Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-307 - Eligibility for Home and Community-Based Services Waivers
Section R414-307-4 - Special Income Group
Universal Citation: UT Admin Code R 414-307-4
Current through Bulletin 2024-06, March 15, 2024
This section sets forth financial eligibility requirements for the special income group that apply to individuals seeking Medicaid coverage for services under an HCBS waiver as defined in 42 CFR 435.217.
(1) If the individual's spouse meets the definition of a community spouse, the eligibility agency shall apply income and resources as defined in Section 1924 of the Social Security Act and in Section R414-305-3.
(2) If the individual does not have a spouse, or the individual's spouse does not meet the definition of a community spouse, the eligibility agency may only count the individual's resources to determine eligibility.
(a) If both members of a married
couple who live together apply for waiver services and meet the criteria for
the special income group, the eligibility agency shall count one-half of
jointly held assets as available to each spouse.
(b) Each spouse must pass the medically needy
resource test for one person.
(c)
The eligibility agency may only count income determined under the most closely
associated cash assistance program to decide if the individual passes the
income eligibility test for the special income group.
(d) The eligibility agency may not count
income of the individual's spouse except for contributions from the
spouse.
(e) If the individual is a
minor child, the eligibility agency may not count income and resources of the
child's parents to decide if the child passes the income and resource tests for
the special income group.
(f) The
eligibility agency shall count contributions from a parent, including
court-ordered support payments as income of the child.
(g) The individual's income cannot exceed
three times the payment that would be made to an individual with no income
under Subsection 1611(b)(1) of the Social Security Act.
(h) The eligibility agency shall apply the
transfer of assets in accordance with Section 1917 of the Social Security
Act.
(i) The individual's
cost-of-care contribution is determined by deducting from the individual's
total income, the post-eligibility allowances for the specific waiver for which
the individual qualifies.
(j) The
eligibility agency shall determine financial eligibility for the special income
group for an individual based on the level-of-care date on a valid waiver
referral form as defined in Subsection
R414-307-3(6).
(k) The eligibility agency shall determine
eligibility for earlier months using the community Medicaid or Institutional
Medicaid rules that apply to the individual's situation.
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