Post by JTsDad on Mar 28, 2013 20:46:44 GMT -5
Children and youth may be eligible for one of two Virginia Medicaid programs. The
state’s basic plan, named FAMIS Plus but typically referred to just as Medicaid, covers children
and youth in families with no or very low income. The Family Access to Medical Insurance
Security (FAMIS) plan covers children and youth in families that earn too much to qualify for
Medicaid (FAMIS Plus) but do not have private insurance. Children and youth under age 21
enrolled in Medicaid (FAMIS Plus) are also eligible for services under the Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) program, which requires that their doctor
document an existing or emerging physical, behavioral, developmental, or mental impairment or
problem that requires treatment to correct it or keep it from getting worse. If their doctor is
unable to provide the needed services, they may be referred to specialty care, and certain of these
services, such as intensive in-home services, therapeutic day treatment, and therapeutic
behavioral services, have more extensive eligibility criteria.
To be eligible for full Medicaid (FAMIS Plus) coverage, gross income (total income
before deductions and taxes are taken out) and resources (assets) must fall within required limits
specified as percentages of the federal poverty level, an index that is adjusted over time. These
income and resource limits vary among Medicaid’s covered populations; however, individuals
and families with incomes of 133 to 200 percent of the federal poverty level are generally
covered. In determining resources, the amount of a person’s or family’s bills and debts is not
considered, but in some instances, such as for individuals who are “medically needy,”
consideration may be given to the impact on a family of exceptionally high medical bills
(counted as “spend-down”) which work like an insurance deductible.
Children and youth from birth to age 19 with disabilities may qualify for Medicaid
(FAMIS Plus) even if their family income exceeds income limits, since parental income and
other financial resources are not considered in determining the child’s eligibility. When a
member of a married couple requires long-term care under Medicaid, special eligibility rules
called spousal impoverishment protections are applied to determine resources and income that
can be kept by the other spouse. Under the MEDICAID WORKS program, individuals who
have a disability and who work or are about to start a job may earn more than for standard
eligibility and retain more in savings or resources while continuing to receive Medicaid
coverage. Additional information on MEDICAID WORKS can be found in the Employment
chapter of this assessment, and because all of these income eligibility criteria are complex, it is
recommended that individuals contact their local social services department for clarifications.
state’s basic plan, named FAMIS Plus but typically referred to just as Medicaid, covers children
and youth in families with no or very low income. The Family Access to Medical Insurance
Security (FAMIS) plan covers children and youth in families that earn too much to qualify for
Medicaid (FAMIS Plus) but do not have private insurance. Children and youth under age 21
enrolled in Medicaid (FAMIS Plus) are also eligible for services under the Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) program, which requires that their doctor
document an existing or emerging physical, behavioral, developmental, or mental impairment or
problem that requires treatment to correct it or keep it from getting worse. If their doctor is
unable to provide the needed services, they may be referred to specialty care, and certain of these
services, such as intensive in-home services, therapeutic day treatment, and therapeutic
behavioral services, have more extensive eligibility criteria.
To be eligible for full Medicaid (FAMIS Plus) coverage, gross income (total income
before deductions and taxes are taken out) and resources (assets) must fall within required limits
specified as percentages of the federal poverty level, an index that is adjusted over time. These
income and resource limits vary among Medicaid’s covered populations; however, individuals
and families with incomes of 133 to 200 percent of the federal poverty level are generally
covered. In determining resources, the amount of a person’s or family’s bills and debts is not
considered, but in some instances, such as for individuals who are “medically needy,”
consideration may be given to the impact on a family of exceptionally high medical bills
(counted as “spend-down”) which work like an insurance deductible.
Children and youth from birth to age 19 with disabilities may qualify for Medicaid
(FAMIS Plus) even if their family income exceeds income limits, since parental income and
other financial resources are not considered in determining the child’s eligibility. When a
member of a married couple requires long-term care under Medicaid, special eligibility rules
called spousal impoverishment protections are applied to determine resources and income that
can be kept by the other spouse. Under the MEDICAID WORKS program, individuals who
have a disability and who work or are about to start a job may earn more than for standard
eligibility and retain more in savings or resources while continuing to receive Medicaid
coverage. Additional information on MEDICAID WORKS can be found in the Employment
chapter of this assessment, and because all of these income eligibility criteria are complex, it is
recommended that individuals contact their local social services department for clarifications.