16 Del. Admin. Code § 25000-25100
Current through Register Vol. 28, No. 7, January 1, 2025
Section 25000-25100 - ELIGIBILITYMedicaid eligibility is available to children who meet ALL of the following seven (7) criteria established by Federal regulation (42 CFR § 435.225):
| 1. | The child must be 18 years of age or younger (under age 19). |
| 2. | The child's countable resources do not exceed the SSI limit for a single individual described in DSSM § 20300. |
| 3. | The child's countable income does not exceed 250% of the SSI benefit level. |
| 4. | The child's profile is consistent with the level of care of a hospital, Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), Intermediate Care Facility for Mental Retardation (ICF/MR), or Intermediate Care Facility Institution for Mental Disease (ICF/IMD). |
| 5. | The child must meet Supplemental Security Income (SSI) medical disability standards codified at 42 U.S.C. § 1382 c(a) (presumptively met if child with chronic condition qualifies for SNF, ICF, ICF/MR, or ICF/IMD level of care). |
| 6. | It is appropriate to provide a comparable level of care in an alternative setting (e.g. natural family home). |
| 7. | The estimated Medicaid cost of care in the alternative setting is no higher than the estimated cost of the comparable facility-based level of care. |
16 Del. Admin. Code § 25000-25100