Utah Administrative Code
Topic - Human Services
Title R539 - Health and Human Services, Services for People with Disabilities
Rule R539-1 - Eligibility
Section R539-1-7 - Medicaid Waiver Eligibility and Enrollment for the Comprehensive Support Waivers

Universal Citation: UT Admin Code R 539-1-7

Current through Bulletin 2024-18, September 15, 2024

(1) Matching federal funds may be available through a comprehensive support waiver that provides an array of home and community-based services for a person with an intellectual disability or related condition, physical disability, or brain injury.

(a) A person must meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.

(b) A person must meet a waiver level of care as determined by the division.

(2) As described in Subsections 62A-5-102(3) and 62A-5-102(4), the division provides a waiver service within an appropriation from the Legislature.

(a) Except as described in Subsection R539-1-7(2)(d), the division determines waiver enrollment by the most critical need ranking.

(b) The division shall use a need assessment tool to determine a person's need score.

(c) Ordering of each person's need score identifies the most critical need ranking.

(d) The Emergency Services Management Committee may approve enrollment in a comprehensive support waiver as described in Section R539-2-9.

(3) Pursuant to Rule R414-510, if the Department of Health determines that sufficient funding is available, an eligible individual may receive a waiver service by transitioning out of an ICF into a comprehensive support waiver.

(4) Pursuant to Rule R414-502, the Department of Health may find a person meeting nursing facility level of care eligible for funding through a comprehensive support waiver.

(5) Any person offered enrollment in a Medicaid waiver may choose not to participate. If an eligible person chooses not to participate in a waiver, the person shall receive only the state funded portion of their assessed need as described in Section R539-1-9.

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