Eligibility Criteria
There are three basic areas of criteria that DFA evaluates to make an eligibility determination for Medical Assistance:
- income,
- resources,
- and non-financial criteria.
Specific income and resource limits are used to determine eligibility for each group of Medicaid services. While non-financial information is generally the same for each set of services, there are some differences – for example, an application for services under the Aid to the Needy Blind program requires an individual to have a medical necessity determination of legally blind, while an application for services for seniors has no medical necessity requirement, but does have an age requirement. Specific details regarding income, resource and non-financial requirements are explained for each set of services on the pages reserved for eligibility for Medical Assistance. DFA coordinates eligibility determinations with the Office of Medicaid Business and Policy and the Bureaus of Elderly and Adult Services and Developmental Services. How to Apply for Assistance.
Medical Determinations
The Medicaid program is responsible for making medical necessity determinations for Aid to the Permanently and Totally Disabled, Child Severely Disabled, Home Care for Child Severely Disabled, Aid to the Needy Blind, emergency medical assistance to non-citizens, and Medical Eligibility for Adults with Disabilities. The Bureau of Elderly and Adult Services provides and coordinates services for Nursing Facility Assistance and Home and Community Based Care Choices for Independence (HCBC-CFI) as well as making the medical necessity determination for these two programs.
In and Out Medical Assistance
In and Out Medical Assistance (Medicaid) helps individuals whose income is not enough to pay their medical bills but is too much to qualify for Medicaid. Individuals are given a Spenddown, similar to a car insurance deductible. When qualifying medical expenses add up to the spenddown amount, Medicaid can then help pay for bills incurred for the duration of the Spenddown period. For more information about In and Out Medical Assistance read, "In and Out Medical Assistance?" (Form 77j) (English) (Spanish) (Bosnian) 
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