application of the special income limit.
If the person does not complete the 30 consecutive days stay in an institutional setting, the special income limit is not used. The income limit for a non-institutional program must be used instead and the person must meet the criteria in another MEPD group as described in Chapter A, General Information and MEPD Groups.