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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.
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