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States also have the option to provide Medicaid coverage for other "categorically needy" groups. These optional groups share characteristics of the mandatory groups, but the eligibility criteria are somewhat more liberally defined. Examples of the optional groups that states may cover as categorically needy (and for which they will get Federal matching funds) under the Medicaid program include the following: - Infants up to age one and pregnant women not covered under the mandatory rules whose family income is below 185% of the Federal poverty level (the percentage to be set by each state);
- Optional targeted low-income children;
- Certain aged, blind, or disabled adults who have incomes above those requiring mandatory coverage, but below the Federal poverty level;
- Children under age 21 who meet income and resources requirements for the Aid to Families with Dependent Children (AFDC), but who otherwise are not eligible for the AFDC;
- Institutionalized individuals with limited income and resources;
- Persons who would be eligible if institutionalized but are receiving care under home and community-based services waivers;
- Recipients of state supplementary payments;
- Tuberculosis-infected persons who would be financially eligible for Medicaid at the Supplemented Security Income (SSI) level (only for TB-related ambulatory services and TB drugs); and
- Low-income, uninsured women screened and diagnosed through a Center's for Disease Control (CDC) Breast and Cervical Cancer Early Detection Program (NBCCEDP) and determined to be in need of treatment for breast or cervical cancer. (Additional information may be found under Downloads and Related Links Inside CMS listed below).
States may use more liberal income and resources methodologies to determine Medicaid eligibility for certain AFDC-related and aged, blind, and disabled individuals under Sections 1902(r)(2) and 1931 of the Social Security Act. For some groups, the more liberal income methodologies cannot result in the individual's income exceeding the limits prescribed for Federal matching.
Page Last Modified: 01/02/2009 1:43:15 PM
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