469 NAC 4-007
The standard used to determine eligibility for medical assistance is determined by the unit or family size. When computing Form DA-3M, the following individuals are considered in determining the unit or family size:
1. Client; and
2. Spouse.
When computing side 1 of Form DA-4M, only the client is considered in determining the medically needy or Federal Poverty income level.
If the client is in a hospital (or receiving acute hospital care) or licensed alcohol/drug treatment center, the worker shall use the standard of need which most accurately reflects the client's living arrangement.
When computing a medical budget or side 1 of Form DA-4M, the worker uses the following steps to determine if the client is eligible for MA only or MA with excess:
1. Compare the client's net income to the percent of the Federal Poverty Level (FPL) (see 469-000-203). If the client's income is equal to or less than the FPL, the client is eligible for MA only. If the client's income is more than the FPL, go to step 2 to determine the amount of Share of Cost. For clients in long term care, go directly to step 2.
2. Subtract the medically needy income level from the client's net income to determine the amount of Share of Cost (see 469-000-203).
When a client enters long term care, the standard is not reduced to the long term care level or Assisted Living Waiver level until the first full month that the client resides in long term care.
{7/28/2000}