DETERMINING FINANCIAL ELIGIBILITY  4.4

Applicants and recipients of the Alliance program must meet income and asset limits. Income and assets that are countable for Medicaid are countable for the Alliance program. Financial eligibility must be verified.

Income Limits 4.4.1

The group's net income must be below 200 percent of the Federal Poverty Limit (FPL) for the group size. See the table for the AX program in Exhibit VI-3, MA Income Standards in Part VI, Chapter 8.

Determining Income Eligibility  4.4.2

To determine if the group meets income requirements, complete the following:

• Determine the group’s gross income in accordance with policies detailed in Part VI: Financial Eligibility Requirements,
• Deduct up to the first $100 in earned income, and
• Compare the result to the current income standard.

The group is eligible if the income after deductions is below the current income standard based on the group size.

Individuals or groups ineligible for Alliance benefits because their incomes exceed income limits cannot become eligible by spending down their income on medical expenses.

Asset Limits  4.4.3

The group must meet the asset limits listed in the chart below:

Third Party Liability  4.4.4

Each applicant who is legally able must assign to the Department rights to third party resources, unless s/he has good cause for not cooperating. A third party resource is a person, entitlement, or program that is liable for payment of all or a part of an individual’s medical expenses. In most instances, the third party is an insurance company. 

An applicant must surrender to the District Government any reimbursements or other payments received from an insurance company, court settlement, or other source for health care or medical services that were covered, and paid for, by the District’s Medicaid or medical assistance programs. See Part V, Chapter 3: Program Requirements and Sanctions, Third Party Requirements, for additional information.