Iowa Admin. Code r. 441-301.1 - [Effective 7/1/2025] Individual eligibility for behavioral health service system funding

To be eligible for behavioral health service system funding, an individual must meet the following financial and needs-based eligibility criteria.

(1) Financial eligibility. Income requirements for adults and household income for children are as follows:

a. Income equal to or less than 200 percent of the federal poverty level.

b. Income will be verified using the best information available.

c. Financial eligibility will be reviewed on an annual basis and may be reviewed more often in response to increases or decreases in income.

d. An individual who is eligible for medical assistance must apply for and exhaust such funding for services and supports prior to utilization of behavioral health service system funding.

(2) Resource requirements. Individuals seeking behavioral 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.

a. The countable value of all countable resources, both liquid and nonliquid, will 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 will be exempt:

(1) A homestead, including equity in a family home or farm that is used as the individual household's principal place of residence. The homestead will 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 will 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.

(3) Needs-based eligibility. An individual must:

a. Be a resident of Iowa or, if a minor, the custodial parent or legal guardian is a resident of Iowa.

b. Currently have, or at any time during the preceding 12-month period have had, a behavioral health condition.

(4) Service-specific eligibility. Notwithstanding the financial and needs-based eligibility requirements in subrule 301.1(1), 301.1(2), or 301.1(3), individuals may be subject to additional diagnostic, level of care, or admission requirements for services. Individuals receiving:

a. Twenty-three-hour observation and holding services must meet admission criteria set forth in 441-subrule 24.37(1).

b. Crisis stabilization community-based services must meet service eligibility requirements set forth in 441-subrule 24.38(1).

c. Crisis stabilization residential services must meet service eligibility requirements set forth in 441-subrule 24.39(1).

d. Covered substance use disorder treatment services must meet the applicable levels of the third edition of the American Society of Addiction Medicine (ASAM) Criteria as published by the ASAM and as amended to July 1, 2025.

e. Assertive community treatment (ACT) services must meet service eligibility requirements set forth in 441-subrule 78.45(1).

f. Subacute services must meet admission requirements set forth in 481-subrule 71.13(2).

g. Outpatient competency restoration must have a court order to receive the service pursuant to Iowa Code section 812.6.

h. Psychiatric medical institutions for children (PMIC) services must meet certification of need requirements set forth in rule 481-41.9 (135H).

(5) Exceptions. Receipt of the following behavioral health services is as defined and is not subject to individual eligibility criteria in subrule 301.1(1), 301.1(2), or 301.1(3):

a. Prevention.

b. Early intervention services.

c. Crisis services.

d. Outpatient competency restoration.

e. Jail-based behavioral health services.

f. System navigation.

Notes

Iowa Admin. Code r. 441-301.1

Adopted by IAB May 14, 2025/Volume XLVII, Number 23, effective 7/1/2025