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 treatment of spousal impoverishment resources for married and
institutionalized individuals in Section
R414-305-6 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 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 Subsection 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 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.
(v) 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;
(vi) health
insurance premiums for the waiver-eligible member paid by the member, or
medical expenses incurred by the member 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 gives to the spouse or dependent family member.
(d) The remaining amount of income after the
deductions is the individual's cost-of-care contribution.
(4) The individual shall 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) Section
R414-305-9 concerning transfers
of assets applies to individuals seeking eligibility or receiving benefits
under this home and community-based services waiver.
Notes
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