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 16.03.05.621 - CHANGES IN PATIENT LIABILITY

Current through August 31, 2023
01.
Increase
			 in Patient Liability
. If the patient liability is increased for the
			 current or a past month, the Department will collect the patient liability
			 directly from the client. (3-17-22)
02.
Decrease in Patient
			 Liability
. If the patient liability is decreased for a current or past
			 month, the funds will be paid to the provider and the provider must reimburse
			 the client for the portion of the costs the client paid in excess of their
			 patient liability. (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 16.03.05.623 - ELIGIBILITY REDETERMINATION

Current through August 31, 2023
An eligibility redetermination is completed at least once every
				year and when a change affecting eligibility occurs. (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 16.03.05.650 - COOPERATION WITH THE QUALITY CONTROL PROCESS

Current through August 31, 2023
When the Department or federal government selects a case for
				review in the quality control process, the participant must cooperate in the
				review of the case. Benefits must be stopped, following advance notice, when a
				participant is unwilling to take part in the quality control process. If the
				participant reapplies for benefits he must fully cooperate with the quality
				control process before the application can be approved. (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 16.03.05.700 - MEDICAID ELIGIBILITY

Current through August 31, 2023
A participant must meet the eligibility requirements for at
				least one (1) Medicaid coverage group to be eligible for Medicaid benefits.
				Income and circumstances in the current month are used for eligibility for the
				current month. Resources are counted as of the first moment of the 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 16.03.05.701 - MEDICAID APPLICATION

Current through August 31, 2023
An adult participant, a legal guardian or a representative of
				the participant must sign the application. The participant must submit the
				application to the Department. A Medicaid application may be made for a
				deceased person. (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 16.03.05.702 - MEDICAL SUPPORT COOPERATION

Current through August 31, 2023
Medical support rights are assigned to the Department by
				signature on the application. The participant must cooperate with the
				Department to secure medical support and payments, to be eligible for Medicaid.
				The participant must cooperate on behalf of himself and any participant for
				whom he can legally assign rights. A participant who cannot legally assign his
				own rights must not be denied Medicaid if the legally responsible person does
				not cooperate. (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 16.03.05.703 - CHILD SUPPORT COOPERATION

Current through August 31, 2023
The participant must cooperate to identify and locate the
				noncustodial parent, establish paternity, and establish, modify and enforce a
				child medical support order, to be eligible for Medicaid. This includes support
				payments received directly from the noncustodial parent. The cooperation
				requirement is waived for poverty level pregnant women exempt from cooperating
				in establishing paternity and obtaining medical support from, or derived from,
				the father of a child born out of wedlock. A participant who cannot legally
				assign his own rights must not be denied Medicaid if the legally responsible
				person does not cooperate. (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 16.03.05.704 - COOPERATION DEFINED

Current through August 31, 2023
Cooperation includes, but is not limited to, providing all
				information to identify and locate the noncustodial parent. Cooperation for
				Medicaid includes identifying other liable third party payers. (3-17-22)
01.
Name of Noncustodial Parent
.
			 The participant must provide the first and last name of the noncustodial
			 parent. (3-17-22)
02.
Information About Noncustodial Parent
. The participant must also
			 provide at least two (2) pieces of information, about the noncustodial parent,
			 listed in Subsections
			 703.02.a. through 703.02.g.
			 (3-17-22)
a. Birth Date. (3-17-22)
b. Social Security Number.
			 (3-17-22)
c. Current address.
			 (3-17-22)
d. Current phone number.
			 (3-17-22)
e. Current employer.
			 (3-17-22)
f. Make, model, and
			 license number of any motor vehicle owned by the noncustodial parent.
			 (3-17-22)
g. Names, phone numbers
			 and addresses of the parents of the noncustodial parent.
			 (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 16.03.05.705 - GOOD CAUSE FOR NOT COOPERATING IN SECURING MEDICAL AND CHILD SUPPORT

Current through August 31, 2023
The participant may claim good cause for failure to cooperate
				in securing medical and child support for himself or a minor child. Good cause
				is limited to the reasons listed in Subsections
				705.01 through
				705.03. (3-17-22)
01.
Rape or Incest
. There is
			 proof the child was conceived as a result of incest or rape.
			 (3-17-22)
02.
Physical or
			 Emotional Harm
. There is proof the child's non-custodial parent may
			 inflict physical or emotional harm to the participant, the child, the custodial
			 parent or the caretaker relative. There is proof another person may inflict
			 physical or emotional harm to an AABD-related participant if the participant
			 cooperates in securing medical and child support. (3-17-22)
03.
Minimum Information Cannot Be
			 Provided
. Substantial and credible proof is provided indicating the
			 participant cannot provide the minimum information regarding the non-custodial
			 parent. (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 16.03.05.706 - CLOSURE AFTER REVIEW OF GOOD CAUSE REQUEST

Current through August 31, 2023
If the participant claims good cause for not cooperating, but
				the Department determines there is not good cause, the participant must be
				given the opportunity to withdraw the application or have his Medicaid closed.
				(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 16.03.05.707 - APPLICATION REQUIREMENTS FOR POTENTIAL MEDICAL COVERAGE

Current through August 31, 2023
01.
Group Health Plan Enrollment
			 Requirement
. Each participant must apply for and enroll in a
			 cost-effective employer group health plan as a condition of eligibility for
			 Medicaid. Medicaid coverage must not be denied, delayed, or stopped pending the
			 start of a participant's group health insurance coverage. A child entitled to
			 enroll in a group health plan must not be denied Medicaid coverage solely
			 because his caretaker fails to apply for the child's enrollment.
			 (3-17-22)
02.
Medicare
			 Enrollment Requirement
. Each participant who may be eligible for
			 Medicare must apply for all parts of Medicare parts A, B, and D for which he is
			 likely to be eligible, as a condition of eligibility for 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 16.03.05.708 - MEDICAID QUALIFYING TRUST PAYMENTS

Current through August 31, 2023
For Medicaid Qualifying Trusts established before August 11,
				1993, the maximum payment permitted to be made to a participant from the trust
				must be counted for Medicaid eligibility. The maximum is counted whether or not
				the trustee actually distributes payments. (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 16.03.05.709 - MEDICAID ELIGIBILITY FOR AABD PARTICIPANT

Current through August 31, 2023
A participant eligible for AABD cash is eligible for Medicaid,
				unless he is in an ineligible institution, receives excess payment from a
				Medicaid Qualifying Trust, or has an irrevocable trust that is not exempt.
				(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 16.03.05.720 - LONG-TERM CARE RESIDENT AND MEDICAID

Current through August 31, 2023
A resident of a long-term care facility must meet the AABD
				eligibility criteria to be eligible for Medicaid. A long-term care facility is
				a nursing facility or an intermediate care facility for persons with
				intellectual disabilities. The need for long-term care is determined using
				IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits." (3-17-22)
01.
Resources of Resident
. The
			 resident's resource limit is two thousand dollars ($2,000). Resources of a
			 married person in long-term care are computed using Federal Spousal
			 Impoverishment rules. Under the SSI method, spouses can use the three thousand
			 dollar ($3,000) couple resource limit if more advantageous. The couple must
			 have lived in the nursing home, in the same room, for six (6) months.
			 (3-17-22)
02.
Medicaid Income
			 Limit of Long-Term Care Resident Thirty Days or More
. The monthly income
			 limit for a long-term care facility resident is three (3) times the Federal SSI
			 benefit for a single person. To qualify for this income limit the participant
			 must be, or be likely to remain, in long-term care at least thirty (30)
			 consecutive days. (3-17-22)
03.
Medicaid Income Limit of Long-Term Care Resident Less Than Thirty
			 Days
. The monthly income limit, for the resident of a long-term care
			 facility for less than thirty (30) consecutive days, is the AABD income limit
			 for the participant's living situation before long-term care. Living situations
			 before long-term care do not include hospital stays. (3-17-22)
04.
Income Not Counted
. The
			 income listed in Subsections
			 720.04.a. through 720.04.e. of
			 these rules is not counted to compute Medicaid eligibility for a long-term care
			 facility resident. This income is counted in determining participation in the
			 cost of long-term care. (3-17-22)
a. Income
			 excluded or disregarded, in determining eligibility for AABD cash, is not
			 counted. (3-17-22)
b. The September
			 1972 RSDI increase is not counted. (3-17-22)
c. Any VA Aid and Attendance allowance,
			 including any increment which is the result of a VA Unusual Medical Expense
			 allowance, is not counted. These allowances are not counted for patient
			 liability, unless the veteran lives in a state operated veterans' home.
			 (3-17-22)
d. RSDI benefit
			 increases, from cost-of-living adjustments (COLA) after April 1977, are not
			 counted if they made the participant lose SSI or AABD cash. The COLA increases
			 after SSI or AABD cash stopped are not counted. (3-17-22)
e. Income paid into an income trust exempt
			 from counting for Medicaid eligibility under Subsection
			 872.02 of these rules is used
			 for patient liability. Income paid to the trust and not used for patient
			 liability, is subject to the asset transfer penalty.
			 (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 16.03.05.721 - QUALIFIED LONG-TERM CARE PARTNERSHIP POLICY

Current through August 31, 2023
Participants who have received, or are entitled to receive,
				benefits under a Qualified Long-Term Care Partnership policy issued in Idaho
				after November 1, 2006, will have certain resources disregarded as described in
				Subsections 721.01 and
				721.02 of these rules.
				(3-17-22)
01.
Value of the
			 Participant's Resources
. The total dollar amount of the insurance
			 benefits paid out for a policy holder of a Qualified Long-Term Care Partnership
			 policy is disregarded in calculating the value of the participant's resources
			 for long-term care Medicaid eligibility. The amount that is disregarded is
			 determined on the effective date of an initial application approval for
			 long-term care Medicaid benefits. (3-17-22)
02.
Resource Disregard Excluded From
			 Estate Recovery
. The amount of the resources disregarded from a
			 Qualified Long-Term Care Partnership policy under Subsection
			 721.01 of this rule, is deducted
			 from the assets of the estate for Medicaid estate recovery. (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 16.03.05.722 - PATIENT LIABILITY

Current through August 31, 2023
Patient liability is the participant's income counted toward
				the cost of long-term care. Patient liability begins the month after the first
				full calendar month the patient is receiving benefits in a long-term care
				facility. (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 16.03.05.724 - INCOME OWNERSHIP OF PARTICIPANT WITH COMMUNITY SPOUSE

Current through August 31, 2023
Income ownership of a long-term care participant with a
				community spouse is determined before patient liability is computed. The
				participant's income ownership is counted as shown in Subsections
				724.01 through
				724.04. (3-17-22)
01.
Income Paid in the Name of
			 Spouse
. Income paid solely in the name of a spouse, and not paid from a
			 trust, is the separate income of the spouse. (3-17-22)
02.
Payment in Name of Both
			 Spouses
. Income paid in the names of both the long-term care participant
			 and the community spouse is divided evenly between each spouse.
			 (3-17-22)
03.
Payment in Name
			 of Spouse or Spouses and Another Person
. Income paid in the names of the
			 participant and/or the community spouse and another person is counted as
			 available to each spouse, in proportion to the spouse's ownership. If payment
			 is made to both spouses, and no proportion of ownership is specified, one-half
			 of the income is counted to each spouse. (3-17-22)
04.
Payment of Aid and
			 Attendance
. In the case of VA Aid and Attendance Allowance paid in the
			 veteran's name, with an increment for the veteran's spouse, the increment is
			 counted to the veteran. (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 16.03.05.726 - PERSONAL NEEDS SUPPLEMENT (PNS)

Current through August 31, 2023
A nursing home participant may receive a PNS to bring his gross
				income up to forty dollars ($40). Gross income is income after exclusions and
				before disregards. Gross income includes money withheld to recover an AABD
				overpayment. The PNS is the difference between the participant's gross income
				and forty dollars ($40). If not in an even dollar amount, the PNS is rounded up
				to the next dollar. The participant's income including the PNS must not exceed
				forty dollars ($40). (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 16.03.05.727 - FAIR HEARING ON CSA DECISION

Current through August 31, 2023
Either spouse may ask for a fair hearing, to show the community
				spouse needs a higher CSA. The hearing officer must consider if, due to unusual
				conditions, using the computed CSA causes significant financial hardship for
				the community spouse. If the fair hearing decision finds the community spouse
				needs more income than the CSA, the CSA must include the additional income.
				(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 16.03.05.731 - MEDICAID ELIGIBILITY OF MARRIED PERSONS

Current through August 31, 2023
There are three (3) methods for Medicaid eligibility of an
				aged, blind, or disabled married person: The SSI method, the Community Property
				(CP) method, and the Federal Spousal Impoverishment (FSI) method. The FSI
				method takes precedence. If the participant is not subject to the FSI method,
				the CP or SSI methods can be used. (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 16.03.05.732 - CHOOSING FSI, SSI, OR CP RESOURCE COUNTING METHOD

Current through August 31, 2023
Table 732 is used determine the resource counting method for a
				married person. If an HCBS participant with a spouse at home is not eligible
				using the FSI method, resources are computed using the SSI/CP method.
TABLE 732 - CHOOSING FSI, SSI, OR
						  CP RESOURCE COUNTING METHOD
SPOUSE ONE (1) IN NURSING HOME BEFORE
						  9/30/89
SPOUSE ONE (1) IN NURSING HOME ON OR AFTER
						  9/30/89
SPOUSE ONE (1) AT HOME NO HCBS
SPOUSE ONE (1) AT HOME WITH HCBS BEFORE
						  9/30/89
SPOUSE ONE (1) AT HOME WITH HCBS ON OR AFTER
						  9/30/89
SPOUSE TWO (2) IN NURSING HOME BEFORE
						  9/30/89
SSI/CP
SSI/CP
SSI/CP
SSI/CP
SSI/CP
SPOUSE TWO (2) IN NURSING HOME ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO (2) AT HOME NO HCBS
SSI/CP
FSI
SSI/CP
SSI/CP
FSI
SPOUSE TWO (2) AT HOME WITH HCBS BEFORE
						  9/30/89
SSI/CP
SSI/CP
SSI/CP
SSI/CP
SSI/CP
SPOUSE TWO (2) AT HOME WITH HCBS ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
(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 16.03.05.733 - CHOOSING FSI, SSI, OR CP INCOME COUNTING METHOD

Current through August 31, 2023
Table 733 is used determine the income counting method for a
				married person. If a participant subject to the FSI method is not eligible
				using FSI, income is computed using the SSI/CP method.
TABLE 733 - CHOOSING FSI, SSI, OR
						  CP INCOME COUNTING METHOD
SPOUSE ONE (1) IN NURSING HOME BEFORE
						  9/30/89
SPOUSE ONE (1) IN NURSING HOME ON OR AFTER
						  9/30/89
SPOUSE ONE (1) AT HOME NO HCBS
SPOUSE ONE (1) AT HOME WITH HCBS BEFORE
						  9/30/89
SPOUSE ONE (1) AT HOME WITH HCBS ON OR AFTER
						  9/30/89
SPOUSE TWO (2) IN NURSING HOME BEFORE
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO (2) IN NURSING HOME ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO (2) AT HOME NO HCBS
FSI
FSI
SSI/CP
FSI
FSI
SPOUSE TWO (2) AT HOME WITH HCBS BEFORE
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO (2) AT HOME WITH HCBS ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
(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 16.03.05.734 - CHOOSING FSI, SSI, OR CP PATIENT LIABILITY OR CLIENT PARTICIPATION METHOD

Current through August 31, 2023
Table 734 is used determine the patient liability or client
				participation method for a married participant in long term care or receiving
				HCBS.
TABLE 734 - PATIENT LIABILITY OR
						  CLIENT PARTICIPATION METHOD
SPOUSE ONE IN NURSING HOME BEFORE
						  9/30/89
SPOUSE ONE IN NURSING HOME ON OR AFTER 9/
						  30/89
SPOUSE ONE AT HOME NO HCBS
SPOUSE ONE AT HOME WITH HCBS BEFORE
						  9/30/89
SPOUSE ONE AT HOME WITH HCBS ON OR AFTER 9/
						  30/89
SPOUSE TWO IN NURSING HOME BEFORE
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO IN NURSING HOME ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO AT HOME NO HCBS
FSI
FSI
N/A
FSI
FSI
SPOUSE TWO AT HOME WITH HCBS BEFORE
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
SPOUSE TWO AT HOME WITH HCBS ON OR AFTER
						  9/30/89
SSI/CP
SSI/CP
FSI
SSI/CP
SSI/CP
(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 16.03.05.735 - FEDERAL SPOUSAL IMPOVERISHMENT (FSI) METHOD OF COUNTING INCOME AND RESOURCES OF A COUPLE

Current through August 31, 2023
The FSI method must be used to compute income and resources of
				a married participant, who requires long-term care as defined in Section
				010 of these rules, and who has a
				community spouse. The participant must have entered long-term care on or after
				September 30, 1989. Terms used in the FSI method are listed in Subsections
				735.01 through
				735.05 of this rule.
				(3-17-22)
01.
Long-Term Care
			 Spouse
. The long-term care spouse must be in a medical institution or
			 nursing facility, or be an HCBS participant, for thirty (30) consecutive days,
			 or appear likely to meet the thirty (30) days requirement. (3-17-22)
02.
Community Spouse
. The
			 community spouse is the husband or wife of the long-term care participant. A
			 community spouse is not in long-term care and is not an HCBS participant.
			 (3-17-22)
03.
Continuous
			 Period of Long-Term Care
. A continuous period of long-term care is a
			 period of residence either in a medical institution with nursing facility
			 services, or at home with HCBS. A continuous period of long-term care is also a
			 combination of institution and personal care services likely to last at least
			 thirty (30) consecutive days. Absence from the institution, or a lapse in HCBS
			 eligibility, of thirty (30) consecutive days breaks continuity. The thirty (30)
			 consecutive days of long-term care must not begin on a day the participant is
			 hospitalized. If the participant is hospitalized after the first day of the
			 thirty (30) consecutive days, the hospital stay does not interrupt the thirty
			 (30) consecutive days. (3-17-22)
04.
Start of Continuous Period
.
			 The start of a continuous period of long-term care is the first month of
			 long-term care or HCBS. (3-17-22)
05.
Nursing Facility Services
.
			 Nursing facility services are services at the nursing facility level or the
			 intermediate care for persons with intellectual disabilities level provided in
			 a medical institution. (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 16.03.05.736 - ASSESSMENT DATE AND COUNTING FSI RESOURCES

Current through August 31, 2023
The assessment date is the start date of the first continuous
				period of long-term care. The Department does a one-time assessment to
				determine the value of the couple's community and separate resources as of the
				date of the first continuous period of long-term care. The resource assessment
				is done at the request of either spouse, after one spouse is in long-term care
				or meets the level of care for HCBS, whether or not the couple has applied for
				Medicaid. State laws relating to community property or the division of marital
				property are not applied in determining the FSI total combined resources of the
				couple. (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 16.03.05.737 - TREATMENT OF RESOURCES FOR ASSESSMENT

Current through August 31, 2023
The resource rules used in determining eligibility for AABD
				cash and Medicaid are also used in determining the couple's total combined
				resources for the FSI resource assessment with the following exceptions:
				(3-17-22)
01.
Resources For
			 Sale
. Excess resources offered for sale, are not excluded from the
			 couple's total combined resources for the FSI resource assessment.
			 (3-17-22)
02.
Jointly Owned
			 Real Property
. Jointly owned real property that is not the principal
			 residence of the participant, is not excluded, if the community spouse is the
			 joint owner. (3-17-22)
03.
Long-term Care Partnership Policy
. Resources excluded because of a
			 participant's qualified long-term care policy are not excluded for the FSI
			 resource assessment. (3-17-22)
04.
Excluded Home
. As defined in
			 42 U.S.C.
			 1396r -
			 5(c)(5), an
			 excluded home placed in trust retains its exclusion for purposes of the
			 resource assessment. (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 16.03.05.738 - ONE-HALF SPOUSAL SHARE

Current through August 31, 2023
The spousal share is one-half (1/2) of the couple's total
				combined resources on the assessment date. The spousal share does not change,
				even if the participant leaves long-term care and then enters long-term care
				again. The Department must inform the couple of the resources counted in the
				assessment and the value assigned. The couple must sign the assessment form
				under penalty of perjury. The signature requirement may be waived for the
				long-term care spouse if he or his representative says he is unable to sign the
				resources assessment. A copy of the assessment form must be provided to each
				spouse when eligibility is determined or when either spouse requests a
				assessment prior to application. (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 16.03.05.742 - COMMUNITY SPOUSE RESOURCE ALLOWANCE

Current through August 31, 2023
The CSRA protects resources for the community spouse. The CSRA
				is determined by subtracting the greater of the minimum resource allowance, or
				the spousal share from the couple's total combined resources as of the first
				day of the application month. The deduction must not be more than the maximum
				resource allowance at the time eligibility is determined. (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 16.03.05.743 - RESOURCE ALLOWANCE LIMITS

Current through August 31, 2023
The maximum resource allowance is computed by multiplying sixty
				thousand dollars ($60,000) by the percentage increase in the consumer price
				index for all urban consumers (all items; U.S. city average) between September
				1988 and the September before the current calendar year. The minimum resource
				allowance is computed by multiplying twelve thousand dollars ($12,000) by the
				percentage increase in the consumer price index for all urban consumers (all
				items; U.S. city average) between September 1988 and the September before the
				current calendar year. If the result is not an even one hundred dollar ($100)
				amount, round up to the next one hundred dollars ($100). The couple's resources
				exceeding the CSRA are counted for the long-term care 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 16.03.05.744 - INCOME COUNTED FIRST FOR CSRA REVISION

Current through August 31, 2023
Income is determined prior to determining resources. If the
				couple's income is more than the minimum CSNS, the CSRA cannot be increased. If
				the community spouse has less income than the minimum CSNS, the CSRA may be
				increased as provided in Section
				745 of these rules. Couple income
				is the community spouse's gross income plus the long-term care spouse's income.
				The long-term care spouse's income is his gross income less the AABD cash
				income exclusions and his patient liability income deductions, but not the CSA
				deduction. (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 16.03.05.745 - UPWARD REVISION OF CSRA

Current through August 31, 2023
If the community spouse's income, including income from his CSA
				and income-producing resources in his CSRA, is less than the minimum CSNS, the
				CSRA may be increased. The CSRA is increased by enough resources, transferred
				from the long-term care spouse, to raise the community spouse's income to the
				minimum CSNS Resources included in the transfer are presumed to produce income
				at the treasury rate, whether or not the resources produce income. If the
				community spouse shows he is making reasonable use of his income and resources,
				to generate income, the Department may waive the treasury rate requirement.
				Actual income produced by the resources transferred to the community spouse is
				used to compute the CSA. A higher CSA can be requested under Section
				727 of these rules. If the
				transferred resources produce more than the treasury rate, the actual income
				produced is used to determine the additional resources that can be transferred
				to the community spouse in the CSRA. The long-term care spouse must transfer
				the resources to the community spouse, or the CSRA is not revised.
				(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 16.03.05.746 - RESOURCE TRANSFER ALLOWANCE (RTA)

Current through August 31, 2023
The resource transfer allowance (RTA) is computed by
				subtracting the community spouse's resources, at the time of application, from
				the CSRA. The community spouse must own less than the CSRA to get an RTA. The
				long term care spouse may transfer the RTA to the community spouse without an
				asset transfer penalty. If the institutional spouse transfers more than the
				RTA, the amount of the couple's resources over the CSRA counts as the
				institutional spouse's resources. After the month a long-term care spouse is
				determined Medicaid eligible under FSI, resources of the community spouse are
				not considered available to the him while he remains in long-term care.
				(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 16.03.05.747 - PROTECTED PERIOD FOR RTA TRANSFER

Current through August 31, 2023
The long-term care spouse has sixty (60) days, from the date
				his application is approved, to transfer his ownership of the RTA resources to
				the community spouse. The long-term care spouse must state, in writing, his
				intent to transfer the RTA resources to the community spouse, within the
				protected period, before he can be Medicaid eligible. Resources not transferred
				within the sixty (60) day protected period are available to the long-term care
				spouse, effective the day he entered the facility. (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 16.03.05.748 - EXTENSION FOR RTA TRANSFER

Current through August 31, 2023
The protected period can be extended beyond sixty (60) days if
				necessary because of the participant's circumstances. (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 16.03.05.749 - RESOURCE ELIGIBILITY FOR COMMUNITY SPOUSE

Current through August 31, 2023
When the community spouse is a Medicaid participant, the
				spouse's resources are counted using Medicaid rules. The FSI rules apply only
				to the long-term care spouse. For the month the couple stopped living together,
				resources of the community spouse available for his Medicaid eligibility are
				the resources owned by the couple. (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 16.03.05.750 - INCOME ELIGIBILITY FOR COMMUNITY SPOUSE

Current through August 31, 2023
When the community spouse is a Medicaid participant, the
				spouse's income is counted using Medicaid rules. The FSI rules apply only to
				the long-term care spouse. The community spouse may choose between the SSI and
				CP methods for determining income for 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 16.03.05.751 - CHANGE IN CIRCUMSTANCES

Current through August 31, 2023
The FSI method of calculating income and resources stops the
				first full calendar month after a change in circumstances resulting in a couple
				no longer having a community spouse and a long-term care 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 16.03.05.752 - NOTICE AND HEARING

Current through August 31, 2023
The Department must tell the participant the CSA, the family
				member allowance, the CSRA and how it was computed, and RTA. Any hearing
				requested about the CSRA or the RTA must be held within thirty (30) days of the
				date of the request for hearing. (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 16.03.05.761 - CHOICE OF SSI OR CP METHODS

Current through August 31, 2023
A married participant, not using FSI, must be furnished a
				written explanation of SSI and CP income and resource counting methods. The
				couple chooses the most useful method, based on their circumstances. The same
				method must be used for both spouses. (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 16.03.05.762 - SSI METHOD OF COUNTING INCOME AND RESOURCES OF A COUPLE

Current through August 31, 2023
The SSI method is the same method used to count income and
				resources for AABD cash. Income and resources of the participant and spouse are
				counted as mutually available. This method must be used for months either
				spouse gets SSI or AABD cash, or an SSI and/or AABD application is filed and
				approved. This method must be used for Medicaid eligibility, and liability for
				the cost of long-term care, whether one (1) or both spouses apply for Medicaid.
				For long-term care, the couple's income and resources are mutually available
				when one (1) or both spouses apply during the month they separated, because one
				(1) or both left their mutual home to enter a long-term care facility.
				(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 16.03.05.763 - COMMUNITY PROPERTY (CP) METHOD OF COUNTING INCOME AND RESOURCES OF A COUPLE

Current through August 31, 2023
A married participant in long-term care, whose spouse is not in
				the community, can use the CP method. A married participant using the FSI
				method, but not income eligible using FSI, may choose the CP method for income
				eligibility. The CP method must not be used for the FSI participant's resource
				eligibility or patient liability. (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 16.03.05.764 - CP METHOD

Current through August 31, 2023
The CP method gives each spouse has an equal one-half (1/2)
				share of the couple's community income and resources. Each spouse also has his
				or her own separate income and resources. Whether the spouses live together or,
				if not living together, the length of time they have lived apart, does not
				change the way income and resources are counted. A spouse's property includes
				income, personal property and real property. The income and resources of a
				married couple acquired during the marriage are presumed to be community
				property of the couple. The couple can give evidence to rebut the presumption
				that property acquired during the marriage is community property.
				(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 16.03.05.765 - TRANSFER OF RIGHTS TO FUTURE INCOME NOT VALID

Current through August 31, 2023
An agreement between spouses, transferring or assigning rights
				to future income from one (1) spouse to the other, is not valid for eligibility
				for 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 16.03.05.766 - CP METHOD NEED STANDARD

Current through August 31, 2023
The participant is budgeted as a single person if his spouse is
				not a Medicaid applicant, is not living with him, or was not living with him on
				the first day of the month. The participant and spouse are budgeted as a couple
				if they both apply, and live together, or if they were living together on the
				first day of the 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 16.03.05.767 - CP METHOD RESOURCE LIMIT

Current through August 31, 2023
The participant's resource limit is two thousand dollars
				($2,000) if his spouse is not a Medicaid applicant, is not living with him, or
				was not living with him on the first day of the month. The participant and
				spouse have a resource limit of three thousand dollars ($3,000) if they both
				apply, and live together, or if they were living together on the first day of
				the 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 16.03.05.768 - CP METHOD INCOME DISREGARDS

Current through August 31, 2023
The participant gets the twenty dollar ($20) standard disregard
				if his spouse is not a Medicaid applicant, is not living with him, or was not
				living with him on the first day of the month. If the participant has earned
				income, he gets the sixty-five dollar plus one-half ($65 + 1/2) of the
				remainder earned income disregard. The participant and spouse get the standard
				disregard on their combined unearned income if they both apply, and live
				together, or if they were living together on the first day of the month. If
				either spouse has earned income, they get the earned income disregard from
				their combined earned income. (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 16.03.05.776 - 1972 RSDI RECIPIENT

Current through August 31, 2023
A participant remains eligible if he meets any of the
				conditions in Subsections
				776.01 through
				776.03 and all other Medicaid
				eligibility requirements. (3-17-22)
01.
Money Payment in August
			 1972
. In August 1972, the participant was eligible for, or received, a
			 state money payment of OAA, AB, APTD or Aid to Families with Dependent Children
			 (AFDC). (3-17-22)
02.
Eligible If Not in Institution
. The participant would have been
			 eligible for OAA, AB, APTD or Aid to Families with Dependent Children (AFDC) if
			 he were not in a medical institution or intermediate care facility in August
			 1972. (3-17-22)
03.
Getting
			 RSDI in August 1972
. The participant received RSDI benefits in August
			 1972, and became ineligible for a state money payment due to the RSDI benefit
			 increase effective in September 1972. (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 16.03.05.777 - ELIGIBLE SSI RECIPIENT

Current through August 31, 2023
An SSI recipient, or an individual who would be SSI eligible if
				he applied, is eligible for Medicaid if he meets any of the conditions in
				Subsections 777.01 through
				777.03. (3-17-22)
01.
Receives SSI
. Gets SSI
			 payments, even if eligibility is based on presumptive disability or presumptive
			 blindness. (3-17-22)
02.
Conditionally Eligible
. Is conditionally eligible for SSI, based
			 on an agreement to dispose of excess resources. (3-17-22)
03.
Eligible Spouse
. Has his SSI
			 payments combined with his spouse's SSI payments. (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 16.03.05.778 - INELIGIBLE SSI RECIPIENT

Current through August 31, 2023
An SSI recipient is not eligible for Medicaid if he meets any
				of the conditions in Subsections
				778.01 through
				778.04. (3-17-22)
01.
Medicaid Qualifying Trust
.
			 Has excess income from a Medicaid Qualifying Trust, created and funded before
			 August 11, 1993. (3-17-22)
02.
Noncooperation
. Fails to cooperate in establishing paternity or
			 securing support. (3-17-22)
03.
Institution
. Is in an ineligible institution. (3-17-22)
04.
Trust
. Has a trust that
			 makes him ineligible for 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 16.03.05.779 - PSYCHIATRIC FACILITY RESIDENT

Current through August 31, 2023
A resident of a long-term care psychiatric medical facility, is
				eligible for Medicaid if he is age sixty-five (65) or older. He must meet all
				the requirements of a long-term-care resident. (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 16.03.05.780 - GRANDFATHERED SSI RECIPIENT

Current through August 31, 2023
A grandfathered SSI recipient is eligible for Medicaid. A
				grandfathered SSI recipient received, or was eligible to receive, APTD,
				APTD-MA, AB or AB-MA or APTD-MA in long-term care on December 31, 1973, or had
				an application for this assistance on file December 31, 1973. (3-17-22)
01.
Disability and Blindness
			 Criteria
. The grandfathered SSI recipient must have been eligible under
			 the disability criteria for APTD or the blindness criteria for AB in effect on
			 December 31, 1973. For each consecutive month after December 1973, the
			 grandfathered SSI recipient must continue to meet the criteria for disability
			 or blindness. (3-17-22)
02.
Eligibility Requirements
. The grandfathered SSI recipient must
			 meet all current Medicaid rules, except the criteria for blindness or
			 disability. A long-term care participant must also remain in long-term care,
			 and continue to need long-term care. (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 16.03.05.781 - RSDI RECIPIENT ENTITLED TO COLA DISREGARD

Current through August 31, 2023
A participant receiving RSDI is eligible for Medicaid if he
				became and remains ineligible for SSI payments as of April 2011, or for AABD
				cash or SSI payments from May 1977 through March 2011. The participant must
				still be entitled to AABD cash or SSI, except for a cost-of-living adjustment
				(COLA) in RSDI benefits. All RSDI COLAs received by the participant, and any
				person whose income and resources are counted in determining the participant's
				eligibility, are disregarded for 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 16.03.05.782 - MEDICAID BENEFITS UNDER SECTION 1619(B) OF THE SOCIAL SECURITY ACT

Current through August 31, 2023
A participant may be eligible for Medicaid under Section
				1619(b)  of the
				Social Security Act either under federal or state criteria, depending on his
				circumstances. (3-17-22)
01.
Federally Qualified Under SSA Section
			 1619(b)
.
			 An SSI recipient with a disability, previously eligible for SSI cash, who,
			 because of earnings from employment, no longer meets the financial eligibility
			 requirements for SSI cash, is eligible for Medicaid. SSA determines the
			 qualification for eligibility under Section
			 1619(b).
			 (3-17-22)
02.
State-Only
			 Qualified Under SSA Section
			 1619(b)
.
			 An AABD cash participant with a disability, who, because of earnings from
			 employment, no longer meets the financial eligibility requirements for AABD
			 cash, may be eligible for Medicaid. The Department determines eligibility for
			 State-only Section 1619(b)
			  Medicaid. State-only Section
			 1619(b)  Medicaid
			 is authorized under Section
			 1905(q)  of the
			 Social Security Act. (3-17-22)
a. Eligibility
			 Requirements. A participant must meet all of the following requirements to be
			 eligible for State-only 1619(b) Medicaid: (3-17-22)
i. The participant received AABD cash in the
			 month prior to the first month of his eligibility under this Section of rule.
			 (3-17-22)
ii. The participant is
			 under age sixty-five (65). (3-17-22)
iii. The participant continues to have a
			 disability. (3-17-22)
iv. The
			 participant must depend on Medicaid coverage to continue working. An individual
			 depends on Medicaid coverage if he: (3-17-22)
(1) Used Medicaid coverage within the past
			 twelve (12) months; or (3-17-22)
(2) Expects to use Medicaid coverage in the
			 next twelve (12) months; or (3-17-22)
(3) Would be unable to pay unexpected medical
			 bills in the next twelve (12) months without Medicaid coverage.
			 (3-17-22)
v. The
			 participant is not able to afford medical insurance equivalent to Medicaid,
			 including attendant care. The participant meets this requirement if his
			 earnings are under the limit referred to in Subsection
			 782.02.a.vii. of this
			 rule. (3-17-22)
vi. The participant
			 continues to meet all of the non-disability eligibility requirements in these
			 rules. (3-17-22)
vii. The
			 participant's annual gross earned income is less than the current calendar
			 year's charted threshold for Idaho as developed by SSA for federal
			 qualification for Section
			 1619(b) 
			 Medicaid. The charted threshold for Idaho is online at
http://policy.ssa.gov/poms.nsf/lnx/0502302200
.
			 (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 16.03.05.783 - APPEAL OF SSA DECISION - APPLICANT DETERMINED SSI ELIGIBLE AFTER APPEAL

Current through August 31, 2023
An applicant denied Medicaid, because he does not meet SSI
				eligibility or RSDI disability requirements, can appeal the SSA denial with
				SSA. He can get Medicaid, if found eligible for SSI or Social Security
				disability as a result of his appeal. The effective date for Medicaid is the
				first day of the month of the Medicaid application that was denied, because of
				the SSA denial. The participant's eligibility for backdated Medicaid coverage
				must be determined. (3-17-22)