Section 181.11. Continuing eligibility

(a) Eligibility for continuing MA benefits begins with the date eligibility is established or the date of application, if the applicant/recipient is otherwise eligible.

(1) If the applicant is ineligible in the month of application, eligibility begins with the first day of the following month if the applicant is eligible beginning from the first day of that month.

(2) Authorization of MA benefits in the GA-related NMP category begins when all eligibility factors are verified, verification is received from a third party or the client has cooperated in the verification attempt and the applicant/recipient is otherwise eligible.

(b) For NMP-MA categories, income eligibility for continuing MA benefits exists when the applicant’s/recipient’s countable monthly net income is equal to, or less than, the income limits for the applicable category. Those income limits are:

(1) For persons in the aged, blind and disabled categories not receiving skilled nursing care or intermediate care, the NMP-MA income limits in Appendix A.

(2) For persons in the aged, blind and disabled categories receiving skilled nursing care or intermediate care, the NMP-MA income limits in Appendix B.

(3) For persons in the AFDC categories and the GA category, the NMP-MA income limits in Appendix C.

(c) For MNO-MA categories, income eligibility for continuing MA benefits exists when the applicant’s/recipient’s countable net income for a 6 calendar month period is equal to, or less than, the appropriate MNO-MA income limits in Appendix F.

(d) For persons who do not meet the requirements of subsection (b) or (c), eligibility for continuing MA benefits exists if the applicant/recipient meets the eligibility requirements under § 181.13 or § 181.14 (relating to eligibility under NMP-MA spend-down; and eligibility under MNO-MA spend-down).

The provisions of this § 181.11 adopted August 26, 1988, effective November 1, 1988, 18 Pa.B. 3949; amended July 28, 2000, the provisions under Act 35 effective retroactive to June 17, 1996, 30 Pa.B. 3779. Immediately preceding text appears at serial pages (211626) and (267115).

Notation

Authority

The provisions of this § 181.11 issued under sections 201(2) and 403(a) of the Public Welfare Code (62 P. S. § § 201(2) and 403(a)).

Cross References

This section cited in 55 Pa. Code § 181.312 (relating to deductions from earned income for the AFDC categories of MNO-MA); and 55 Pa. Code § 181.314 (relating to deductions from earned income for the GA categories of MNO-MA).