reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.784 - APPEAL OF SSA DECISION AND CONTINUED MEDICAID

Current through August 31, 2023
A Medicaid participant, denied RSDI or SSI because he is not
				disabled, can continue to get Medicaid if he appeals the SSA decision. The
				appeal must be filed within sixty (60) days of the SSA decision. If the final
				administrative decision rules against the participant's appeal, Medicaid
				benefits must end. Medicaid benefits paid during the appeal are not an
				overpayment. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.785 - CERTAIN DISABLED CHILDREN

Current through August 31, 2023
A disabled child, not eligible for Medicaid outside a medical
				institution, is eligible for Medicaid if he meets the conditions in Subsections
				785.01 through
				785.08 of these rules.
				(3-17-22)
01.
Age
. Is
			 under nineteen (19) years old. (3-17-22)
02.
AABD Criteria
. Meets the
			 AABD blindness or disability criteria. (3-17-22)
03.
AABD Resource Limit
. Meets
			 the AABD single person resource limit. (3-17-22)
04.
Income Limit
. Has monthly
			 income not exceeding three (3) times the Federal SSI benefit payable monthly to
			 a single person. (3-17-22)
05.
Eligible for Long Term Care
. Meets the medical conditions for
			 long-term care in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."
			 (3-17-22)
06.
Appropriate
			 Care
. Is appropriately cared for outside a medical institution, under a
			 physician's plan of care. (3-17-22)
07.
Cost of Care
. Can be cared
			 for cost effectively outside a medical institution. The estimated cost of
			 caring for the child must not exceed the cost of the child's care in a
			 hospital, nursing facility, or ICF/IID. (3-17-22)
08.
Share of Cost
. The
			 financially responsible adult of a certain disabled child, who has family
			 income above one hundred fifty percent (150%) of the federal poverty
			 guidelines, is required to share in the cost of the child's Medicaid benefits
			 under the provisions in IDAPA 16.03.18, "Medicaid Cost-Sharing."
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.786 - EXTENDED (POSTPARTUM) MEDICAID FOR PREGNANT WOMEN

Current through August 31, 2023
A woman receiving Medicaid while pregnant continues to be
				eligible through the last day of the month in which the sixty (60) day post
				partum period ends. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.787 - HOME AND COMMUNITY BASED SERVICES (HCBS)

Current through August 31, 2023
An aged, blind, or disabled participant, who is not income
				eligible for SSI or AABD cash, in his own home or community setting, is
				eligible for Medicaid if he meets the conditions in Subsections
				787.01 through
				787.07 of these rules, and meets
				all requirements in one (1) of the waiver Sections
				788 through
				789 of these rules.
				(3-17-22)
01.
Resource
			 Limit
. Meets the AABD single person resource limit. (3-17-22)
02.
Income Limit
. Income of the
			 participant must not exceed three (3) times the Federal SSI monthly benefit for
			 a single person. A married participant living at home with his spouse who is
			 not an HCBS participant, may choose between the SSI, CP, and FSI methods. If
			 his spouse is also an HCBS participant or lives in a nursing home, the couple
			 may choose between the SSI and CP methods. (3-17-22)
03.
Maintained in the Community
.
			 The applicant must be able to be maintained safely and effectively in his own
			 home or in the community with the waiver services. (3-17-22)
04.
Cost of Care
. The cost of
			 the participant's care must be determined to be cost effective as provided in
			 IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits." (3-17-22)
05.
Waiver Services Needed
. The
			 participant must need and receive, or be likely to need and receive, waiver
			 services for thirty (30) consecutive days. The participant is ineligible when
			 there is a break in need for, or receipt of, waiver services for thirty (30)
			 consecutive days. (3-17-22)
06.
Effective Date
. Waiver services are effective the first day the
			 participant is likely to need and receive waiver services. Medicaid begins the
			 first day of the month in which the first day of approved waiver services are
			 received. (3-17-22)
07.
Annual Limit
. The Department limits the number of participants
			 approved for waiver services each year. A participant who applies for waiver
			 services after the annual limit is reached, must be denied waiver services.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.788 - AGED AND DISABLED (A&D) WAIVER

Current through August 31, 2023
In order to be eligible for the Aged and Disabled (A&D)
				Waiver, the participant must: (3-17-22)
01.
Age Eighteen Through
			 Sixty-Four
. Be eighteen (18) through sixty-four (64) years old and meet
			 both the disability criteria, as provided in Section
			 156 of these rules, and need
			 nursing facility level of care as provided in IDAPA 16.03.10 "Medicaid Enhanced
			 Plan Benefits"; or (3-17-22)
02.
Age Sixty-Five or Older
. Be age sixty-five (65) or older and need
			 nursing facility level of care as provided in IDAPA 16.03.10 "Medicaid Enhanced
			 Plan Benefits." (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.789 - DEVELOPMENTALLY DISABLED (DD) WAIVER

Current through August 31, 2023
To be eligible, the participant must be at least eighteen (18)
				years of age and need the level of care provided by an intermediate care
				facility for persons with intellectual disabilities (ICF/IID) under IDAPA
				16.03.10 "Medicaid Enhanced Plan Benefits." (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.799 - MEDICAID FOR WORKERS WITH DISABILITIES

Current through August 31, 2023
An individual is eligible to participate in the Medicaid for
				Workers with Disabilities coverage group if the individual meets the
				requirements in Subsections
				799.01 through
				799.07 of this rule.
				(3-17-22)
01.
Non-Financial
			 Requirements
. An individual must: (3-17-22)
a. Be at least sixteen (16) but less than
			 sixty-five (65) years of age; (3-17-22)
b. Meet the Medicaid residency requirement as
			 described in Section 100 of these
			 rules; (3-17-22)
c. Meet the
			 citizenship requirements as described in Sections
			 105 and
			 106 of these rules;
			 (3-17-22)
d. Meet the SSN
			 requirements as described in Section
			 104 of these rules; and
			 (3-17-22)
e. Meet the child support
			 cooperation requirements as described in Sections
			 703 through
			 706 of these rules.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.800 - NEWBORN CHILD OF MEDICAID MOTHER

Current through August 31, 2023
A child is deemed eligible for Medicaid without an application
				if born to a woman receiving Medicaid on the date of the child's birth,
				including during a period of retroactive eligibility for the mother. The child
				remains eligible for Medicaid for up to one (1) year without an application. An
				application for Medicaid must be filed on behalf of the child no later than his
				first birthday. He must qualify for Medicaid in his own right after the month
				of his first birthday. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.801 - INELIGIBLE NON-CITIZEN WITH EMERGENCY MEDICAL CONDITION

Current through August 31, 2023
A non-citizen, who is otherwise ineligible only because of his
				status as a non-citizen, is eligible only for medical services necessary to
				treat an emergency medical condition. (3-17-22)
01.
Emergency Medical Condition
.
			 An emergency medical condition can reasonably be expected to seriously harm the
			 patient's health, cause serious impairment to bodily functions, or cause
			 serious dysfunction of any bodily organ or part, without immediate medical
			 attention. The Division of Medicaid determines if the condition is an emergency
			 and the services necessary to treat it. (3-17-22)
02.
Effective Date of
			 Eligibility
. Medicaid eligibility begins no earlier than the date the
			 participant experienced the medical emergency and ends the date the emergency
			 condition stops. The Division of Medicaid determines the beginning and ending
			 dates. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.802 - WOMAN DIAGNOSED WITH BREAST OR CERVICAL CANCER

Current through August 31, 2023
A woman not otherwise eligible for Medicaid and meeting the
				conditions in Subsections
				802.01 through
				802.06 of this rule is eligible
				for Medicaid for the duration of her cancer treatment. Medicaid income and
				resource limits do not apply to this coverage group. (3-17-22)
01.
Diagnosis
. The participant
			 is diagnosed with breast or cervical cancer through the Centers for Disease
			 Control and Prevention's National Breast and Cervical Cancer Early detection
			 Program. (3-17-22)
02.
Age
. The participant is under age sixty-five (65).
			 (3-17-22)
03.
Creditable
			 Health Insurance
. The participant is uninsured or, if insured, the plan
			 does not cover her type of cancer. (3-17-22)
04.
Non-Financial Eligibility
.
			 The participant meets the Medicaid non-financial eligibility requirements in
			 Sections 100 through
			 108 and Sections
			 166 and
			 167 of these rules.
			 (3-17-22)
05.
Medical Support
			 Cooperation
. The participant meets the medical support cooperation
			 requirement in Sections
			 702 through
			 706 of these rules.
			 (3-17-22)
06.
Group Health
			 Plan Enrollment
. The participant meets the requirement to enroll in
			 available cost-effective employer group health insurance. (3-17-22)
07.
Presumptive Eligibility
. The
			 Department can presume the participant is eligible for Medicaid, before a
			 formal Medicaid eligibility determination is made. A clinic authorized to
			 screen for breast or cervical cancer by the National Breast and Cervical Cancer
			 Early Detection Program makes the presumptive eligibility determination. The
			 clinic tells the participant how to complete the formal Medicaid determination
			 process. The Medicaid notice and hearing rights do not apply to presumptive
			 eligibility. No overpayment occurs if the formal Medicaid determination finds
			 the participant is not eligible. (3-17-22)
08.
End of Treatment
. The
			 Division of Medicaid determines the end of treatment date according to IDAPA
			 16.03.10, "Medicaid Enhanced Plan Benefits." (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.806 - DISABLED ADULT CHILD

Current through August 31, 2023
A participant age eighteen (18) or older is eligible for
				Medicaid if he received SSI or AABD cash based on blindness or a disability
				which began before he reached age twenty-two (22), and becomes ineligible for
				and remains ineligible for AABD cash or SSI because his disabled child RSDI
				benefit started or increased July 1, 1987, or later. (3-17-22)
01.
RSDI Benefits Disregarded for
			 Disabled Adult Child
. If the participant became ineligible because he
			 began receiving a disabled child benefit on or after July 1, 1987, the benefit
			 amount and any later increases are disregarded. (3-17-22)
02.
RSDI Increase Disregarded for
			 Disabled Adult Child
. If the participant became ineligible because his
			 disabled child benefit increased on or after July 1, 1987, the increase and any
			 later increases are disregarded. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.808 - EARLY WIDOWS AND WIDOWERS BEGINNING JANUARY 1, 1991

Current through August 31, 2023
A participant who meets the conditions in Subsections
				808.01 through
				808.06 is considered an SSI
				recipient for Medicaid. (3-17-22)
01.
Age
. The participant, age fifty (50) to age sixty four and
			 one-half (64-1/2), began receiving early widows or widowers Social Security
			 benefits. (3-17-22)
02.
Lost
			 SSI or AABD
. The participant lost SSI or AABD cash because he began
			 receiving early widows or widowers Social Security benefits.
			 (3-17-22)
03.
Received SSI or
			 AABD
. The participant received SSI or AABD cash in the month, before the
			 month, he became ineligible because he began receiving early widows or widowers
			 Social Security benefits. (3-17-22)
04.
Widows or Widowers Benefits
.
			 The participant would still be eligible for SSI or AABD cash if his Social
			 Security early widows or widowers benefits were not counted as income.
			 (3-17-22)
05.
No "Part A"
			 Insurance
. The participant is not entitled to Medicare Part A hospital
			 insurance. (3-17-22)
06.
Applied On or After January 1, 1991
. The participant's Medicaid
			 application was filed, or pending, on or after January 1, 1991.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.809 - CERTAIN DISABLED WIDOWS AND WIDOWERS THROUGH JUNE 30, 1988

Current through August 31, 2023
A participant who meets the conditions in Subsections
				809.01 through
				809.04 is considered an SSI
				recipient for Medicaid. (3-17-22)
01.
Age
. The participant was under age sixty (60) when his disabled
			 widows and widowers benefits began. (3-17-22)
02.
Lost SSI
. The participant is
			 ineligible for SSI because of an increase in SSA disability benefits starting
			 January, 1984. (3-17-22)
03.
Continuously Entitled
. The participant is continuously entitled to
			 Social Security benefits for disabled widows and widowers starting January,
			 1984 or earlier. (3-17-22)
04.
Applied Before July 1, 1988
. The participant applied for Medicaid
			 before July 1, 1988. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.810 - QUALIFIED MEDICARE BENEFICIARY (QMB)

Current through August 31, 2023
A person meeting all requirements in Subsections
				810.01 through
				810.07 is eligible for QMB. QMB
				Medicaid pays Medicare premiums, coinsurance, and deductibles. (3-17-22)
01.
Medicare Part A
. The
			 participant must be entitled to hospital insurance under Part A of Medicare at
			 the time of his application. (3-17-22)
02.
Nonfinancial Requirements
.
			 The participant must meet the Medicaid residence, citizenship, support
			 cooperation, and SSN requirements. (3-17-22)
03.
Income
. Monthly income must
			 not exceed one hundred percent (100%) of the Federal Poverty Guidelines (FPG).
			 The single person income limit is the poverty line for a family of one (1)
			 person. The couple income limit is the poverty line for a family of two (2)
			 persons. The annual Social Security cost of living increase is disregarded from
			 income, until the month after the month the annual FPG revision is published.
			 AABD cash is not counted as income. The income exclusions and disregards used
			 for AABD are used for QMB. (3-17-22)
04.
Dependent Income
. Income of
			 the dependent child, parent, or sibling is not counted. (3-17-22)
05.
QMB Dependent Family Member
			 Disregard
. A dependent family member is a minor child, adult child
			 meeting SSA disability criteria, parent or sibling of the participant or spouse
			 living with the participant. The family member is or could be claimed on the
			 Federal tax return of the participant or spouse. A participant with a dependent
			 family member has an income disregard based on family size. The spouse is
			 included in family size, whether or not the spouse is also participant. The
			 disregard is based on the official poverty line income as defined by the OMB.
			 The disregard is the difference between the poverty line for one (1) person, or
			 two (2) persons if the participant has a spouse, and the poverty line for the
			 family size including the participant, spouse, and dependent.
			 (3-17-22)
06.
Resource
			 Limit
. The resource limit is equal to the amount defined under
			 42 U.S.C.
			 1396d(p)(1)(C). The resource
			 exclusions used for AABD are used for QMB. (3-17-22)
07.
Effective Dates
. The
			 effective date of QMB coverage is no earlier than the first day of the month
			 after the approval month. A QMB participant is not entitled to backdated
			 Medicaid. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.811 - SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)

Current through August 31, 2023
A person meeting all requirements in Subsections
				811.01 through
				811.06 is eligible for SLMB.
				Medicaid pays the Medicare Part B premiums for a SLMB. The income and resource
				exclusions and disregards used for AABD are used for SLMB. (3-17-22)
01.
Other Medicaid
. The SLMB may
			 be eligible for other Medicaid. (3-17-22)
02.
Medicare Part A
. The SLMB
			 must be entitled to hospital insurance under Part A of Medicare at the time of
			 his application. (3-17-22)
03.
Nonfinancial Requirements
. The SLMB must meet the Medicaid
			 eligibility requirements of residence, citizenship, support cooperation, and
			 SSN. (3-17-22)
04.
Income
. The annual Social Security cost of living increase is
			 disregarded from income, until the month after the month the annual FPG
			 revision is published. The single person limit is based on a family of one (1).
			 The couple limit is based on a family of two (2). The monthly income limit is
			 up to one hundred twenty percent (120%) of the FPG. (3-17-22)
05.
Resource Limit
. The resource
			 limit is equal to the amount defined under
			 42 USC
			 1396d(p)(1)(C). The resource
			 exclusions used for AABD are used for SLMB. (3-17-22)
06.
Effective Dates
. SLMB
			 coverage begins on the first day of the application month. SLMB coverage may be
			 backdated up to three (3) calendar months before the application month.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.812 - QUALIFIED INDIVIDUAL (QI)

Current through August 31, 2023
A person meeting all requirements in Subsections
				812.01 through
				812.07 is eligible for QI.
				Medicaid pays the Medicare Part B premiums for a QI. The income and resource
				exclusions and disregards used for AABD are used for QI. (3-17-22)
01.
Other Medicaid
. The QI
			 cannot be eligible for any other type of Medicaid. (3-17-22)
02.
Medicare Part A
. The QI must
			 be entitled to hospital insurance under Part A of Medicare at the time of his
			 application. (3-17-22)
03.
Nonfinancial Requirements
. The QI must meet the Medicaid
			 eligibility requirements of residence, citizenship, support cooperation, and
			 SSN. (3-17-22)
04.
Income
. The annual Social Security cost of living increase is
			 disregarded from income, until the month after the month the annual FPG
			 revision is published. The single person limit is based on a family of one (1).
			 The couple limit is based on a family of two (2). The monthly income limit is
			 up to one hundred thirty-five percent (135%) of the FPG. (3-17-22)
05.
Resource Limit
. The resource
			 limit is equal to the amount defined under
			 42 USC
			 1396d(p)(1)(C). The resource
			 exclusions used for AABD are used for SLMB. (3-17-22)
06.
Coverage Limits
. There is an
			 annual limit on participants served, based on availability of federal funds.
			 New applications are denied when the annual limit is reached.
			 (3-17-22)
07.
Effective
			 Dates
. QI coverage begins on the first day of the application month. QI
			 coverage may be backdated up to three (3) calendar months before the
			 application month. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.813 - QUALIFIED DISABLED AND WORKING INDIVIDUAL (QDWI)

Current through August 31, 2023
A person meeting all requirements in Subsections
				812.01 through
				812.05 of these rules is
				eligible for QDWI. The person must not be eligible for any other type of
				Medicaid. A QDWI is eligible only for Medicaid payment of his Medicare Part A
				premium. (3-17-22)
01.
Age and
			 Disability
. The participant must be a disabled worker under age
			 sixty-five (65). (3-17-22)
02.
Nonfinancial Requirements
. The participant must meet the Medicaid
			 eligibility requirements of residence, citizenship, support cooperation and
			 SSN. (3-17-22)
03.
Section
			 1818A Medicare
. SSA
			 determined the participant meets the conditions of Section
			 1818A of the Social Security Act.
			 (3-17-22)
04.
Income
.
			 Monthly income must not exceed two hundred percent (200%) of the one (1) person
			 official poverty line defined by the OMB. (3-17-22)
05.
Resource Limit
. The resource
			 limit is equal to the amount defined under
			 42 USC
			 1396d(s). The resource
			 exclusions used for AABD are used for QDWI. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.814 - SPONSORED LEGAL NON-CITIZEN

Current through August 31, 2023
All income and resources of a legal non-citizen's sponsor are
				deemed for Medicaid eligibility if the sponsor has signed an I-864 affidavit of
				support. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.815 - CHILD SUBJECT TO DEEMING

Current through August 31, 2023
Income and resources of a child's stepparent are not deemed to
				the child in determining his Medicaid eligibility. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.816 - FUGITIVE FELON OR PROBATION OR PAROLE VIOLATOR

Current through August 31, 2023
A person denied SSI or AABD cash because of the prohibition
				against payment to fugitive felons and probation and parole violators is not
				disqualified from Medicaid. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.831 - ASSET TRANSFER RESULTING IN PENALTY

Current through August 31, 2023
Starting August 11, 1993, the participant is subject to a
				penalty if he transfers his income or resources for less than fair market
				value. The asset transfer penalty applies to Medicaid services received October
				1, 1993 and later. Excluded resources, other than the home and associated
				property, are not subject to the asset transfer penalty. Asset transfers
				subject to penalty under these rules may be voided and set aside by court
				action as provided in Section
				56218, Idaho Code. The asset
				transfer penalty applies to a Medicaid participant in long-term care or HCBS. A
				participant in long-term care is a patient in a nursing facility or a patient
				in a medical institution, requiring and receiving the level of care provided in
				a nursing facility. (3-17-22)
01.
Rebuttable Presumption
. Unless a transfer meets the requirements
			 of Section 841 of these rules, it is presumed
			 that the transfer was made for the purpose of qualifying for Medicaid. The
			 asset transfer penalty is applied unless the participant shows that the asset
			 transfer would not have affected his eligibility for Medicaid or the transfer
			 was made for another purpose than qualifying for Medicaid. (3-17-22)
02.
Contract for Services Provided by a
			 Relative
. A contract for personal services to be furnished to the
			 participant by a relative is presumed to be made for the purpose of qualifying
			 for Medicaid. The asset transfer penalty applies unless the participant shows
			 that: (3-17-22)
a. A written contract for
			 personal services was signed before services were delivered. The contract must
			 require that payment be made after services are rendered. The contract must be
			 dated and the signatures notarized. Either party must be able to terminate the
			 contract; and (3-17-22)
b. The
			 contract must be signed by the participant or a legally authorized
			 representative through a power of attorney, legal guardianship or
			 conservatorship. A representative who signs the contract must not be the
			 provider of the personal care services under the contract; and
			 (3-17-22)
c. Compensation for
			 services rendered must be comparable to rates paid in the open market.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.832 - MEDICAID PENALTY FOR ASSET TRANSFERS

Current through August 31, 2023
The asset transfer penalty is restricted Medicaid coverage.
				(3-17-22)
01.
Restricted
			 Coverage
. Restricted coverage means Medicaid will not participate in the
			 cost of nursing facility services. Medicaid will not participate in a level of
			 care in a medical institution equal to nursing facility services. The penalty
			 for a person receiving PCS or community services under the HCBS waiver is
			 ineligibility. (3-17-22)
02.
Notice and Exemption
. The participant must be notified, in
			 writing, at least ten (10) days before an asset transfer penalty is imposed.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.833 - ASSET TRANSFER LOOK-BACK PERIOD

Current through August 31, 2023
The asset transfer penalty applies to any transfer for less
				than fair market value made during a period preceding or following a request
				for long-term care services. The look-back period is determined as follows:
				(3-17-22)
01.
Transfers Prior to
			 February 8, 2006
. For any asset transferred prior to February 8, 2006,
			 the look-back period is thirty-six (36) months, unless the transfer is to or
			 from a trust. If the transfer is to or from a trust, the look-back period is
			 sixty (60) months. If the person is entitled to Medicaid or HCBS services, the
			 look-back period is counted from the month long-term care or HCBS services
			 began, or would have begun, were it not for a penalty. If the person is not
			 entitled to Medicaid, the look-back period is counted from the month prior to
			 the month the application was submitted. (3-17-22)
02.
Transfers On or After February 8,
			 2006
. Any asset transferred on or after February 8, 2006, regardless of
			 type, is subject to a look-back period of sixty (60) months. The look-back
			 period is counted from the date of the application for long-term care or HCBS
			 services or the date of the transfer, whichever is later in time.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.834 - PERIOD OF RESTRICTED COVERAGE FOR ASSET TRANSFERS

Current through August 31, 2023
The period of restricted coverage is the number of months
				computed by dividing the net uncompensated value of the transferred asset by
				the statewide average cost of nursing facility services to private patients.
				The cost is computed for the time of the participant's most recent request for
				Medicaid. If the spouse becomes eligible for long-term care Medicaid, the rest
				of the period of restricted coverage is divided between the participant and
				spouse. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.835 - APPLYING THE PENALTY PERIOD OF RESTRICTED COVERAGE

Current through August 31, 2023
Restricted coverage continues until the participant or spouse
				recovers all the assets, receives fair market value at the time of the transfer
				for all of the assets, or the period of restricted coverage ends. The penalty
				continues whether or not the participant is in long-term care. The penalty
				period for asset transfers is applied as follows: (3-17-22)
01.
Penalty Period for Transfer Prior
			 to February 8, 2006
. For assets transferred prior to February 8, 2006,
			 there is no penalty if the amount transferred is less than the cost of one (1)
			 month's care. The penalty period begins running the month the transfer took
			 place. The month the transfer took place is counted as one (1) of the penalty
			 months. A penalty period is computed for each transfer. A penalty period must
			 expire before the next begins. Each partial month before the end of consecutive
			 penalty periods is a penalty month. A partial month at the end of consecutive
			 penalty periods is dropped. (3-17-22)
02.
Penalty Period for Transfers On or
			 After February 8, 2006
. For assets transferred on or after February 8,
			 2006, the penalty period begins running the first day of the month after the
			 month the transfer took place or was discovered to have taken place, or the
			 date the individual would have been eligible for long-term care services or
			 HCBS, if not for the transfer, whichever date is later in time. The value of
			 all asset transfers made during the look-back period is accumulated for the
			 purpose of calculating the penalty. If an additional transfer is discovered
			 after the penalty has been served, a new penalty period begins the month
			 following timely notice of closure of benefits. When a penalty period ends
			 after the first day of the month, eligibility for long-term care services
			 begins the day after the penalty period ends. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.836 - MULTIPLE PENALTY PERIODS APPLIED CONSECUTIVELY

Current through August 31, 2023
A penalty period is computed for each transfer. One (1) penalty
				period must expire before the next begins. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.838 - ANNUITY AS ASSET TRANSFER

Current through August 31, 2023
Except as provided in this rule, when assets are used to
				purchase an annuity during the look-back period, it is an asset transfer
				presumed to be made for the purpose of qualifying for Medicaid. To rebut this
				presumption, the participant must provide proof that clearly establishes the
				annuity was not purchased to make the participant eligible for Medicaid or
				avoid recovery from the estate following death. Proof is met if the participant
				shows the annuity meets the requirements described in Subsections
				838.02 through
				838.05 of this rule.
				(3-17-22)
01.
Revocable
			 Annuity
. A revocable annuity is an annuity that can be assigned. The
			 surrender amount of a revocable annuity is a countable resource.
			 (3-17-22)
02.
Irrevocable
			 Annuity
. The purchase price of an irrevocable, non-assignable annuity is
			 treated as an asset transfer, unless the requirements of Subsections
			 838.03 through
			 838.05 of this rule are met.
			 (3-17-22)
03.
Irrevocable
			 Annuity Life Expectancy Test
. The participant's life expectancy, as
			 shown in the following table, must equal or exceed the term of the annuity.
			 Using the Table 838.03 compare the face value of the annuity to the
			 participant's life expectancy at the purchase time. The annuity meets the life
			 expectancy test if the participant's life expectancy equals or exceeds the term
			 of the annuity. If the exact age is not in the Table, use the next lower age.
TABLE 838.03 - LIFE EXPECTANCY
						  TABLE
Age
Years of Life Remaining
						  Male
Years of Life Remaining
						  Female
0
73.26
79.26
10
64.03
69.93
20
54.41
60.13
30
45.14
50.43
40
35.94
40.86
50
27.13
31.61
60
19.07
22.99
61
18.33
22.18
62
17.60
21.38
63
16.89
20.60
64
16.19
19.82
65
15.52
19.06
66
14.86
18.31
67
14.23
17.58
68
13.61
16.85
69
13.00
16.14
70
12.41
15.44
71
11.82
14.75
72
11.24
14.06
73
10.67
13.40
74
10.12
12.74
75
9.58
12.09
76
9.06
11.46
77
8.56
10.85
78
8.07
10.25
79
7.61
9.67
80
7.16
9.11
81
6.72
8.57
82
6.31
8.04
83
5.92
7.54
84
5.55
7.05
85
5.20
6.59
86
4.86
6.15
87
4.55
5.74
88
4.26
5.34
89
3.98
4.97
90
3.73
4.63
95
2.71
3.26
100
2.05
2.39
110
1.14
1.22
(3-17-22)
04.
State Named as Beneficiary
.
			 The purchase of an annuity is treated as an asset transfer unless the State of
			 Idaho, Medicaid Estate Recovery is named as: (3-17-22)
a. The remainder beneficiary in the first
			 position for at least the total amount of medical assistance paid on behalf of
			 the institutionalized individual under this title; or (3-17-22)
b. The remainder beneficiary in the second
			 position after the community spouse or minor or disabled child and is named in
			 the first position if the community spouse or a representative of the minor or
			 disabled child disposes of any remainder for less than fair market value.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.839 - TRUSTS AS ASSET TRANSFERS

Current through August 31, 2023
A trust established wholly or partly from the participant's
				assets is an asset transfer. Assets transferred to a trust on or after August
				11, 1993 are subject to the asset transfer penalty, regardless of when the
				trust was established. If the trust includes assets of another person, the
				asset transfer penalty applies to the participant's share of the trust.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.840 - TRANSFER OF JOINTLY-OWNED ASSET

Current through August 31, 2023
Transfer of an asset owned jointly by the participant and
				another person is considered a transfer by the participant. The participant's
				share of the asset is used to compute the penalty. If the participant and his
				spouse are joint owners of the transferred asset, the couple's combined
				ownership is used to compute the penalty. If the spouse becomes eligible for
				long-term care Medicaid, the rest of the period of restricted coverage is
				divided between the participant and spouse. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.871 - TREATMENT OF TRUSTS

Current through August 31, 2023
These trust treatment rules apply to all Medicaid participants.
				These rules apply to trusts established with the participant's assets on August
				11, 1993 or later, and to amounts placed in trusts on or after August 11, 1993.
				Section 871 of these
				rules does not apply to an irrevocable trust if the participant meets the undue
				hardship exemption in Subsection
				841.11 of these rules. Assets
				transferred to a trust are subject to the asset transfer penalty. Section
				871 does not apply to a trust
				created with assets other than those of the individual, including a trust
				established by a will. (3-17-22)
01.
Revocable Trust
. Revocable trusts are treated as listed in
			 Subsections 871.01.a. through 871.01.d. of
			 these rules. A revocable burial trust is not a trust for the purposes of
			 Subsection 871.01 of these rules. (3-17-22)
a. The body (corpus) of a revocable trust is
			 a resource. (3-17-22)
b. Payments
			 from the trust to or for the participant are income. (3-17-22)
c. Any other payments from the trust are an
			 asset transfer, triggering an asset transfer penalty period.
			 (3-17-22)
d. As defined in
			 42 U.S.C.
			 1396p(e)(5), the home and
			 adjoining property loses its exclusion for eligibility purposes when
			 transferred to a revocable trust, unless the participant or spouse is the sole
			 beneficiary of the trust. The home is excluded again if removed from the trust.
			 The exclusion restarts the month following the month the home was removed from
			 the trust. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.872 - EXEMPT TRUSTS

Current through August 31, 2023
A trust, created or funded on or after August 11, 1993, is
				exempt from trust treatment and not subject to the asset transfer penalty if it
				meets a condition in Subsections
				872.01 through
				872.03 of this rule.
				(3-17-22)
01.
Trust for Disabled
			 Person
. To be exempt, a trust for a disabled person must meet all the
			 conditions in Subsections
			 872.01.a. through 872.01.f. of
			 this rule. (3-17-22)
a. The trust contains
			 the assets of a person under age sixty-five (65). (3-17-22)
b. The person is blind or totally disabled
			 under the Social Security and SSI rules in 20 CFR Part 416 .
			 (3-17-22)
c. The trust is
			 established for the person's benefit by his parent, grandparent, legal guardian
			 or a court. (3-17-22)
d. The trust
			 is irrevocable. (3-17-22)
e. The
			 trust is exempt until the person reaches age sixty-five (65). After the person
			 reaches age sixty-five (65), additions or augmentations are not exempt from
			 trust treatment. (3-17-22)
f. Upon
			 the person's death, the amount not distributed by the trust must first be paid
			 to the state of Idaho, up to the amount Medicaid has paid on the person's
			 behalf. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.873 - PAYMENTS FROM AN EXEMPT TRUST FOR DISABLED PERSON OR POOLED TRUST

Current through August 31, 2023
Cash payments from an exempt trust for a disabled person or a
				pooled trust must be treated as described in Subsections
				873.01 through
				873.04 of these rules.
				(3-17-22)
01.
Payments from
			 Exempt Trust
. Cash payments from an exempt trust for a disabled person
			 are income in the month received. (3-17-22)
02.
Payments from Pooled Trust
.
			 Cash payments from a pooled trust made directly to the participant are income
			 in the month received. (3-17-22)
03.
Payments for Food or
			 Shelter
. Payments for the participant's food or shelter are income in
			 the month paid. The payments for food or shelter are valued at one-third (1/3)
			 of the AABD budgeted needs for the participant's living arrangement.
			 (3-17-22)
04.
Payments Not
			 Made to Participant
. Payments from the exempt trust not made to, or on
			 behalf of, the participant are an asset transfer. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.05 - ELIGIBILITY FOR AID TO THE AGED, BLIND, AND DISABLED › Section 16.03.05.915 - MEDICAID REDETERMINATION

Current through August 31, 2023
Medicaid eligibility is redetermined each year. The
				redetermination for AABD cash is the Medicaid redetermination for participants
				receiving both programs. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.06 - REFUGEE MEDICAL ASSISTANCE › Section 16.03.06.010 - DEFINITION OF TERMS AND ABBREVIATIONS

Current through August 31, 2023
For the purposes of these rules, the following terms and
				abbreviations apply: (3-17-22)
01.
Department
. The Idaho Department of Health and Welfare or
			 designee. (3-17-22)
02.
Federal Poverty Guidelines (FPG)
. The federal poverty guidelines
			 issued annually by the Department of Health and Human Services (HHS).
			 (3-17-22)
03.
INA
.
			 Immigration and Nationality Act,
			 8 USC Sections
			 1101 -
			 1537. (3-17-22)
04.
I-94
. An alien
			 identification card issued to refugees prior to their release to a sponsor.
			 This card gives the refugee's name, United States address, and other
			 identifying data. (3-17-22)
05.
Medical Assistance Program
.
Services funded by
			 Titles XIX or XXI of the federal Social Security Act, as amended.
			 (3-17-22)
06.
Children's
			 Health Insurance Program (CHIP)
. CHIP is Title XXI of the Social
			 Security Act. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.06 - REFUGEE MEDICAL ASSISTANCE › Section 16.03.06.100 - IDENTIFICATION OF REFUGEES

Current through August 31, 2023
A person has refugee status for purposes of assistance under
				the Refugee Medical Assistance Program if they are one (1) of the following:
				(3-17-22)
01.
I-94
			 Indication
. A person from any country who has an I-94 indicating that
			 the person has been: (3-17-22)
a. Paroled
			 under Section 212(d)(5)
			  of the INA as a refugee or asylee; or
			 (3-17-22)
b. Admitted as a
			 conditional entrant under Section
			 203(a)(7)  of the
			 INA; or (3-17-22)
c. Admitted as a
			 refugee under Section
			 207 of INA; or (3-17-22)
d. Granted asylum under Section
			 208 of INA; or
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.06 - REFUGEE MEDICAL ASSISTANCE › Section 16.03.06.150 - REFUGEE MEDICAL ASSISTANCE PROGRAM

Current through August 31, 2023
01.
Time
			 Limitation
. Medical assistance under the Refugee Medical Assistance
			 Program will be limited to eight (8) consecutive months beginning with the
			 month the refugee enters the United States. (3-17-22)
02.
Eligibility
. Refugees whose
			 countable income does not exceed one hundred fifty percent (150%) of the
			 Federal Poverty Guidelines are eligible for Refugee Medical Assistance.
			 (3-17-22)
03.
Refugee Medical
			 Assistance with "Spend Down."
An applicant for Refugee Medical
			 Assistance whose countable income exceeds one hundred fifty percent (150%) FPG
			 for their family size may become eligible for Refugee Medical Assistance under
			 certain conditions. A special provision, for refugees only, will allow those
			 refugees whose income exceeds one hundred fifty percent (150%) FPG for their
			 family size to subtract their medical costs from their income and thus "spend
			 down" to the FPG limit for their family size. (3-17-22)
04.
Counting Income for Refugee Medical
			 Assistance
. (3-17-22)
a. Income is
			 counted or excluded in accordance with IDAPA 16.03.01, "Eligibility for Health
			 Care Assistance for Families and Children." The sole exception is that Refugee
			 Cash Assistance is excluded from income when determining eligibility for
			 Refugee Medical Assistance. (3-17-22)
b. The income of sponsors, and the in-kind
			 services and shelter provided to refugees by their sponsors, will not be
			 considered in determining eligibility for Refugee Medical Assistance.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.06 - REFUGEE MEDICAL ASSISTANCE › Section 16.03.06.700 - OVERPAYMENTS AND RESTORATION OF BENEFITS

Current through August 31, 2023
Policy governing recovery of overpayments and restoration of
				benefits of Refugee Medical Assistance is contained in IDAPA 16.03.01,
				"Eligibility for Health Care Assistance for Families and Children."
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.06 - REFUGEE MEDICAL ASSISTANCE › Section 16.03.06.995 - PROVISIONS CONTINGENT UPON FEDERAL FUNDING

Current through August 31, 2023
The provisions in these rules, are contingent upon availability
				and receipt of funds appropriated through federal legislation. When federal
				funds are not available to the State of Idaho, these provisions, or any part
				therein, will not be in force and operation of the Refugee Medical Assistance
				Program in Idaho will be suspended. Advance notice of termination or reduction
				of benefits is not needed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.07 - HOME HEALTH AGENCIES › Section 16.03.07.000 - LEGAL AUTHORITY

Current through August 31, 2023
Section
				39-2401(2), Idaho
				Code, authorizes the Board to adopt rules for the operation of home health
				agencies (HHAs). (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.07 - HOME HEALTH AGENCIES › Section 16.03.07.006 - CONFIDENTIALITY OF RECORDS AND PUBLIC RECORDS REQUESTS

Current through August 31, 2023
01.
Confidential Records
. Information about an individual covered by
			 these rules and contained in the Department's records must comply with IDAPA
			 16.05.01, "Use and Disclosure of Department Records." (3-17-22)
02.
Public Records
. The
			 Department will comply with Title 74, Chapter 1, Idaho Code, when requests for
			 the examination and copying of public records are made. Unless exempted, all
			 public records in Department custody are subject to disclosure.
			 (3-17-22)
03.
Disclosure of
			 Patient Identity
. Information received by the Department through filed
			 reports, inspections, or as authorized under the law, will not be disclosed
			 publicly so as to identify individual patients except as necessary in a
			 proceeding involving a question of licensure. (3-17-22)
04.
Public Availability of
			 Deficiencies
. The agency survey reports are available upon written
			 request to the Department and posted on the Licensing and Certification
			 website. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.07 - HOME HEALTH AGENCIES › Section 16.03.07.009 - CRIMINAL HISTORY AND BACKGROUND CHECK REQUIREMENTS

Current through August 31, 2023
01.
Compliance with Department's
			 Criminal History and Background Check
. A home health agency (HHA) must
			 comply with IDAPA 16.05.06, "Criminal History and Background Checks."
			 (3-17-22)
02.
Individuals
			 Subject To Criminal History Checks
. Owners, administrators, employees,
			 and contractors hired or contracted with after October 1, 2007, who have direct
			 access to patients must complete and receive Department criminal history and
			 background check clearance. (3-17-22)
03.
Availability to Work
. Any
			 direct patient access individual hired or contracted on or after October 1,
			 2007, must complete an application before having access to patients and have
			 their fingerprints submitted to the Department within twenty-one (21) days of
			 completion of the notarized application. If a disqualifying crime as described
			 in IDAPA 16.05.06, "Criminal History and Background Checks," is disclosed, the
			 individual cannot have access to any patient without a clearance by the
			 Department. Once the notarized application is completed the individual can only
			 work under supervision until the individual has been fingerprinted.
			 (3-17-22)