22 Va. Admin. Code § 30-130-40 - Eligibility determination

A. To request home-based services, the adult or the adult's responsible person shall submit a service application (Application for Adult Services Form) to the local department. The service application shall be on a form provided by the department. The local department shall document receipt of the application in the department-designated case management system. A service application shall not be required to request a screening for long-term care services and supports, for an assisted living facility assessment, or for review of an annual guardian report.

B. Determinations for functional eligibility and financial eligibility are separate processes but shall be pursued simultaneously. Functional and financial eligibility shall be determined as promptly as possible. The local department shall notify the adult of its eligibility determination decision no later than 45 days from the date the application is received by the local department.

C. The local department shall determine the adult's functional eligibility for home-based services. Home-based services shall not be available to adults who reside in an institutional setting including a nursing facility, assisted living facility, or hospital. The local department shall assess the adult using the UAI, the department-designated form, including evaluating the adult's degree of independence or need for assistance with performing ADLs and IADLs.

D. The local department shall determine the adult's financial eligibility for home-based services.

1. If the local department chooses to offer home-based services under universal access, the adult is financially eligible for home-based services without consideration of the adult's income.

2. If the local department chooses to offer home-based services under income maintenance, the local department shall verify and document the adult's source of income in the department-designated case management system, and document whether the adult is eligible for an Auxiliary Grant, Temporary Assistance for Needy Families, or Supplemental Security Income. Adults who receive an Auxiliary Grant, Temporary Assistance for Needy Families, or Supplemental Security Income meet the financial eligibility requirement for home-based services offered under the income maintenance category.

3. If the local department chooses to offer home-based services under eligibility based on income, each local board shall select a threshold percentage of the median income to evaluate financial eligibility for adults. The department shall provide a scale of the median income for a family of four in Virginia as updated periodically in the Federal Register by the U.S. Department of Health and Human Services annually to local departments to use to determine financial eligibility. The adult's income, not resources, shall be counted when determining the adult's financial eligibility. The local department shall verify and document the adult's income in the department-designated case management system. Income from the following resources shall be disregarded when determining financial eligibility for home-based services in eligibility based on income category:

a. Home produce utilized by the adult for his own consumption;

b. The value of food benefits under the Supplemental Nutrition Assistance Program;

c. The value of supplemental food assistance received under the Child Nutrition Act of 1966 (42 USC §§ 1771 through 1789). This includes all school meals programs; the Women, Infants and Children program; and the Child Care Food program;

d. The value of foods donated under the U.S. Department of Agriculture Commodity Distribution Program, including those foods furnished through the school meal programs;

e. Benefits received under Nutrition Program for the Elderly, Title VII of the Older Americans Act of 1965, as amended (42 USC §§ 3001 et seq.);

f. Grants or loans to any undergraduate students for educational purposes made or insured under any program administered by the U.S. Secretary of Education;

g. A scholarship or grant obtained and used under conditions that preclude its use for current living costs;

h. Training allowance provided by the department for persons participating in rehabilitative services programs;

i. Payments to VISTA volunteers;

j. The Veterans Administration educational amount for the caretaker 18 years of age or older when used specifically for educational purposes. Any additional money included in the benefit amount for dependents is to be counted as income;

k. Income tax refunds including earned income tax credit advance payments and refunds;

l. Payments made under the Energy Assistance Program;

m. All federal, state, and local government rent and housing subsidies and utility payments;

n. Funds distributed to or held in trust for members of any Indian tribe under Public Laws 92-254, 93-134, 94-540, 97-458, 98-64, 98-123, or 98-124. Additionally, interest and investment income accrued on such funds while held in trust, and purchases made with such interest and investment income;

o. All bona fide loans. The loan may be for any purpose and may be from a private individual as well as from a commercial institution. The amount disregarded is limited to the principal of the loan;

p. Monetary gifts for special occasions such as the adult's birthday, holidays, or graduations;

q. Withdrawals of bank deposits;

r. Payments to vendors for services provided to the adult; and

s. Lump sum insurance payments.

Notes

22 Va. Admin. Code § 30-130-40

Derived from Virginia Register Volume 37, Issue 19, eff. 6/9/2021.

Statutory Authority: §§ 51.5-131 and 51.5-145 of the Code of Virginia.