Utah Administrative Code
Topic - Human Services
Title R539 - Health and Human Services, Services for People with Disabilities
Rule R539-1 - Eligibility
Section R539-1-8 - Medicaid Waiver Eligibility and Enrollment for the Limited Supports Waiver

Universal Citation: UT Admin Code R 539-1-8

Current through Bulletin 2024-18, September 15, 2024

(1) Matching federal funds may be available through a limited support waiver that provides an array of home and community-based services for a person with an intellectual disability or related condition, 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 Section 62A-5-102, the division determines waiver enrollment.

(a) The division shall offer enrollment in order of time spent waiting.

(b) The division shall identify a person through:
(i) an adjusted critical needs score at or below the person's age group threshold; and

(ii) no immediate need for out-of-home residential support services.

(c) The adjusted critical need score equals the person's total critical need score minus the time spent waiting component.

(d) A person shall be enrolled in a limited support waiver only if the person's assessed need can be safely met within the individual budget limit.

(4) 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 limited support waiver.

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

(6) 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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