Virginia Administrative Code (Last Updated: January 10, 2017) |
Title 12. Health |
Agency 30. Department of Medical Assistance Services |
Chapter 40. Eligibility Conditions and Requirements |
Section 220. Income eligibility levels
-
Part IV. Eligibility Requirements
A. Mandatory Categorically Needy
1. AFDC-related groups other than poverty level pregnant women and infants.
Family Size
Need Standard
Payment Standard
Maximum Payment Amounts
See Table 1
See Table 2
STANDARDS OF ASSISTANCE
(Increased annually by the increase in the Consumer Price Index)GROUP I
Size of Assistance Unit
Table 1 (100%)
Table 2 (90%)
1
$151.11
$135.58
2
237.01
214.24
3
305.32
274.27
4
370.53
333.27
5
436.77
393.30
6
489.55
441.94
7
553.72
498.87
8
623.07
559.93
9
679.99
611.68
10
743.13
669.64
Each person above 10
63.13
57.96
MAXIMUM REIMBURSABLE PAYMENT $403
GROUP II
Size of Assistance Unit
Table 1 (100%)
Table 2 (90%)
1
$180.09
$162.49
2
265.99
239.08
3
333.27
301.18
4
399.51
359.14
5
472.99
423.35
6
526.81
474.03
7
589.95
529.92
8
658.26
592.02
9
716.22
644.80
10
780.39
701.73
Each person above 10
63.13
57.96
MAXIMUM REIMBURSABLE PAYMENT $435
GROUP III
Size of Assistance Unit
Table 1 (100%)
Table 2 (90%)
1
$251.50
$227.70
2
338.44
304.29
3
406.75
366.39
4
472.99
424.35
5
560.97
505.08
6
613.75
552.69
7
677.92
610.65
8
745.23
672.75
9
806.26
725.53
10
868.33
781.42
Each person above 10
63.13
57.96
MAXIMUM REIMBURSABLE PAYMENT $518
2. Pregnant women and infants under 1902(a)(10)(i)(IV) of the Act:
Effective April 1, 1990, based on 133% of the official federal income poverty level.
3. Children under § 1902(a)(10)(i)(VI) of the Act (children who have attained age 1 but have not attained age 6), the income eligibility level is 133% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.
4. For children under § 1902(a)(10)(i)(VII) of the Act (children who were born after September 30, 1983, and have attained age 6 but have not attained age 19), the income eligibility level is 100% of the federal poverty level (as revised annually in the Federal Register) for the size family involved.
B. Treatment of COLA for groups with income related to federal poverty level.
1. If an individual receives a Title II benefit, any amount attributable to the most recent increase in the monthly insurance benefit as a result of a Title II COLA is not counted as income during a "transition period" beginning with January, when the Title II benefit for December is received, and ending with the last day of the month following the month of publication of the revised annual federal poverty level.
2. For individuals with Title II income, the revised poverty levels are not effective until the first day of the month following the end of the transition period.
3. For individuals not receiving Title II income, the revised poverty levels are effective no later than the beginning of the month following the date of publication.
C. Qualified Medicare beneficiaries with incomes related to federal poverty level.
The levels for determining income eligibility for groups of qualified Medicare beneficiaries under the provisions of § 1905(p)(2)(A) of the Act are as follows:
Section 1902(f) states which as of January 1, 1987, used income standards more restrictive than SSI. (VA did not apply a more restrictive income standard as of January 1, 1987.)
Based on the following percentage of the official federal income poverty level:
Effective Jan. 1, 1989: 85%
Effective Jan. 1, 1990: 90% (no more than 100)
Effective Jan. 1, 1991: 100% (no more than 100)
Effective Jan. 1, 1992: 100%
D. Aged and disabled individuals described in § 1902(m)(1) of the Act; Level for determining income eligibility for aged and disabled persons described in § 1902(m)(1) of the Act is 80% of the official federal income poverty level (as revised annually in the Federal Register) for the size family involved.
E. Income levels—medically needy. (Increased annually the increase in the Consumer Price Index but no higher than the level permitted to claim federal financial participation.)
1. The following income levels are applicable to all groups, urban and rural.
2. The agency has methods for excluding from its claim for FFP payments made on behalf of individuals whose income exceeds these limits.
(1)
(2)
(3)
Family Size
Net income level protected for maintenance for 12 months
Amount by which Column 2 exceeds limits specified in 42 CFR 435.10071
Group I
Group II
Group III
1
$2,691.00
$3,105.00
$4,036.50
$0
2
$3,519.00
$3,824.00
$4,867.00
$0
3
$4,036.50
$4,450.50
$5,485.50
$0
4
$4,554.00
$4,968.00
$6,003.00
$0
5
$5,071.50
$5,485.50
$6,520.50
$0
6
$5,589.00
$6,003.00
$7,038.00
$0
7
$6,106.50
$6,520.50
$7,555.50
$0
8
$6,727.50
$7,141.50
$8,073.00
$0
9
$7,348.50
$7,762.50
$8,797.50
$0
10
$8,073.00
$8,487.00
$9,418.50
$0
For each additional person, add:
$695.52
$695.52
$695.52
$0
1As authorized in § 4718 of OBRA '90.
GROUPING OF LOCALITIES
GROUP I
Counties
Accomack
King George
Alleghany
King and Queen
Amelia
King William
Amherst
Lancaster
Appomattox
Lee
Bath
Louisa
Bedford
Lunenburg
Bland
Madison
Botetourt
Matthews
Brunswick
Mecklenburg
Buchanan
Middlesex
Buckingham
Nelson
Campbell
New Kent
Caroline
Northampton
Carroll
Northumberland
Charles City
Nottoway
Charlotte
Orange
Clarke
Page
Craig
Patrick
Culpeper
Pittsylvania
Cumberland
Powhatan
Dickenson
Prince Edward
Dinwiddie
Prince George
Essex
Pulaski
Fauquier
Rappahannock
Floyd
Richmond
Fluvanna
Rockbridge
Franklin
Russell
Frederick
Scott
Giles
Shenandoah
Gloucester
Smyth
Goochland
Southampton
Grayson
Spotsylvania
Greene
Stafford
Greensville
Surry
Halifax
Sussex
Hanover
Tazewell
Henry
Washington
Highland
Westmoreland
Isle of Wight
Wise
James City
Wythe
York
Cities
Bristol
Franklin
Buena Vista
Galax
Clifton Forge
Norton
Danville
Poquoson
Emporia
Suffolk
GROUP II
Counties
Albemarle
Loudoun
Augusta
Roanoke
Chesterfield
Rockingham
Henrico
Warren
Cities
Chesapeake
Portsmouth
Covington
Radford
Harrisonburg
Richmond
Hopewell
Roanoke
Lexington
Salem
Lynchburg
Staunton
Martinsville
Virginia Beach
Newport News
Williamsburg
Norfolk
Winchester
Petersburg
GROUP III
Counties
Arlington
Montgomery
Fairfax
Prince William
Cities
Alexandria
Fredericksburg
Charlottesville
Hampton
Colonial Heights
Manassas
Fairfax
Manassas Park
Falls Church
Waynesboro
Historical Notes
Derived from VR460-03-2.6101:1, eff. June 30, 1994; amended, Volume 11, Issue 10, eff. March 9, 1995; Volume 11, Issue 24, eff. October 1, 1995; Volume 17, Issue 18, eff. July 1, 2001; Errata, 17:21 VA.R. 3124 July 2, 2001; amended, Virginia Register Volume 18, Issue 07, eff. January 16, 2002; Volume 18, Issue 18, eff. July 1, 2002.
Statutory Authority
§ 32.1-325 of the Code of Virginia.