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

Attachment 3.1-A to Attachment 3.1-I Services describe 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 describe 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