Utah Admin. Code R539-1-7 - Medicaid Waiver Eligibility and Enrollment for the Comprehensive Support Waivers

Current through Bulletin 2022-07, April 1, 2022

(1) Matching federal funds may be available through a comprehensive support waiver that provides an array of home and community-based services for a person with an intellectual disability or related condition, physical disability, or brain injury.
(a) A person must meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.
(b) A person must meet a waiver level of care as determined by the division.
(2) As described in Subsections 62A-5-102(3) and 62A-5-102(4), the division provides a waiver service within an appropriation from the Legislature.
(a) Except as described in Subsection R539-1-7(2)(d), the division determines waiver enrollment by the most critical need ranking.
(b) The division shall use a need assessment tool to determine a person's need score.
(c) Ordering of each person's need score identifies the most critical need ranking.
(d) The Emergency Services Management Committee may approve enrollment in a comprehensive support waiver as described in Section R539-2-9.
(3) Pursuant to Rule R414-510, if the Department of Health determines that sufficient funding is available, an eligible individual may receive a waiver service by transitioning out of an ICF into a comprehensive support waiver.
(4) Pursuant to Rule R414-502, the Department of Health may find a person meeting nursing facility level of care eligible for funding through a comprehensive support waiver.
(5) Any person offered enrollment in a Medicaid waiver may choose not to participate. If an eligible person chooses not to participate in a waiver, the person shall receive only the state funded portion of their assessed need as described in Section R539-1-9.


Utah Admin. Code R539-1-7
Amended by Utah State Bulletin Number 2016-22, effective 10/25/2016 Amended by Utah State Bulletin Number 2020-08, effective 4/8/2020 Amended by Utah State Bulletin Number 2020-22, effective 11/9/2020 Amended by Utah State Bulletin Number 2022-05, effective 2/22/2022

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