Iowa Admin. Code r. 441-25.16 - Financial eligibility requirements
The
(1)
Income requirements.
a. Income requirements for adult mental
health and disability services shall be as follows:
(1) The person must have an income equal to
or less than 150 percent of the federal poverty level .
(2) A person who is eligible for federally
funded services and other support must apply for such services and
support.
b. Income
requirements for children's behavioral health services shall be as follows:
(1) The child 's family has countable
household income equal to or less than 500 percent of the federal poverty
level . Countable household income and family size shall be determined using the
modified adjusted gross income methodology.
(2) An eligible child whose family's
countable household income is at least 150 percent and not more than 500
percent of the federal poverty level shall be subject to a cost share as
described in subrule 25.16(3).
(3)
Verification of income . Income shall be verified using the best information
available.
1. Pay stubs, tip records and
employers' statements are acceptable forms of verification of earned
income .
2. Self-employment income
can be verified through business records from the previous year if they are
representative of anticipated earnings. If business records from the previous
year are not representative of anticipated earnings, an average of the business
records from the previous two or three years may be used if that average is
representative of anticipated earnings.
(4) Changes in income . Financial eligibility
shall be reviewed on an annual basis and may be reviewed more often in response
to increases or decreases in income .
(5) A child who is eligible for federally
funded services and other support must apply for such services and
support.
(2)
Resource requirements. There are no resource limits for the
family of a child seeking children's behavioral health services . An adult
seeking mental health and disability services must have resources that are
equal to or less than $2,000 in countable value for a single-person household
or $3,000 in countable value for a multiperson household or follow the most
recent federal supplemental security income guidelines.
a. The countable value of all countable
resources , both liquid and non-liquid, shall be included in the eligibility
determination except as exempted in this subrule.
b. A transfer of property or other assets
within five years of the time of application with the result of, or intent to,
qualify for assistance may result in denial or discontinuation of
funding.
c. The following resources
shall be exempt:
(1) The homestead, including
equity in a family home or farm that is used as the individual household 's
principal place of residence. The homestead shall include all land that is
contiguous to the home and the buildings located on the land.
(2) One automobile used for
transportation.
(3) Tools of an
actively pursued trade.
(4) General
household furnishings and personal items.
(5) Burial account or trust limited in value
as to that allowed in the medical assistance program .
(6) Cash surrender value of life insurance
with a face value of less than $1,500 on any one person.
(7) Any resource determined excludable by the
Social Security Administration as a result of an approved Social Security
Administration work incentive.
d. If an individual does not qualify for
federally funded or state-funded services or other support but meets all
income , resource, and functional eligibility requirements of this chapter, the
following types of resources shall additionally be considered exempt from
consideration in eligibility determination:
(1) A retirement account that is in the
accumulation stage.
(2) A medical
savings account .
(3) An assistive
technology account .
(4) A burial
account or trust limited in value as to that allowed in the medical assistance
program .
e. An individual
who is eligible for federally funded services and other support must apply for
and accept such funding and support.
(3)
Cost-share standards. A
regional administrative entity must comply with cost-share standards as defined
in Iowa Code sections
225C.62 and
225C.64.
a. Cost sharing is allowed for adults with
income above 150 percent of the federal poverty level as defined by the most
recently revised poverty guidelines published by the United States Department
of Health and Human Services.
Cost-share amounts for regionally funded
b. Cost-share amounts for children's
behavioral health services are applicable to core services as defined in Iowa
Code section 225C.66. The family of a child
receiving regional funding for behavioral health services shall be responsible
for a cost-share amount based on the family's household income as follows:
|
Family |
Cost Share % Paid by Family |
|
0 to 150% |
0% |
|
151 to 200% |
10% |
|
201 to 250% |
15% |
|
251 to 300% |
20% |
|
301 to 350% |
35% |
|
351 to 400% |
50% |
|
401 to 450% |
65% |
|
451 to 500% |
80% |
|
Over 500% |
100% |
(4)
Cost-share standards required by
any federal, state, regional, or municipal program. Any cost sharing
or other client participation required by any federal, state, regional or
municipal program in which the individual participates shall be required by the
regional administrative entity . Such cost sharing includes, but is not limited
to:
a. Client participation for maintenance in
a residential care facility through the state supplementary assistance
program.
b. The financial liability
for institutional services paid by counties as provided in Iowa Code section
230.15.
c. The financial liability
for attorney fees related to commitment as provided by Iowa Code section
229.8.
Notes
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