477 Neb. Admin. Code, ch. 27, § 007

Current through September 17, 2024
Section 477-27-007 - MEDICALLY NEEDY

Parents or caretaker relatives, children, pregnant women, and aged, blind, or disabled (ABD) individuals with a medical need and high medical expenses whose income exceeds the guidelines for Medicaid eligibility in another eligibility category may be eligible as medically needy if all other eligibility requirements are met. A medically needy individual must incur and obligate a certain amount of medical expenses each month before Medicaid will provide coverage for the rest of the month. These medical expenses must be at least equal to the difference between the individual's income and the applicable income standard. The share of cost obligation varies depending on the individual's household size and income. Each month is determined separately and continuous eligibility does not apply. Individuals without a demonstrated medical need are not eligible under this category.

007.01AGE. A medically needy child is eligible through age 18 years old if the child is a citizen or is a qualified non-citizen.
007.01(A)EXCEPTION. A medically needy child may be found eligible under this category if the child is receiving inpatient care in an institution for mental disease (IMD). If an individual is an inpatient in an institution for mental disease (IMD) when the individual reaches 21 years old, the individual may remain eligible either until discharge or until reaching 22 years old, whichever comes first.
007.02TWO-PARENT FAMILIES. If unmarried parents are living together and the father has acknowledged paternity for their child, eligibility must be considered for the family as a unit.
007.03SHARE OF COST OBLIGATION. The share of cost (SOC) obligation for medically needy individuals is calculated in accordance with the provisions of 477 NAC 25.

477 Neb. Admin. Code, ch. 27, § 007

Amended effective 9/28/2021