| Home
and Community Based Waiver Programs:
Brain
Injury Waiver
This
Utah Medicaid Waiver program assists clients who have a brain
injury and would be medically appropriate for institutional
care to remain in their own home, instead of being placed
in an institution. Clients are eligible for medical
services that are not generally available to Medicaid recipients,
such as supported employment, day treatment programs, behavioral
training, and in-home respite care. The income standard,
after allowable deductions, is 100% of the Federal Poverty
Level, which is typically adjusted annually. All of
the client's income counts. The
Federal Poverty Level is available on the Internet at http://aspe.hhs.gov/poverty
Income
Eligibility Standards in Monthly Amounts (April
2005)
Household
Size *Monthly
Income
1
. . . . . . . . . . . . . . . . $ 798
*Deductions
Deduct
$125 earned income, spousal and family allowance, health and
accident insurance premiums, medical expenses, and some shelter
costs.
*Spenddown
Medicaid
applicants whose income exceeds the monthly income standard
may be considered for the Medically Needy program, sometimes
referred to as the Spenddown Program. This program allows
a person who is otherwise eligible either to pay "excess"
monthly income to the state or to accept responsibility for
a portion of their monthly medical bills.
Asset
Limits
Nursing
home client - $2,000.00
For married
persons with a spouse in the home, assets are divided between
husband and wife. All assets are considered to be jointly
owned even if only one member of the couple is shown as the
owner. Special allowances for burial spaces and funeral
plans. As of January 2003, the spouse at home
is allowed to keep at least $18,132 of the assets the couple
owned when the client entered the nursing home, and no more
than $90,660. Current limits can be found at the web site
for the Centers for Medicare & Medicaid Services: http://cms.hhs.gov/medicaid/eligibility/
Transfer
of Assets
Sanctions
apply if either (1) individual or spouse transfers assets
within 36 months, or within 60 months if a trust, of application
date for Medicaid, or (2) the individual transfers assets
at any time after eligibility is determined. Waiver services
are not paid during a sanction period
Retroactive
Coverage
Medicaid
eligibility for any of the three months prior to the month
of application. Most Medicaid programs allow an applicant
to request coverage for medical services for up to three months
prior to the month in which the person filed a Medicaid application.
A person who received medical, dental or mental health services
and subsequently qualifies for Medicaid may return to each
provider with a Medicaid Identification Card for the month
in which service was provided. A provider who has already
rendered services may subsequently choose to accept Medicaid
as payment in full or refuse to seek Medicaid payment
because the patient had not been determined eligible for Medicaid
at the time of service. If the provider accepts Medicaid,
Medicaid may pay for the service. If the provider refuses
Medicaid, the patient is responsible for the charges.
RETURN
TO TOP OF PAGE
|
