reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.431 - MEDICAID ESTATE RECOVERIES, WAIVER OF RECOVERY BASED UPON UNDUE HARDSHIP

Current through Register Vol. 13, July 5, 2024
(1) The department shall waive, in whole or
				in part, its claim under
				53-6-167,
				MCA, if the applicant demonstrates that recovery would result in an undue
				hardship to the applicant as provided in this rule.
(2) An applicant may request an undue
				hardship waiver of estate recovery by filing an application on the form
				prescribed by the department. Application forms may be obtained from and must
				be filed with the Department of Public Health and Human Services, Quality
				Assurance Division, Third Party Liability, 2401 Colonial Drive, P.O. Box
				202953, Helena, MT 59620-2953. Application forms may also be obtained from
				county human services or welfare offices, but must be filed with the Quality
				Assurance Division office in Helena at the above address.
(a) The department may require the applicant
				to submit any information and documentation regarding the applicant's finances,
				property, employment, liabilities, expenses, and other matters relevant and
				necessary to determine whether an undue hardship would result from
				recovery.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.432 through 37.82.434 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.435 - MEDICAID REAL PROPERTY LIEN, NOTICE AND RIGHT TO HEARING

Current through Register Vol. 13, July 5, 2024
(1) At least 30 days prior to filing a lien
				under
				53-6-171,
				MCA upon real property of a Medicaid applicant or recipient, the department
				must provide the applicant or recipient notice of its determination that
				applicant or recipient is permanently institutionalized and that none of the
				exceptions provided by
				53-6-171,
				MCA or federal law apply. The notice must inform the applicant or recipient of
				the exceptions that would prevent imposition of a lien and of the right to a
				fair hearing as provided in (2).
(2) The applicant or recipient upon whose
				property the department proposes to impose a lien under
				53-6-171,
				MCA is entitled to a fair hearing according to the provisions of ARM
				37.5.304,
				37.5.305,
				37.5.307,
				37.5.310,
				37.5.311,
				37.5.313,
				37.5.316,
				37.5.322,
				37.5.318,
				37.5.325,
				37.5.328,
				37.5.331,
				37.5.334, and
				37.5.337. The applicant or
				recipient must request the hearing within 30 days of receipt of the notice
				required under (1).
(a) The hearing is
				limited to issues regarding imposition of the lien and may not address issues
				relating to recovery on the lien, undue hardship, spousal exemption, or similar
				issues.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.436 - MEDICAID REAL PROPERTY LIEN, WAIVER OF LIEN RECOVERY BASED UPON UNDUE HARDSHIP

Current through Register Vol. 13, July 5, 2024
(1) The department
				shall waive, in whole or in part, its recovery upon a lien under
				53-6-171
				through
				53-6-188,
				MCA, if the applicant demonstrates that recovery would result in an undue
				hardship to the applicant.
(a) A waiver may
				be granted under this rule only to forego or prevent recovery under a lien
				previously imposed under
				53-6-171,
				MCA. A waiver may not be granted under this rule to forego or prevent
				imposition of a lien under
				53-6-171,
				MCA.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.437 - MEDICAID REAL PROPERTY LIEN, SPOUSE'S LIMITED RECOVERY EXEMPTION

Current through Register Vol. 13, July 5, 2024
(1) The department shall provide to the
				recipient's surviving spouse an exemption from recovery on a lien under
				53-6-171,
				MCA to the extent and under the conditions specified in
				53-6-182,
				MCA, according to the procedures and requirements specified in this rule.
(a) An exemption may be granted under this
				rule only to forego, prevent or reduce a recovery under a lien previously
				imposed under
				53-6-171,
				MCA. An exemption may not be granted under this rule to forego or prevent
				imposition of a lien under
				53-6-171,
				MCA.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.4 - General Non-Financial And Financial Eligibility Requirements for the Categorically Needy and the Medically Needy › Rule 37.82.438 - MEDICAID REAL PROPERTY LIEN, RELEASE OF LIEN AFTER RECIPIENT'S RETURN HOME

Current through Register Vol. 13, July 5, 2024
(1) If a recipient upon whose real property
				the department has imposed a lien under
				53-6-171,
				MCA has been discharged from the facility and has returned home, the department
				shall upon written request file a release of the lien in the clerk and
				recorder's office.
(2) The written
				request must contain the name and social security number of the recipient and
				must be accompanied by a copy of the legal description of the property subject
				to the lien.
(3) The department may
				require reasonable documentation or verification that the recipient has been
				discharged from the facility and returned home.
53-6-189,
					 MCA; IMP,
					 53-6-174,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.7 - Eligibility Requirements for the Noninstitutionalized Categorically Needy: AFDC-Related Families and Children › Rule 37.82.702 - NONFINANCIAL REQUIREMENTS, NONINSTITUTIONALIZED FAIM FINANCIAL ASSISTANCE RELATED FAMILIES AND CHILDREN

Current through Register Vol. 13, July 5, 2024
(1) Individuals
				eligible for FAIM financial assistance are presumed to have met the
				nonfinancial requirements of the Medicaid program.
(2) For individuals under 19 who are not
				eligible for foster care or adoption assistance under Title IV-E or do not
				qualify as dependent children, the nonfinancial requirements for Medicaid under
				this subchapter are as provided in ARM
				37.82.701(3).
53-4-211,
					 53-4-212,
					 53-4-231,
					 53-6-113,
					 MCA; IMP,
					 53-4-211,
					 53-4-212,
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.7 - Eligibility Requirements for the Noninstitutionalized Categorically Needy: AFDC-Related Families and Children › Rule 37.82.703 - FINANCIAL REQUIREMENTS, NONINSTITUTIONALIZED FAIM FINANCIAL ASSISTANCE RELATED FAMILIES AND CHILDREN

Current through Register Vol. 13, July 5, 2024
(1) Individuals
				eligible for FAIM financial assistance are presumed to have met all the
				financial requirements for Medicaid eligibility.
(2) Notwithstanding the above and in
				accordance with ARM
				37.82.701(1)(d),
				for purposes of this coverage group:
(a) the
				increase in OASDI benefits on July 1, 1972 will be excluded from unearned
				income; and
(b) ineligibility for
				FAIM financial assistance on the basis of the gross monthly income test found
				in ARM 37.78.420 will not preclude
				continued Medicaid coverage under ARM
				37.82.701(1)(c).
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.7 - Eligibility Requirements for the Noninstitutionalized Categorically Needy: AFDC-Related Families and Children › Rule 37.82.704 - THREE MONTH RETROACTIVE COVERAGE, NONINSTITUTIONALIZED FAIM FINANCIAL ASSISTANCE RELATED FAMILIES AND CHILDREN

Current through Register Vol. 13, July 5, 2024
(1)
				Three month retroactive coverage will be provided to individuals determined
				eligible for Medicaid under this subchapter if:
(a) they received medical services during any
				of the three months prior to application;
(b) they are determined eligible for Medicaid
				on the 1st day of the month in the month or months medical services were
				received.
(c) Eligibility in the
				retroactive period will be determined in accordance with this subchapter,
				except that eligibility with respect to income will be determined using actual
				income received in the month or months of service.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.7 - Eligibility Requirements for the Noninstitutionalized Categorically Needy: AFDC-Related Families and Children › Rule 37.82.710 - RESOURCE EXCLUSIONS: FAMILY MEDICAID FOR NONINSTITUTIONALIZED CATEGORICALLY NEEDY CHILDREN AND FAMILIES

Current through Register Vol. 13, July 5, 2024
(1) In
				determining eligibility for noninstitutionalized categorically needy children
				and families under the family Medicaid coverage groups in regard to the factor
				of resources, no exclusions will be applied to any property that is not owned
				by a member of the filing or assistance unit. No exclusion will be applied to
				any property that is owned or held by any entity, including but not limited to
				a trust or corporation, limited liability company, or any other legal entity,
				instrument, device, or arrangement of any kind, under which a member of the
				filing or assistance unit does not own the property.
53-6-113,
					 MCA; IMP,
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.9 - Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples › Rule 37.82.901 - GROUPS COVERED, NON-INSTITUTIONALIZED SSI-RELATED INDIVIDUALS AND COUPLES

Current through Register Vol. 13, July 5, 2024
(1) Medicaid will be provided to:
(a) Aged, blind or disabled individuals or
				couples receiving SSI, including:
(i) those
				receiving SSI pending final determination of blindness or disability;
(ii) those receiving SSI under an agreement
				with the social security administration to dispose of resources that exceed the
				SSI dollar limits on resources; and
(iii) those deemed to be receiving SSI under
				the special SSI eligibility status granted by the social security
				administration to certain severely impaired individuals who work.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.9 - Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples › Rule 37.82.902 - NON-FINANCIAL REQUIREMENTS, NON-INSTITUTIONALIZED SSI-RELATED INDIVIDUALS AND COUPLES

Current through Register Vol. 13, July 5, 2024
(1) Aged, blind or
				disabled individuals or couples receiving SSI, mandatory state supplements, or
				only a state supplementary payment under the optional state supplementary
				program are presumed to have met the non-financial requirements for medicaid
				eligibility.
(2) For individuals
				and couples under the heading aged, blind or disabled individuals or couples
				who are not receiving SSI, the SSI non-financial requirements which are set
				forth in 20 CFR Part 416, Subparts H and I, will be used to determine whether
				an individual is aged, blind or disabled. 20 CFR Part 416, Subpart H, contains
				the SSI criteria for determining age, and 20 CFR Part 416, Subpart I, contains
				the SSI criteria for determining blindness and disability. The department
				hereby adopts and incorporates by reference 20 CFR Part 416, Subparts H and I.
				A copy of these federal regulations may be obtained from the Department of
				Public Health and Human Services, Human and Community Services Division, Public
				Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena,
				MT 59620-2952.
(3) For individuals
				and couples under the heading aged, blind or disabled individuals or couples
				who are not receiving a state supplementary payment under the optional state
				supplementary program, the optional state supplementary program non-financial
				requirements set forth in ARM
				37.43.101 through
				37.43.104 will be used to
				determine whether an individual is aged, blind or disabled and is certified as
				requiring the services covered by the state supplementary payment.
(4) For individuals under the heading
				individuals who were eligible for medicaid in December 1973, the December 1973
				OAA, AB, APTD, or AABD non-financial requirement will be used to determine
				whether an individual continues to be a medicaid eligible essential spouse, as
				provided in ARM
				37.82.901(4) (a),
				or may be considered blind or disabled in spite of SSI criteria, as provided in
				ARM 37.82.902(4) (b).
				A copy of the December 1973 OAA, AB, APTD, and AABD non-financial requirements
				may be obtained from the Department of Public Health and Human Services, Human
				and Community Services Division, Public Assistance Bureau, Cogswell Building,
				1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.
Sec.
					 53-6-113,
					 MCA; IMP, Sec.
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.9 - Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples › Rule 37.82.903 - FINANCIAL REQUIREMENTS, NON-INSTITUTIONALIZED SSI-RELATED INDIVIDUALS AND COUPLES

Current through Register Vol. 13, July 5, 2024
(1) Aged, blind or
				disabled individuals or couples receiving SSI, mandatory state supplements, or
				only a state supplementary payment under the optional state supplementary
				program are presumed to have met the financial requirements for medicaid
				eligibility.
(2) For individuals
				and couples under the heading aged, blind or disabled individuals or couples
				who are not receiving SSI, the SSI financial requirements which are set forth
				in 20 CFR Part 416, Subparts J, K and L, will be used to determine whether an
				individual or couple is eligible with respect to resources and with respect to
				income. 20 CFR Part 416, Subpart J, contains the SSI criteria for evaluating
				family relationships; 20 CFR Part 416, Subpart K, for evaluating income,
				including the income of financially responsible relatives; and 20 CFR Part 416,
				Subpart L, for evaluating resources, including the resources of financially
				responsible relatives. The department hereby adopts and incorporates by
				reference 20 CFR Part 416, Subparts J, K and L. A copy of these federal
				regulations may be obtained from the Department of Public Health and Human
				Services, Human and Community Services Division, Public Assistance Bureau,
				Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.
(a) Notwithstanding the above and in
				accordance with ARM
				37.82.901(2) (b), (c), (d) and
				(e) for purposes of this coverage group:
(i) the increase in OASDI benefits on July 1,
				1972, will be excluded from unearned income;
(ii) any cost-of-living increases in OASDI
				paid under section 215(i) of the Social Security Act after April 1977 will be
				excluded from unearned income; and
(iii) the January 1, 1984, increase in social
				security disabled widow's and widower's benefits caused by an elimination
				factor for individuals who became entitled to said benefits before age 60 will
				be excluded from unearned income; and
(iv) Title II early widow(er) 's benefits for
				individuals who meet eligibility criteria at ARM
				37.82.901(2) (e) 
				will be excluded from unearned income.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.9 - Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples › Rule 37.82.904 - THREE MONTH RETROACTIVE COVERAGE, NON-INSTITUTIONALIZED SSI-RELATED INDIVIDUALS AND COUPLES

Current through Register Vol. 13, July 5, 2024
(1) Three month
				retroactive coverage will be provided to individuals determined eligible for
				medicaid under this subchapter if:
(a) they
				received medical services during any of the three months prior to
				application;
(b) they are
				determined eligible for medicaid in the month or months medical services were
				received.
(c) Eligibility in the
				retroactive period will be determined in accordance with this subchapter,
				except that eligibility with respect to income will be determined using actual
				income received in the month or months of service.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.9 - Eligibility Requirements for the Non-Institutionalized Categorically Needy: SSI-Related Individuals and Couples › Rule 37.82.910 - RESOURCE EXCLUSIONS: AGED, BLIND, AND DISABLED MEDICAID FOR NONINSTITUTIONALIZED INDIVIDUALS AND COUPLES

Current through Register Vol. 13, July 5, 2024
(1) In
				determining eligibility for noninstitutionalized categorically needy
				individuals and couples under the aged, blind, and disabled Medicaid coverage
				groups in regard to the factor of resources, no exclusions will be applied to
				any property that is not owned by a member of the filing or assistance unit. No
				exclusion will be applied to any property that is owned or held by any entity,
				including but not limited to a trust or corporation, limited liability company,
				or any other legal entity, instrument, device, or arrangement of any kind,
				under which a member of the filing or assistance unit does not own the
				property.
53-6-113,
					 MCA; IMP,
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.10 - Medicaid for Workers With Disabilities › Rule 37.82.1003 - MEDICAID FOR WORKERS WITH DISABILITIES: APPLICABLE LAW

Current through Register Vol. 13, July 5, 2024
(1) Except as specifically provided in this
				subchapter or in the Aged Blind Disabled (ABD) Medicaid Manual adopted and
				incorporated by reference in ARM
				37.82.101, the Medicaid for
				Workers with Disabilities program shall be administered in accordance with
				Title XIX of the Social Security Act,
				42 USC
				1396, et seq. and ARM Title 37, chapter 5,
				chapter 82, subchapters 1, 2, and 4, chapter 85, chapter 86, chapter 87,
				chapter 88, and chapter 90.
53-6-113,
					 MCA; IMP,
					 53-6-131,
					 53-6-195,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.10 - Medicaid for Workers With Disabilities › Rule 37.82.1004 - MEDICAID FOR WORKERS WITH DISABILITIES: GENERAL ELIGIBILITY CRITERIA

Current through Register Vol. 13, July 5, 2024
(1) An individual is eligible for benefits
				through the Medicaid for Workers with Disabilities program if the individual:
(a) is employed;
(b) has a disability as defined in
				42 USC
				1382 c, except that the criteria that the
				individual must be unable to engage in substantial gainful activity does not
				apply;
(c) has family income and
				resources that do not exceed the limits specified in ARM
				37.82.1005 and
				37.82.1006;
(d) pays a cost-share amount as specified in
				ARM 37.82.1007; and
(e) satisfies all other eligibility
				requirements specified in the authorities cited in ARM
				37.82.1003.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.10 - Medicaid for Workers With Disabilities › Rule 37.82.1005 - MEDICAID FOR WORKERS WITH DISABILITIES: INCOME

Current through Register Vol. 13, July 5, 2024
(1) An individual is eligible for benefits
				through the Medicaid for Workers with Disabilities program in regard to income
				if the individual's net family income is less than 250% of the 2011 U.S.
				Department of Health and Human Services poverty level for a family of that
				size.
(2) The individual's net
				family income will be determined using the income provisions of the
				supplemental security income (SSI) regulations at 20 CFR, part 416, subpart K,
				as amended through May 17, 2010, and of the Aged Blind Disabled (ABD) Medicaid
				Manual adopted and incorporated by reference in ARM
				37.82.101. 20 CFR, part 416,
				subpart K, which contains the SSI criteria for evaluating income, including the
				income of financially responsible relatives, is adopted and incorporated by
				reference. In case of a conflict between a provision of 20 CFR, part 416,
				subpart K, and a provision of the ABD Medicaid Manual, the provision of the
				Medicaid Manual shall apply. The ABD Medicaid Manual is available for public
				viewing at each local office of public assistance or at the Department of
				Public Health and Human Services, Human and Community Services Division, 111 N.
				Jackson Street, 5th Floor, P.O. Box 202925, Helena, MT 59620-2925.
53-6-113,
					 53-6-195,
					 MCA; IMP,
					 53-6-101,
					 53-6-131,
					 53-6-195,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.10 - Medicaid for Workers With Disabilities › Rule 37.82.1006 - MEDICAID FOR WORKERS WITH DISABILITIES: RESOURCES

Current through Register Vol. 13, July 5, 2024
(1) An individual is eligible in regard to
				resources if the individual's resources, including any resources of relatives
				deemed to be available to the individual pursuant to the supplemental security
				income (SSI) regulations at 20 CFR, part 416, subpart L, as amended through May
				17, 2010, have a value of $8,000 or less. 20 CFR, part 416, subpart L, which
				contains the SSI criteria for evaluating resources, including the resources of
				financially responsible relatives, is adopted and incorporated by reference. A
				married individual who resides with his or her spouse is eligible in regard to
				resources if the resources of the individual and his or her spouse, including
				any resources of relatives deemed to be available to the individual pursuant to
				20 CFR, part 416, subpart L, have a value of $12,000 or less.
(2) Except as provided in (3) below, the
				individual's resources will be determined using the resource provisions of SSI
				regulations at 20 CFR, part 416, subpart L, and of the ABD Medicaid Manual
				adopted by reference in ARM
				37.82.101. In case of a conflict
				between a provision of 20 CFR, part 416, subpart L, and a provision of the ABD
				Medicaid Manual, the provision of the Medicaid Manual shall apply.
(3) Funds in a retirement or pension fund or
				plan are excluded as a resource.
53-6-113,
					 53-6-195,
					 MCA; IMP,
					 53-6-131,
					 53-6-195,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.10 - Medicaid for Workers With Disabilities › Rule 37.82.1007 - MEDICAID FOR WORKERS WITH DISABILITIES: COST SHARE FEES

Current through Register Vol. 13, July 5, 2024
(1) Except as provided in (2) below, an
				otherwise eligible individual must make a monthly cost share fee in accordance
				with the table in (3) below, as a condition of eligibility for benefits under
				the Medicaid for Workers with Disabilities program. The payment is based on the
				gross income of the individual only, not the individual's family income. The
				amount of the payment varies depending on what percentage of the federal
				poverty level for a family of one the individual's gross income
				represents.
(2) Indians are not
				required to pay any cost share fee regardless of their income.
(3) The amount of an individual's cost share
				fee will be determined using the following table:
Gross Income as a percentage of federal poverty level
							 (FPL)
Monthly gross income dollar amount
Monthly payment
Up to 100%
$01.00 to $903
$35
Over 100% to 150%
$903.01 to $1,354
$67
Over 150% to 200%
$1,354.01 to $1,805
$100
Over 200% to 250%
$1805.01 to $2,256
$135
53-6-113,
					 53-6-195,
					 MCA; IMP,
					 53-6-131,
					 53-6-195,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1101 - INDIVIDUALS COVERED, NON-INSTITUTIONALIZED MEDICALLY NEEDY

Current through Register Vol. 13, July 5, 2024
(1) Medicaid under this subchapter will be
				provided to the following individuals who would be receiving FAIM financial
				assistance if their income had not exceeded the income standards found in ARM
				37.78.420 provided they are also
				eligible under ARM
				37.82.1102,
				37.82.1106,
				37.82.1107 and
				37.82.1110:
(a) pregnant women whose pregnancy has been
				verified;
(b) individuals who are
				under the age of 18 or are age 18 and a full-time student in a secondary school
				and can reasonably be expected to obtain a secondary school diploma or its
				equivalent in or before the month of their 19th birthday;
(c) a child born on or after October 1, 1983,
				through the month of their 19th birthday whose family income and resources meet
				the requirements listed in ARM
				37.78.401 and
				37.82.1106;
(d) individuals under
				age 19 who are ineligible for medicaid under ARM
				37.82.701; and
(e) individuals in a FAIM financial
				assistance lump sum period of ineligibility.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1102 - NON-FINANCIAL REQUIREMENTS, NON- INSTITUTIONALIZED MEDICALLY NEEDY

Current through Register Vol. 13, July 5, 2024
(1) Except as provided in (2), for groups
				covered under ARM
				37.82.1101(1),
				the AFDC nonfinancial requirements which are set forth in ARM 46.10.301 through
				46.10.307, 46.10.320 and 46.10.321 will be used to determine whether:
(a) an individual under age 19 is considered
				a dependent child because he is deprived of parental support or care;
(b) an individual is an eligible member of a
				family with a dependent child; and
(c) notwithstanding the above and in
				accordance with ARM
				37.82.1101(1) (c),
				(d), and (e), the school attendance
				requirement found in ARM 46.10.301 and the JOBS participation requirements
				found in ARM 46.10.805 through 46.10.847 do not apply to this coverage
				group.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1106 - MEDICALLY NEEDY INCOME STANDARDS

Current through Register Vol. 13, July 5, 2024
(1) To
				be eligible for medically needy assistance, SSI and family-related
				institutionalized and non-institutionalized recipients must meet:
(a) non-financial criteria of ARM
				37.82.1102;
(b) resource criteria of ARM
				37.82.1110; and
(c) income criteria of ARM
				37.82.1107.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1107 - INCOME ELIGIBILITY, NONINSTITUTIONALIZED MEDICALLY NEEDY

Current through Register Vol. 13, July 5, 2024
(1) Medically needy income eligibility for
				non-institutionalized and family-related persons will be computed using a one
				month prospective budget period.
(a) For
				groups covered under ARM
				37.82.1101(1)(a)
				through (1)(e), monthly countable income will
				be determined using family-related Medicaid income requirements, in particular
				those with respect to prospective budgeting and earned income disregards, set
				forth in the Family Medicaid Program Policy Manual, sections 601-1 and 602-1.
(i) In the case of individuals whose income
				must be deemed when determining eligibility, the family-related Medicaid income
				requirements contained in the Family Medicaid Program Policy Manual, section
				603-1 will be used.
(ii) In the
				case of individuals under age 21 who reside in an inpatient psychiatric
				facility, only income which belongs to the individual or which is actually
				contributed to the individual will be used to determine
				eligibility.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1110 - RESOURCE STANDARDS, NON-INSTITUTIONALIZED MEDICALLY NEEDY

Current through Register Vol. 13, July 5, 2024
(1) Except as provided in (2) for households
				receiving assistance in the FAIM project, the medically needy resource
				limitations are:
Family
Size
1
$2,000
2
3,000
(a) One hundred
				dollars will be added to the two person standard for each additional family
				member.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1111 - THREE MONTH RETROACTIVE COVERAGE, NON-INSTITUTIONALIZED MEDICALLY NEEDY

Current through Register Vol. 13, July 5, 2024
(1) The retroactive period may include any or
				all of the three months immediately preceding the month of
				application.
(2) To be eligible for
				retroactive medically needy coverage, during each month of the retroactive
				period, SSI and AFDC-related persons and families must meet:
(a) non-financial criteria of ARM
				37.82.1102;
(b) resource criteria of ARM
				37.82.1110 as of the first day of
				the month; and
(c) income criteria
				of ARM 37.82.1107 except that income will
				be determined using actual income received in the retroactive period.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.11 - Eligibility Requirements for the Non-Institutionalized Medically Needy › Rule 37.82.1116 - RESOURCE EXCLUSIONS: MEDICALLY NEEDY COVERAGE FOR NONINSTITUTIONALIZED INDIVIDUALS, COUPLES, AND FAMILIES

Current through Register Vol. 13, July 5, 2024
(1) In
				determining eligibility for noninstitutionalized medically needy individuals,
				couples, and families under the family Medicaid and aged, blind, and disabled
				Medicaid coverage groups in regard to the factor of resources, no exclusions
				will be applied to any property that is not owned by a member of the filing or
				assistance unit. No exclusion will be applied to any property that is owned or
				held by any entity, including but not limited to a trust or corporation,
				limited liability company, or any other legal entity, instrument, device, or
				arrangement of any kind, under which a member of the filing or assistance unit
				does not own the property.
53-6-113,
					 MCA; IMP,
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1301 - DEFINITIONS RELATING TO INSTITUTIONAL STATUS

Current through Register Vol. 13, July 5, 2024
(1) As used in this subchapter:
(a) "Active treatment in institutions for the
				mentally retarded" requires the following:
(i) The individual's regular participation,
				in accordance with an individual plan of care, in professionally developed and
				supervised activities, experiences, or therapies.
(ii) An individual written plan of care that
				sets forth measurable goals or objectives stated in terms of desirable behavior
				and that prescribes an integrated program of activities, experiences or
				therapies necessary for the individual to reach those goals or objectives. The
				overall purpose of the plan is to help the individual function at the greatest
				physical, intellectual, social, or vocational level he can presently or
				potentially achieve.
(iii) An
				interdisciplinary professional evaluation that:
(A) is completed for a recipient, before
				admission to the institution but not more than three months before, and for an
				individual applying for medicaid after admission, before the institution
				requests payment;
(B) consists of
				complete medical, social and psychological diagnosis and evaluations and an
				evaluation of the individual's need for institutional care; and
(C) is made by a physician, a social worker
				and other professionals, at least one of whom is a qualified mental retardation
				professional.
(iv)
				Reevaluation medically, socially and psychologically at least annually by the
				staff involved in carrying out the resident's individual plan of care. This
				must include review of the individual's progress toward meeting the plan
				objectives, the appropriateness of the individual plan of care, assessment of
				his continuing need for institutional care, and consideration of alternate
				methods of care.
(v) An individual
				postinstitutional plan, as part of the individual plan of care, developed
				before discharge by a qualified mental retardation professional and other
				appropriate professionals. This must include provision for appropriate
				services, protective supervision, and other follow-up services in the
				resident's new environment.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1302 through 37.82.1304 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1305 - GROUPS COVERED, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Medicaid will be provided to the
				following AFDC-related institutionalized individuals under the heading
				categorically needy:
(a) Individuals under
				age 21 in intermediate care facilities, including in intermediate care
				facilities for the mentally retarded.
(b) Individuals under age 21 receiving active
				treatment as inpatients in psychiatric facilities or programs provided that the
				youth is in the custody of the department or has been committed to the
				department by district court pursuant to
				41-3-403,
				41-3-404,
				41-3-406 or
				41-5-523,
				MCA.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1306 - GROUPS COVERED, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Medicaid will be provided to the
				following SSI-related institutionalized individuals under the heading
				categorically needy:
(a) Individuals
				receiving SSI on the basis of the SSI income standard for institutionalized
				individuals.
(b) Individuals in
				medical institutions and intermediate care facilities who are ineligible for
				SSI because the SSI income standard for institutionalized individuals is lower
				than the SSI income standard for noninstitutionalized individuals.
(c) Individuals who were eligible for
				medicaid in December, 1973, as inpatients of medical institutions or residents
				of intermediate care facilities, if, for each consecutive month after December,
				1973, they:
(i) continue to meet the
				December, 1973, eligibility requirements;
(ii) remain institutionalized; and
(iii) continue to need institutional
				care.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1307 through 37.82.1309 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1310 - NON-FINANCIAL REQUIREMENTS, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Individuals under age 19 who continue to
				receive AFDC even though they are in a medical institution or intermediate care
				facility are presumed to have met the non-financial requirements for medicaid
				eligibility.
(2) For individuals
				under age 21 in intermediate care facilities, including intermediate care
				facilities for the mentally retarded, or receiving treatment in psychiatric
				facilities or programs pursuant to the requirements of ARM
				37.82.1305(1)
				(b), the nonfinancial requirements for
				medicaid under this subchapter, whether as categorically needy or medically
				needy, consist of the age requirement and applicable service
				requirements.
Sec.
					 53-6-113,
					 MCA; IMP, Sec.
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1311 - NON-FINANCIAL REQUIREMENTS, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Individuals receiving SSI on the basis of
				the SSI income standard for institutionalized individuals are presumed to have
				met the nonfinancial requirements for medicaid eligibility.
(2) For individuals in medical institutions
				and intermediate care facilities who are ineligible for SSI because the SSI
				income standard for institutionalized individuals is lower than the SSI income
				standard for noninstitutionalized individuals, the nonfinancial requirements
				for medicaid under this subchapter, whether as categorically needy or medically
				needy, are the SSI nonfinancial requirements which are set forth in 20 CFR,
				Part 416, subparts H and I. These will be used to determine whether an
				individual is aged, blind, or disabled. 20 CFR, Part 416, subpart H, contains
				the SSI criteria for determining age, and 20 CFR, Part 416, subpart I, contains
				the SSI criteria for determining blindness and disability. The department
				hereby adopts and incorporates 20 CFR, Part 416, subparts H and I. A copy of
				these federal regulations may be obtained from the Department of Public Health
				and Human Services, Human and Community Services Division, Public Assistance
				Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT
				59620-2952.
(3) For individuals who
				were eligible for medicaid in December, 1973, as inpatients of medical
				institutions or residents of intermediate care facilities, the nonfinancial
				requirements for medicaid under this subchapter are the December, 1973 OAA, AB,
				APTD, or AABD nonfinancial requirements. A copy of the December, 1973 OAA, AB,
				APTD, and AABD nonfinancial requirements may be obtained from the Department of
				Public Health and Human Services, Human and Community Services Division, Public
				Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena,
				MT 59620-2952.
Sec.
					 53-6-113,
					 MCA; IMP, Sec.
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1312 - FINANCIAL REQUIREMENTS, AFDC-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Individuals under age 19 who continue to
				receive AFDC even though they are in a medical institution or intermediate care
				facility are presumed to have met the financial requirements for medicaid
				eligibility.
(2) For individuals
				under age 21 in intermediate care facilities, including intermediate care
				facilities for the mentally retarded, or receiving treatment in psychiatric
				facilities or programs pursuant to the requirements of ARM
				37.82.1305(1)
				(b), the financial requirements for medicaid
				under this subchapter as categorically needy are the AFDC financial
				requirements which are set forth in ARM 46.10.401 through 46.10.406 and
				46.10.505 through 46.10.514. These will be used to determine whether:
(a) the individual in his placement is
				eligible with respect to resources;
(b) the individual in his placement is
				eligible with respect to gross and net income and with respect to the
				applicable benefit standards.
(c)
				In applying the above;
(i) because the
				individual is not living with his parent, parental income will be considered
				only when actually contributed; and
(ii) applicable standards are the child only
				standards.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1313 - FINANCIAL REQUIREMENTS, SSI-RELATED INSTITUTIONALIZED INDIVIDUALS

Current through Register Vol. 13, July 5, 2024
(1) Individuals receiving SSI on the basis of
				the SSI income standard for institutionalized individuals are presumed to have
				met the financial requirements for medicaid eligibility.
(2) For individuals in medical institutions
				and intermediate care facilities who are ineligible for SSI because the SSI
				income standard for institutionalized individuals is lower than the SSI income
				standards for noninstitutionalized individuals, the financial requirements for
				medicaid under this subchapter as categorically needy are the categorically
				needy financial requirements for noninstitutionalized SSI-related individuals
				and couples which are set forth in subchapter 9. The provisions of this
				subchapter, in particular those which apply to the individual living in his own
				home, apply identically to the above described individual.
(3) For individuals in medical institutions
				and intermediate care facilities who are ineligible under (2) because of excess
				income, the financial requirements for medicaid under this subchapter as
				medically needy are the medically needy financial requirements for
				noninstitutionalized SSI-related individuals and couples which are set forth in
				subchapter 11. The financial provisions of this subchapter which apply to the
				individual living in his own home apply identically to the above described
				individual.
(4) For individuals who
				were eligible for medicaid in December, 1973, as inpatients of medical
				institutions or residents of intermediate care facilities, the financial
				requirements for medicaid under this subchapter are the December, 1973 OAA, AB,
				APTD, or AABD financial requirements. A copy of the December, 1973, OAA, AB,
				APTD, and AABD financial requirements may be obtained from the Department of
				Public Health and Human Services, Human and Community Services Division, Public
				Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena,
				MT 59620-2952.
Sec.
					 53-6-113,
					 MCA; IMP, Sec.
					 53-6-131,
					 MCA;
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1314 through 37.82.1319 - Reserved

Current through Register Vol. 13, July 5, 2024
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1320 - POST-ELIGIBILITY APPLICATION OF PATIENT INCOME TO COST OF CARE

Current through Register Vol. 13, July 5, 2024
(1) After the nonfinancial and resource
				eligibility criteria are met, the income of individuals in a residential
				medical institution will be applied toward the cost of care as provided in this
				section. This provision applies to all covered groups in this subchapter,
				except:
(a) individuals under age 19 who
				continue to receive AFDC even though they are in a medical institution or
				intermediate care facility, as provided in ARM
				37.82.1305(1)(a);
				and
(b) individuals receiving
				supplemental security income on the basis of the supplemental security income
				standard for institutional individuals, as provided in ARM
				37.82.1306(1)(a).
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1321 - PROHIBITED COVERAGE

Current through Register Vol. 13, July 5, 2024
(1) Medicaid will
				not be provided to:
(a) an individual who is
				an inmate of a public institution;
(b) an individual who is a patient under age
				65 in an institution for tuberculosis or mental disease except as an inpatient
				receiving active treatment in a psychiatric facility or program.
Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.82 - MEDICAID ELIGIBILITY › Subchapter 37.82.13 - Eligibility Requirements for the Institutionalized Categorically Needy and Medically Needy › Rule 37.82.1322 - RESOURCE EXCLUSIONS: FAMILY MEDICAID AND AGED, BLIND, AND DISABLED MEDICAID FOR INSTITUTIONALIZED CATEGORICALLY NEEDY AND MEDICALLY NEEDY INDIVIDUALS, COUPLES, AND FAMILIES

Current through Register Vol. 13, July 5, 2024
(1) In determining
				eligibility for categorically needy and medically needy institutionalized
				individuals, couples, and families under the family Medicaid and aged, blind,
				and disabled Medicaid coverage groups in regard to the factor of resources, no
				exclusions will be applied to any property that is not owned by a member of the
				filing or assistance unit. No exclusion will be applied to any property that is
				owned or held by any entity, including but not limited to a trust or
				corporation, limited liability company, or any other legal entity, instrument,
				device, or arrangement of any kind, under which a member of the filing or
				assistance unit does not own the property.
53-6-113,
					 MCA; IMP,
					 53-6-131,
					 MCA;