Utah Admin. Code R414-307-7 - Community Supports Home and Community-Based Services Waiver for Individuals with Intellectual Disabilities and Other Related Conditions
(1) Medicaid
eligibility for the Community Supports Home and Community-Based Services waiver
is limited to individuals with intellectual disabilities and other related
conditions.
(2) An individual's
resources must be equal to or less than the Medicaid resource limit applicable
to an institutionalized person. The spousal impoverishment resource provisions
for married, institutionalized individuals in Section
R414-305-3
apply to a married individual.
(3)
An eligible individual may be required to pay a contribution toward the
cost-of- care to receive home and community-based services. The eligibility
agency shall determine an individual's cost-of-care contribution as follows:
(a) The eligibility agency shall count all of
the individual's income unless such income is excluded under other federal laws
that exclude certain income from being counted to determine eligibility for
federally-funded, needs-based medical assistance.
(b) The eligibility agency shall deduct the
following amounts from the individual's income:
(i) For an individual with earned income,
earned income up to the substantial gainful activity level of earnings defined
in Section 223(d)(4) of the Compilation of the Social Security Laws in effect
April 4, 2012, to determine countable earned income.
(ii) A personal needs allowance for the
individual equal to 100% of the federal poverty level for one person.
(iii) In the case of a married individual
with a community spouse, a deduction for a community spouse and dependent
family members living with the community spouse in accordance with the
provisions of Section 1924 of the Social Security Act.
(iv) In the case of an individual who does
not have a community spouse or whose spouse is also eligible for institutional
or waiver services, an allowance for a dependent family member that is equal to
one-third of the difference between the minimum monthly spousal needs allowance
defined in Section 1924 of the Social Security Act and the family member's
monthly income. If more than one individual who qualifies for a Medicaid home
and community-based waiver or institutional Medicaid coverage contributes
income to the dependent family member, the combined income deductions of such
individuals cannot exceed one-third of the difference between the minimum
monthly spousal needs allowance and the family member's monthly
income.
(v) Health insurance
premiums for the waiver-eligible recipient paid by the recipient, or medical
expenses incurred by the recipient in accordance with Section
R414-304-11.
(c) The income deduction to
provide an allowance to a spouse or a dependent family member cannot exceed the
amount the individual actually gives to such spouse or dependent family
member.
(d) The remaining amount of
income after such deductions is the individual's cost-of-care
contribution.
(4) The
individual must pay the contribution to cost-of-care to the eligibility agency
each month to receive home and community-based services.
(5) The eligibility agency shall count
parental and spousal income only if the individual receives a cash contribution
from a parent or spouse.
(6) The
provisions of Section
R414-305-9
concerning transfers of assets apply to individuals seeking eligibility or
receiving benefits under this home and community-based services
waiver.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Medicaid eligibility for the Community Supports Home and Community-Based Services waiver is limited to individuals with intellectual disabilities and other related conditions.
(2) An individual's resources must be equal to or less than the Medicaid resource limit applicable to an institutionalized person. The spousal impoverishment resource provisions for married, institutionalized individuals in Section R414-305-3 apply to a married individual.
(3) An eligible individual may be required to pay a contribution toward the cost-of- care to receive home and community-based services. The eligibility agency shall determine an individual's cost-of-care contribution as follows:
(a) The eligibility agency shall count all of the individual's income unless such income is excluded under other federal laws that exclude certain income from being counted to determine eligibility for federally-funded, needs-based medical assistance.
(b) The eligibility agency shall deduct the following amounts from the individual's income:
(i) For an individual with earned income, earned income up to the substantial gainful activity level of earnings defined in Section 223(d)(4) of the Compilation of the Social Security Laws in effect April 4, 2012, to determine countable earned income.
(ii) A personal needs allowance for the individual equal to 100% of the federal poverty level for one person.
(iii) In the case of a married individual with a community spouse, a deduction for a community spouse and dependent family members living with the community spouse in accordance with the provisions of Section 1924 of the Social Security Act.
(iv) In the case of an individual who does not have a community spouse or whose spouse is also eligible for institutional or waiver services, an allowance for a dependent family member that is equal to one-third of the difference between the minimum monthly spousal needs allowance defined in Section 1924 of the Social Security Act and the family member's monthly income. If more than one individual who qualifies for a Medicaid home and community-based waiver or institutional Medicaid coverage contributes income to the dependent family member, the combined income deductions of such individuals cannot exceed one-third of the difference between the minimum monthly spousal needs allowance and the family member's monthly income.
(v) Health insurance premiums for the waiver-eligible recipient paid by the recipient, or medical expenses incurred by the recipient in accordance with Section R414-304-11.
(c) The income deduction to provide an allowance to a spouse or a dependent family member cannot exceed the amount the individual actually gives to such spouse or dependent family member.
(d) The remaining amount of income after such deductions is the individual's cost-of-care contribution.
(4) The individual must pay the contribution to cost-of-care to the eligibility agency each month to receive home and community-based services.
(5) The eligibility agency shall count parental and spousal income only if the individual receives a cash contribution from a parent or spouse.
(6) The provisions of Section R414-305-9 concerning transfers of assets apply to individuals seeking eligibility or receiving benefits under this home and community-based services waiver.