General Program Administration and Table of Contents

Administering Medicaid Programs – these numbered pages contain federal cites and brief statements regarding program administration and organization of the state organization Medicaid

• Section 1 - Single State Agency
• Section 2 - Coverage and Eligibility
• Section 3 - Services: General Provisions
• Section 4 - General Program Administration
• Section 5 - Personnel Administration
• Section 6 - Financial Administration
• Section 7 - General Provisions

MAGI Eligibility and Benefits State Plan Amendments

Describes Medicaid program client coverage and conditions of eligibility; Application forms and methods for individuals to apply for and renew Medicaid coverage

• MAGI-Based Eligibility Groups
• S94  General Eligibility Requirements, Eligibility Process
• S10  MAGI-Based Income Methodologies
• A1, A2, & A3  Addresses single state agencies delegation of appeals and determinations
• S88  Residency
• S89  Non-Financial Eligibility Citizenship & Non-Citizen
• S21  Hospital Presumptive Eligibility

Attachment 2.1-A Definition of an HMO to 2.2-A Eligibility Groups

Describes Medicaid program client coverage and conditions of eligibility

• Mandatory Coverage - Categorically Needy and Other Required Special Groups
• Optional Groups Other Than the Medically Needy
• Optional Coverage of the Medically Needy
• Requirements Relating to Determining Eligibility for Medicare Prescription Drug Low-Income Subsidies
• Method for Determining Cost Effectiveness of Caring for Certain Disabled Children at Home

Attachment 2.6-A Income and Resource Eligibility

Describes Medicaid program client coverage and conditions of income and resource eligibility

• 2.6-A  Eligibility Conditions and Requirements, Pages 1-26
• 2.6-A  Supplements 1-18

1. Income Eligibility Levels
2. Resource Levels
3. Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered Under Medicaid
4. Methods for Treatment of Income That Differ From Those of The SSI Program
5. More Restrictive Methods of Treating Resources Than Those of The SSI Program - Section 1902(f) States Only
6. Standards for Optional State Supplementary Payments
7. Income Levels for 1902(f) States - Categorically Needy Who are Covered Under Requirements More Restrictive Than SSI
8. Resource Standards for 1902(f) States - Categorically Needy
9. Transfer of Resources
10. The agency does not apply the trust provisions in any case in which the agency determines that such application would work an undue hardship.
11. More Liberal Policy Under Section 1902(r) of the Social Security Act
12. Eligibility Under Section 1931 of the Act
13. Section 1924 provisions
14. Income and Resource Requirements for Tuberculosis (TB) Infected Individuals
15. Asset Verification System
16. Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
17. Methodology for Identification of Applicable FMAP Rates

Attachment 3.1-A to Attachment 3.1-I Services

Describes amount, duration, scope, and types of covered services

• 3.1-A  Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
• 3.1-B  Amount, Duration, and Scope of Services Provided Medically Needy Group(s)
• 3.1-C  Standards and Methods of Assuring High Quality Care
• 3.1-D  Methods of Providing Transportation
• 3.1-E  Standards for the Coverage of Organ and Tissue Transplant Services
• 3.1-I  1915(i) State Plan Home and Community Based Services Administration and Operation

Attachment 3.1-L Delaware Alternative Benefit Plan

Identifies and defines the Adult eligibility group that receives their Medicaid coverage through an Alternative Benefit Plan (ABP)

• ABP1 - Alternative Benefit Plan Populations
• ABP2a - Voluntary Benefit Package Selection Assurances - Eligibility Group Under Section 1902(a)(10)(A)(i)(VIII) of the Act
• ABP3 - Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package
• ABP4 - Alternative Benefit Plan Cost-Sharing
• ABP5 - Benefits Description
• ABP7 - Benefits Assurances
• ABP8 - Service Delivery Systems
• ABP10 – General Assurances
• ABP11 – Payment Methodology

Attachment 4.11-A to Attachment 7.7.C COVID-19 Treatment at section 1905(a)(4)(F)
of the Social Security Act

Describes reimbursement, quality control and Title VI Civil Rights

• 4.11-A  Standards for Institutions
• 4.14-B  Methods for Control of the Utilization of Intermediate Care Facility (ICF) Services
• 4.16-A  Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies and Title V Grantees
• 4.17-1  Liens and Adjustments or Recoveries
• 4.18-A  Charges Imposed on Categorically Needy
• 4.18-C  Charges Impose on the Medically Needy
• 4.18-D  Premiums Imposed on Low Income Pregnant Women and Infants
• 4.18-E  Optional Sliding Scale Premiums Imposed on Qualified Disabled and Working Individuals
• 4.19-A  Payment Adjustment for Provider preventable Conditions
• 4.19-A  Methods and Standards for Establishing Payment Rates – Inpatient Hospital Care
• 4.19-A.1  Methods and Standards for Establishing payment Rates Inpatient Psychiatric Hospital Care
• 4.19-A.2  Methods and Standards for Establishing Payment Rates for Freestanding Inpatient Rehabilitation Hospital Services
• 4.19-B  Methods and Standards for Establishing Payment Rates Other Types of Care
• 4.19-C  Standards for Payment of Reserved Beds During Absence from Long-Term Care Facilities
• 4.19-D  Methods and Standards for Establishing Payment Rates Prospective Reimbursement System for Long-Term Care Facilities
• 4.19-E  Definition of a "claim"
• 4.22-A through 4.22-C  Requirements for Third Party Liability (TPL)
• 4.30 Sanctions for Psychiatric Hospitals
• 4.32-A  Income and Eligibility Verification System Procedures Requests to Other State Agencies
• 4.33-A  Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
• 4.34-A  Requirements for Advance Directives Under State Plans for Medical Assistance
• 4.35-A through 4.35-H  Enforcement of Compliance for Nursing Facilities
• 4.38  Disclosure of Additional Registry Information
• 4.39  Definition of Specialized Services
• 4.39-A  Categorical Determinations
• 4.40-A through 4.40-E  Eligibility Conditions and Requirements
• 4.42-A  False Claims Act Attachment
• 7.2-A  Methods of Administration-Civil Rights
• 7.7-A Vaccine and Vaccine Administration at Section 1905(a)(4)(E) of the Social Security Act
• 7.7-B COVID-19 Testing at section 1905(a)(4)(F) of the Social Security Act
• 7.7-C COVID-19 Treatment at section 1905(a)(4)(F) of the Social Security Act