Home and Community Based Waiver Programs:

Medically Fragile / Technology Dependent Children

This Utah Medicaid Waiver program assists medically fragile children (up to age 21) to remain in their own homes, rather than being placed in an institution.  There is a limit on the number of children allowed into the waiver program.  Applications are taken through the a Division of Family Health Services case manager.  None of the parent's income or assets is counted in considering the child's eligibility.  Also, an intensive service plan is written for the child, and all services are paid by Medicaid.  To be eligible for this program, children must meet specific medical criteria.  The income standard, after allowable deductions, is 100% of the Federal Poverty Level, which is typically adjusted annually.  All of the child'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 $500 from 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

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

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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