(1) An individual must be 65 years of age or
older, or at least 18 through 64 years of age and disabled to be eligible for
the New Choices Waiver, as defined in Subsection 1614(a)(3) of the Social
Security Act. In accordance with the waiver, the eligibility agency considers
an individual to be 18 years of age after the month in which the individual
turns 18 years old.
(2) A single
individual or any married individual with a community spouse, who is eligible
under the special income group, may be required to pay a contribution toward
the cost -of -care to receive services under an HCBS waiver. The eligibility
agency determines a member's cost-of-care contribution as follows:
(a) The eligibility agency counts the
member's income unless the income is excluded under other federal laws that
exclude certain income from being counted to determine eligibility for
federally funded, needs-based medical assistance.
(b) The eligibility agency shall deduct the
following amounts from the individual's income:
(i) a personal needs allowance equal to 100%
of the federal poverty guideline for a household of one;
(ii) for individuals with earned income, up
to $125 of gross-earned income;
(iii) monthly shelter costs not to exceed
$300. This deduction includes mortgage, insurance, property taxes, rent, and
other shelter expenses;
(iv) a
deduction for monthly utility costs equal to the standard utility allowance the
state uses under Subsection 5(e) of the Food Stamp Act of 1977. If the waiver
member shares utility expenses with others, the allowance is prorated
accordingly;
(v) in the case of a
married individual with a community spouse, an allowance for a community spouse
and dependent family members who live with the community spouse, in accordance
with Section 1924 of the Social Security Act;
(vi) if an individual has a dependent family
member at home and Section 1924 of the Social Security Act does not apply an
allowance for a dependent family member that is equal to one-third of the
difference between the minimum monthly spousal needs allowance defined in
Section 1924 of the Social Security Act and the family member's monthly income;
and
(vii) if more than one
individual qualifies for an HCBS waiver or Institutional Medicaid coverage and
contributes income to the dependent family member, the combined income
deductions of these individuals cannot exceed one-third of the difference
between the minimum monthly spousal needs allowance and the family member's
monthly income.
(c) The
eligibility agency shall end this deduction if the dependent family member
enters a medical institution and medical and remedial care expenses incurred by
the individual are in accordance with Section
R414-304-11.
(d) The income deduction to provide an
allowance to a spouse or a dependent family member may not exceed the amount
the individual gives to the spouse or dependent family member.
(e) The remaining amount of income after the
deductions in Subsections (2)(a), (b) and (c) is the individual's cost-of-care
contribution.
(3) The
individual shall pay the cost-of-care contribution to the eligibility agency
each month to receive services under an HCBS waiver.
