Current through Register Vol. 48, No. 9, September 27, 2024
A. A
medical evaluation must be supplied as evidence of disability. It is the
responsibility of the applicant to provide any required medical evaluation(s)
on the agency-supplied forms. Additional medical data may be supplied in any
form and will be considered by the Agency. If the evaluation shows that the
individual is either totally and permanently disabled or is not disabled, the
application for GDA shall be denied by the County Department.
B. In all other cases, eligibility decisions
based on medical information shall be made by a Medical Social Worker, with the
assistance of a consulting physician when necessary. The medical evaluation,
along with a social evaluation completed by the County Department and
containing information relating to the family, background, work history, and
past and present health of the applicant, as well as rehabilitation efforts,
will be evaluated by the Medical Social Worker to determine if the individual
is medically eligible, and if so, for how many months.
C. If a disability exists but is expected to
last longer than six months, the individual shall be referred to the Social
Security Administration (SSA) to apply for the SSI program.
D. Eligibility for GDA shall not be extended
beyond six months for any one medical diagnosis. A new and different diagnosis,
however, may qualify an individual for a new grant. A new application will be
necessary in case of a new and different diagnosis of disability.
E. To be considered eligible for GDA, an
individual can have no cash reserve or any other resources except the
following:
(1) An individual may own or retain
a homestead,
(2) An individual may
have insurance policies with a face value of any amount, but the total cash
surrender or loan value shall not exceed fifteen hundred dollars for all
policies.
(3) An individual may
have one licensed vehicle that is used for transportation purposes and is not
income producing.
(4) An individual
may have up to 2 times the maximum monthly payment level for the GDA Program in
cash reserves.
F. If an
individual sells real or personal property, the money from the sale shall be
considered as income for meeting current living expenses. If an individual
transfers real or personal property without receiving fair market value
therefor, he will not be eligible for GDA until such time as fair market value
is received and used for current living expenses.
G. Any income from employment shall render an
individual ineligible for GDA. The spouse of the individual may have income
from employment. If the spouse is included in the budgetary computation, the
spouse's gross wages shall be considered as available income.
H. For purposes of budgeting, an individual
and spouse who are living together shall be treated as a unit, except as
follows:
(1) If the spouse is receiving SSI or
Aid to Families with Dependent Children (AFDC), the spouse is not included in
the GDA budget and any income which has been considered by SSA in determining
the SSI payment amount or which has been considered in determining the AFDC
payment amount shall not be considered available to the GDA applicant or
recipient.
(2) If the spouse has
children of which the GDA applicant or recipient is not the legal parent and
the children are not eligible for SSI or AFDC, the spouse's income shall be
allocated to the children according to current AFDC standards. Any income of
the children shall be subtracted from the AFDC standard in determining the
amount to be allocated from the parent.
(3) If both members of the couple apply for
and are found eligible for GDA, a budget is computed for the couple to
determine if a deficit exists. If so, each person may be certified for a
payment equal to one-half the deficit, not to exceed the maximum payment level
per individual.
I. Total
needs consist of an allowance for basic requirements and of allowances for
special needs, if applicable.
(1) Basic
requirements are items of need considered essential to all people in the
assistance budget. Allowances are included for food, clothing, medical chest,
incidentals, household needs, laundry, insurance, shelter, and utilities. The
basic requirements allowance for an individual is ninety-four dollars and
fifty-five cents per month and the basic requirement allowance for an
individual and spouse is one hundred forty-three dollars and eighty cents per
month.
(2) Allowances for the
following special needs may be included if verification is provided by an
individual's physician that the special need currently exists.
(a) A standard allowance of six dollars per
month for a special diet will be included for each person with tuberculosis or
an arrested tubercular case who still requires medication for the
illness.
(b) An allowance of up to
one hundred thirty dollars per month will be included for nursing care in the
home if medical necessity is verified and documented and if the care cannot be
provided by responsible relatives in the home.
J. Total income for eligibility purposes
means total gross income.
If any person in a GDA budget receives income from the sources
specified in 114-11-50 B, such income shall be disregarded in the same manner
as in the AFDC program. Income received on a weekly basis shall be multiplied
by four and one-third to obtain the monthly amount. Irregular unearned income
as defined in 114-11-50(A)(2)(b) shall be computed in the same manner as in the
AFDC program.
K. Amount of
assistance to be granted shall be determined by subtracting total rounded
income from total rounded needs. The award will be the amount of the deficit,
but may not exceed the maximum payment level.
L. Maximum payment level for GDA shall be set
by the agency each year according to funds available from the State General
Appropriation Act.
M. An individual
who is determined eligible for a GDA money payment shall be eligible for State
Medical Assistance beginning with the first day of the month of certification
for GDA payment. There shall be no eligibility for medical services performed
before this date for GDA clients.
N. Institutional Living Situations.
(1) An individual who needs or desires to
live in a public or private institution may be eligible for GDA and medical
vendor payments, depending on the nature of the institution and whether the
individual is otherwise eligible for GDA.
(2) To be eligible for GDA while living in an
institution, the individual must be in a public or private Title XIX certified
hospital or nursing facility or a licensed residential care facility.
(3) An individual shall not be eligible for
GDA while a patient in or resident of a public or private medical institution
which is not Title XIX certified or which is operated primarily for the care of
mentally ill or tubercular patients.
(4) The need for nursing care must be
certified by the Professional Standards Review Organization (PSRO) before
medical vendor payment can be authorized.
(5) The institution in which the individual
is living must be licensed by the appropriate State licensing
authority.
(6) If the individual is
a patient in a public or private hospital, financial eligibility shall be
determined according to the individual's home situation.
(7) An individual who resides in a licensed
nursing facility shall be allowed a personal needs allowance, the amount of
which is set annually by the agency.
(a) If
the individual has income it shall be subtracted from the personal needs
allowance in determining the amount of the GDA payment. If the income exceeds
the personal needs amount, a budget shall be computed to see if the individual
would be eligible in his or her home situation. If so, the individual shall be
eligible for GDA-Medical Assistance Only.
(b) Any income the individual has in excess
of the personal needs allowance shall be applied to his or her cost of
care.
(8) A GDA-eligible
individual who resides in a licensed residential care facility shall have
financial eligibility established according to the Net Income Limitation (NIL)
as defined in 114-19-10(C) for the Optional Supplementation Program. The NIL is
set by the State General Appropriation Act.
(a) All income available to the individual
shall be budgeted against total requirements in determining the GDA
payment.
(b) The payment amount
will be the exact amount of the deficit.
