Need Standards

Need Standards. A. The appropriate need standard used to test income depends on the coverage group for which the client is applying. B. Medicaid need standards are based on the following: 1. SSI Federal Benefit Rates (FBR) set by SSI policy and subject to increase in January of each year. SSI FBRs are used for SSI-related cases. a) Countable income cannot equal or exceed the appropriate FBR for Medicaid eligibility. 2. Federal Poverty Levels (FPL) set by the federal government and subject to change each year, usually in February or March. FPLs are used at varying rates (100%, 120%, 135%, 200%, and 250%) depending on the coverage group. a) Countable income can be equal to, but cannot exceed the appropriate FPL for Medicaid eligibility. 3. 300% of the SSI FBR is the formula required by federal regulation, 42 CFR 435.1005, to set the institutional need standard for all long term care coverage groups. This limit is subject to increase in January of each year when SSI FBRs increase. a) Countable income cannot be equal to or exceed the institutional limit for Medicaid eligibility. b) If income does equal or exceed the limit, ineligibility exists for that month unless an Income Trust is in effect.