Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 40 - Medicaid for Elders and Adults with Disabilities › Subchapter 15 - Disabled Working Adults › Part 1 - Medicaid Code of Administrative Rules, Section 1373 Medicaid for Working People with Disabilities Program › Section 210-RICR-40-15-1.7 - Medicaid Long-term Services and Supports (LTSS)

Current through June 14, 2024
1.7.1
Eligibility Determination
				  Process
Adults with disabilities who are seeking LTSS - both
					 current Medicaid beneficiaries and new applicants - who do not qualify for MACC
					 group LTSS are evaluated for eligibility across the pathways set forth in
					 §50-00-1.8 of this Title using the SSI method. Accordingly, they may
					 qualify for the work-related income disregards identified in §
											1.4(B)(1)
					   of this Part (above) in the eligibility determination process. A separate
					 disability determination by the MART is not required for
					 applicants/beneficiaries who meet the clinical/functional level of care
					 criteria for Medicaid LTSS.
1.7.2
Service Plan
All Medicaid LTSS beneficiaries must have a service plan
					 that ties benefits to their functional and clinical needs. If employment
					 supports are needed, the role of work, if any, and any associated employment
					 supports must be a component of this plan. For LTSS beneficiaries choosing home
					 and community-based services, the service plan must reflect the decisions they
					 make about their health goals established in the person-centered planning
					 process set forth in
					  42 C.F.R. §
												441.725  and in Part 50-10-1 of this Title.
					 The development of a service plan is guided by agency representatives as the
					 components may vary depending on the type of a person's disability, program
					 requirements, and associated provisions under the Section 1115 waiver and
					 Medicaid State Plan. Accordingly, specific guidance is provided on this
					 process. In response to the novel Coronavirus Disease (COVID-19), EOHHS will
					 postpone in-person person centered planning.
1.7.3
Cost of Care
A. In accordance with Federal requirements,
				  under the State's Medicaid State Plan and Section 1115 waiver, all LTSS
				  Medicaid beneficiaries eligible based on the SSI method who can afford to do so
				  must pay a portion of income toward the cost of their care. A beneficiary's
				  liability for the cost of care is calculated in the post-eligibility treatment
				  of income process in accordance with Part 50-00-8 of this Title and is based on
				  gross monthly income - earned and unearned - less certain deductions or
				  "allowances." To encourage LTSS beneficiaries who have disabilities to work,
				  there are special allowances which require the State to exclude some or all of
				  the beneficiary's earned income when determining the amount available to be
				  applied toward the cost of care.
1. HCBS - The
				  following are special allowances for Medicaid LTSS working adults with
				  disabilities who are receiving home and community-based services:
a. Programs for persons with
				  intellectual/developmental disabilities. The Rhode Island Department of
				  Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH)
				  Development Disabilities (DD) Program administers programs for persons with DD,
				  including those who work and qualify for Medicaid HCBS integrated employment
				  supports. To further BHDDH employment first goals, the State has implemented
				  the I/DD-Special Maintenance Needs Allowance (I/DD-MNA).
(1) Purpose. The I/DD-MNA reduces the amount
				  of income that is available to pay toward the LTSS cost of care through a
				  series of standard and special allowances that protect a higher portion of the
				  earned income of working adults with disabilities than is permitted for other
				  beneficiaries.
(2) Allowance order.
				  In determining available income, all other allowances identified in Part
				  50-00-8 of this Title pertaining to the post-eligibility treatment of income
				  are applied first. (The sequence of deductions is contained in
				  §50-00-8.5(C) of this Title). Once this calculation is complete, available
				  income is reduced further by the I/DD-MNA which deducts any earned income up to
				  but not to exceed three hundred percent (300%) of the SSI income standard. The
				  amount of income remaining after this final allowance is applied constitutes
				  the beneficiary's liability for LTSS. The SSI income standard changes annually
				  and is located in Subchapter 00 Part 3 of this Chapter.