Iowa Admin. Code r. 441-177.4 - Eligibility and application
(1)
Eligibility. To be eligible for in-home health-related care:
a. The individual must be eligible for
supplemental security income in every respect except for income.
b. A physician must certify in accordance
with rule
441-177.6 (249)
that the individual requires either skilled services or personal care services
and that those services can be provided in the individual's own home . The
certification shall be provided using Form 470-0673.
c. The individual shall live in the
individual's own home . Notwithstanding the foregoing, an individual will remain
eligible for a period not to exceed 15 days in any calendar month when the
client is temporarily absent from the client's home.
d. The individual shall obtain a physical
examination report annually and shall be under the supervision of a
physician.
e. The required skilled
services or personal care services must not be available under any other state
or federal program.
f. The
countable income of the individual and spouse living in the home shall be
limited to $480.55 per month if one needs care or $961.10 if both need care,
after the following disregards from gross income:
(1) The amount of the basic supplemental
security income standard for an individual or a couple, as
applicable.
(2) When income is
earned, $65.00 plus one-half of any remaining income.
(3) The amount of the supplemental security
income standard for a dependent plus any established unmet medical needs, for
each dependent living in the home. Any income of the dependent shall be applied
to the dependent's needs before making this disregard.
(4) The amount of the established medical
needs of the ineligible spouse which are not otherwise met.
(5) The amount of the established medical
needs of the applicant or recipient which are not otherwise met and would not
be met if the individual were eligible for the medical assistance
program.
g. Income for
children.
(1) All income received by the
parents in the home shall be deemed to the child with the following disregards:
1. The amount of the basic supplemental
security income standard for an individual when there is one parent in the home
or for a couple when there are two parents in the home.
2. The amount of the basic supplemental
security income standard for a dependent for each ineligible child in the
home.
3. The amount of the unmet
medical needs of the parents and ineligible dependents.
4. When all income is earned, an additional
basic supplemental security income standard for an individual in a one-parent
home or for a couple in a two-parent home.
5. When the income is both earned and
unearned, $65.00 plus one-half of the remainder of the earned income.
(2) The countable income of the
child shall be limited to $480.55 per month after the following disregards from
gross income:
1. The amount of the basic
supplemental security income standard for an individual.
2. The amount of the established medical
needs of the child which are not otherwise met and would not be met if the
child were eligible for the medical assistance program.
3. One-third of the child support payments
received from an absent parent.
(2)
Application. Application
for in-home health-related care shall be made on Form 470-5170 or 470-5170(S)
and submitted to the department. An eligibility determination shall be
completed within 30 days from the date of the application, unless one or more
of the following conditions exist:
a. An
application has been filed and is pending for federal supplemental security
income benefits.
b. The application
is pending because the department has not received information, which is beyond
the control of the client or the department.
c. The application is pending due to the
disability determination process performed through the department.
d. The application is pending because the
provider agreement has not been completed and completion is beyond control of
the client. When the provider agreement cannot be completed due to the client's
failure to locate a provider, applications shall not be held pending beyond 60
days from the date of application.
Notes
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