This section sets forth financial eligibility requirements
for the medically needy coverage group, and applies to individuals seeking
Medicaid coverage for HCBS under the New Choices Waiver, Community Transitions
Waiver, or the Individuals with Physical Disabilities Waiver.
(1) If an individual's spouse meets the
definition of a community spouse, the eligibility agency shall apply resources
as defined in 42 U.S.C.
1396r-5, Section
R414-305-3, and Section
R414-305-4.
(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 medically needy waiver group, the eligibility agency shall count one-half
of jointly held assets 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 of the individual determined under
the most closely associated cash assistance program to decide eligibility for
the medically needy waiver group.
(d) The eligibility agency may not count
income of the individual's spouse except for actual contributions from the
spouse.
(e) If the individual is a
minor child, the eligibility agency may only count income and resources of the
child and may not count income and resources of the child's parents to decide
if the child passes the income and resource tests for the medically needy
waiver 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 must exceed three
times the payment that would be made to an individual with no income under
42 U.S.C.
1382(b)(1).
(h) To determine eligibility for an
individual, the eligibility agency shall apply the income deductions allowed by
the community Medicaid category under which the individual qualifies.
(i) The eligibility agency shall compare
countable income to the applicable medically needy income limit for a
one-person household to determine the individual's spenddown.
(j) The individual's medical expenses,
including the cost of long-term care services, must exceed the spenddown
amount.
(k) To receive Medicaid
eligibility, the individual must meet the monthly spenddown as defined in
Subsection R414-304-11(12).
(l) The eligibility agency shall deduct
medical expenses incurred by the individual in accordance with Section
R414-304-11.
(m) The eligibility agency shall determine an
individual's financial eligibility for the medically needy waiver group based
on the level-of-care date on a valid waiver referral form as defined in
Subsection R414-307-3(6).
(n) The eligibility agency shall determine
eligibility for earlier months using the community Medicaid or Institutional
Medicaid rules that apply to the individual's situation.
