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NEVADA STATE DIVISION OF WELFAREANDSUPPORTIVE SERVICESMEDICAL ASSISTANCEPROGRAM MANUALAPPENDIX AMAGI INCOME CHARTSVERIFICATION PLANAID CODE CHARTS
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAGI INCOME CHARTEffective 4/1/2016HouseholdSize12345678Each AddAMlimit 319 407 495 582 670 758 846 934 88100%FPL 990 1,335 1,680 2,025 2,370 2,715 3,061 3,408 347Division of Welfare and Supportive ServicesMedical Assistance Manual16 May 01 MTL 02/16122% FPL 1,208 1,629 2,050 2,471 2,891 3,312 3,734 4,158138%FPL 1,366 1,842 2,318 2,795 3,271 3,747 4,224 4,703165%205% 1,634 2,203 2,772 3,341 3,911 4,480 5,051 5,623 2,030 2,737 3,444 4,151 4,859 5,566 6,275 6,986APPENDIX AMAGI INCOME CHART
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALVERIFICATION MATRIXType of VerificationIdentification andCitizenshipVerification of identitymay be required as partof citizenshipdocumentation.Identity documentationis not a separaterequirement fromcitizenship.Social SecurityNumberVerified through theNUMIDENT system.HouseholdCompositionPregnancy &Unborn CountCaretaker RelativeResidencyIncome(Earned/Unearned)Verify current monthlyincome using electronicdata sources includingSNAP/TANF caseinformation. Use themost current source ofinformation available.Insurance/TPLDuplicate Assistance(includes out of fyN/AAPPENDIX AVERIFICATION MATRIXDivision of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAGI MEDICAL GROUPSACA MAGIMedicalGroupsAMDefinitionParents & CaretakersIncome Limits1 - 3192 - 4073 - 4954 - 5825 - 6706 - 7587 - 846 88 each additionalParent/Caretaker musthave a dependent child inthe home.Buy-in Eligible.Expanded Parent &CaretakersAM Limit – 138% FPLCHPoverty Level Children &Pregnant WomenChildren 6-18: 122% FPLChildren under 6: 165% FPLPregnant women: 165% FPLCH1Expanded Children’sGroupAges 6 – 18AM1CH5OBRA babyDivision of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15Exceptions/RulesCannot be Medicareeligible; Children must beenrolled in coverage forparent to be eligible.Cannot be pregnant.Buy-In EligibleBuy-In Eligible123% - 138% FPLN/AChildren born to Medicaideligible mother deemedeligible for 12 monthsfrom month of birth. OnlyOBRA if not eligible underthe child groups.APPENDIX AAID CODE CHARTSMAGI MEDICAL GROUPS
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAGI MEDICAL GROUPS (CONT’D.)CANon-Parents 19–64years old 138% FPLNCNevada Check-Up – thestate CHIP program forchildren under 19Children under 6:166%-205%Children 6-18:139%-205% FPLTRTransitional Medicaid 139%PMPost MedicalN/AEM2Emergency medicalexpanded adult groupEM4Emergency medicalcoverage for all groupscovered prior to ACAEM8Emergency medicalexpanded children’sgroupAPPENDIX AAID CODE CHARTSMAGI MEDICAL GROUPS (CONT’D.)Adults with income AMlimit but less than 138%FPLParents AM Payment;Children 0-5 165%FPL;Children 6-18 122%FPL;Pregnant women 165%Children 6-18123%-138%Cannot be pregnant;Cannot be Medicareeligible;Cannot be eligible inanother Medical group.Premium paymentrequired;Cannot have otherinsurance;Cannot be Medicaideligible.12 months of continuouseligibility for HH losingeligibility due to increasein earned income of aparent/caretaker, if HHparent/caretaker waseligible for and receivedAM in 3 of the last 6months.4 months continuouseligibility for householdthat lose AM eligibilitydue to an increase inSpousal Support.Must meet all eligibilitycriteria of AM1 withexception of citizenshipMust meet all eligibilitycriteria of AM, CH withthe exception ofcitizenship.Must meet all eligibilitycriteria of CH1 withexception of citizenshipDivision of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALSPECIALIZED MEDICAL GROUPSACASpecializedMedicalGroupsDefinitionIncome LimitsAOAged Out of Foster CareNo income or resourcedetermination61Children for Whom aPublic Agency hasAssumed FinancialResponsibilityNo income or resourcedetermination61MCBTitle IV-E eligible fosterchildren at Rite ofPassageBreast and CervicalcancerDivision of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15No income or resourcedeterminationNo income or resourcedetermination by DWSS.CDC screening includesincome determination.Exceptions/RulesUnder 26 years of age;were in foster care andenrolled in Medicaid atthe time they turned 18years of age.Public agency hasassumed responsibility;Child cannot be in DCFScustodyChildren under 18 yearsof age residing at Rite ofPassage receiving IV-Efoster care benefitsApplications processed atYerington D.O.Under age 65;Uninsured or underinsured;Not eligible under anyother medical assistanceprogram;Screened by CDC and inneed of treatment.Applications processedby Elko D.O.APPENDIX AAID CODE CHARTSSPECIALIZED MEDICAL GROUPS
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAABD MEDICAL GROUPSACA NonMAGIMedicalGroupsIN1IN3IN9DefinitionSSI RecipientsIncome LimitsExceptions/RulesCategorically eligible,income and resourcedetermination made by SSIReceiving SSI as a NevadaresidentReceived SSI based ondisability which began priorto turning age 22;AD1AD3AD9Adult Disabled childrenPublic LawResource Limit 2,000Lost SSI solely due toreceipt of adult disabledchild benefits;Would be eligible for SSI ifthe adult disabled childbenefits were excluded.SDX will display “D” inPublic Law column.Receiving RSDI;PK1PK3PK9Previously receivedSSI/RSDI in same month;Pickle Amendment –Public LawResource Limit 2,000Became ineligible for SSI;And would be SSI eligiblenow if the RSDI cost ofliving increase wasexcluded from income.At least 60, but not yet 65years of age;Eligible for Widow/Widowerbenefits;WW3WW9Widow/Widowers PublicLawResource Limit 2,000Losing SSI due toWidow/Widower benefits;Not entitled to Medicare;Would be SSI eligible ifWidow/Widower benefitswere excluded.APPENDIX AAID CODE CHARTSMAABD MEDICAL GROUPSDivision of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAABD MEDICAL GROUPS (Cont’d.)Were receiving SSIbenefits;WS1WS3WS9Widow/Widowers andSurviving DivorcedSpousesPublic LawResource Limit 2,000SU1SU3SU9Suspension of SSI due toIncome Public LawResource Limit 2,000SS1SS3SS9SSI Institutional 30 SSI Institutionalpayment rateLost SSI due to receipt ofTitle II spousal benefits;Not entitled to MedicarePart A.SDX will display “S” inPublic Law column.Social Security determinesthis status.SDX will display “I” in thePublic Law column.Categorically eligible,income and resourcedetermination made bySSA.Residing in long term care.Over 65 years of age, blindor disabled;SI1SI3SI9WB1WB3WB9State Institutional specialincome groupWould be receiving SSI orState Supplement if not inLTCIncome between SSIpayment level and 142% ofSSI payment;Resource limit 2,000Income 30 but SSI;Resource limit 2,000In-patient stay greater than30 days;Requires spousal resourceassessment;Patient liabilitydetermination post eligibility.Over 65 years of age, blindor disabled.Over 65 years of age, blindor disabled;CM1CM3CM9County Match InstitutionalIncome 1,041.00 –300% SSI payment level;Resource limit 2,000In-patient stay greater than30 days;Requires spousal resourceassessment;Patient liabilitydetermination post eligibility.Division of Welfare and Supportive ServicesMedical Assistance Manual15 Nov 01 MTL 03/15APPENDIX AAID CODE CHARTSMAABD MEDICAL GROUPS (Cont’d.)
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAABD MEDICAL GROUPS (Cont’d.)GC1GC3GC9Group CareIncome SSI paymentlevel;Resource limit 2,000HC1Home and Communitybased waiver for theElderlyIncome 300% SSIpayment level;Resource limit 2,000Assisted Living WaiverIncome 300% SSIpayment level;Resource limit 2,000AL1Individuals receiving SSIand residing in group care;Facility retains a portion ofthe SSI payment for roomand board.Over 65 years of age;Meets the level of careassessment;Requires spousal resourceassessment.Over 65 years of age;Residing in approvedassisted living facility in LasVegas only;Requires spousal resourceassessment.Over 65 years of age, blindor disabled;HD1HD3HD9Home and Communitybased waiver for the aged,blind or disabledIncome 300% SSIpayment level;Resource limit 2,000Meets the level of careassessment;Requires spousal resourceassessment.Over 65 years of age orblind;HG1HG3HG9Group Care Waiver for theaged or blindIncome 300% SSIpayment level;Resource limit 2,000Meets the level of careassessment;Requires spousal resourceassessment.Mentally retarded;HR1HR3HR9Home and Communitybased waiver for thementally impairedAPPENDIX AAID CODE CHARTSMAABD MEDICAL GROUPS (Cont’d.)Income 300% SSIpayment level;Resource limit 2,000Living in a communitysetting;Requires spousal resourceassessment.Division of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15
MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICALMAABD MEDICAL GROUPS (Cont’d.)Child under 19 years of age;Residing at home withparents;KB3KB9PR1PR3PR9Katie Beckett Waiver fordisabled children noteligible for SSIPrior medical for the aged,blind or disabledIncome 300% SSIpayment level;Resource limit 2,000Income SSI paymentlevel;Resource limit 2,000Denied SSI for excessincome of parents;Meets level of careassessment and can becared for at home for lesscost than institutionalization;Only child income/resourcesused in eligibilitydetermination.Disability determinationmade by DHCFPNot eligible for Medicaidunder any other category;WY5WY9Health Insurance forworking disabledGross earned 450% FPL;Unearned 699;Net earned unearned 250%Between 16-64 years ofage;Employment relateddisregards allowed;Must be disabled or blind.Division of Welfare and Supportive ServicesMedical Assistance Manual15 Jul 01 MTL 01/15APPENDIX AAID CODE CHARTSMAABD MEDICAL GROUPS (Cont’d.)
AL1 Assisted Living Waiver Income 300% SSI payment level; Resource limit 2,000 Over 65 years of age; Residing in approved assisted living facility in Las Vegas only; Requires spousal resource assessment. HD1 HD3 HD9 Home and Community based waiver for the aged, blind or disabled Income 300% SSI payment level; Resource limit 2,000
