Section 16.03.10.702 - ADULT DD WAIVER SERVICES: ELIGIBILITYWaiver eligibility will be determined by the Department as described in Section 509 of these rules. The participant must be financially eligible for Medical Assistance as described in IDAPA 16.03.05, "Eligibility for Aid for the Aged, Blind, and Disabled (AABD)," Section 787. The cited chapter implements and is in accordance with the Financial Eligibility Section of the Idaho State Plan. In addition, waiver participants must meet the following requirements: (3-17-22)
01.Age of Participants. DD waiver participants must be eighteen (18) years of age or older. (3-17-22)02.Eligibility Determinations. The Department must determine that: (3-17-22) a. The participant would qualify for ICF/IID level of care as set forth in Section 584 of these rules, if the waiver services listed in Section 703 of these rules were not made available; and (3-17-22)b. The participant could be safely and effectively maintained in the requested or chosen community residence with appropriate waiver services. This determination must: be made by a team of individuals with input from the person-centered planning team; and prior to any denial of services on this basis, be determined by the plan developer that services to correct the concerns of the team are not available. (3-17-22)c. The average annual cost of waiver services and other medical services to the participant would not exceed the average annual cost to Medicaid of ICF/IID care and other medical costs. (3-17-22)03.Home and Community-Based Services Waiver Eligible Participants. A participant who is determined by the Department to be eligible for services under the Home and Community-Based Services Waivers for DD may elect not to utilize waiver services but may choose admission to an ICF/IID. (3-17-22)04.Processing Applications. The participant's self-reliance staff will process the application in accordance with IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD)," as if the application was for admission to an ICF/IID, except that the self-reliance staff will forward potentially eligible applications immediately to the Department for review. The Medicaid application process cited above conforms to all statutory and regulatory requirements relating to the Medicaid application process. (3-17-22)05.Transmitted Decisions to Self-Reliance Staff. The decisions of the Department regarding the acceptance of the participants into the waiver program will be transmitted to the self-reliance staff. (3-17-22)06.Case Redetermination. (3-17-22)a. Financial redetermination will be conducted pursuant to IDAPA 16.03.01, "Eligibility for Health Care Assistance for Families and Children," and IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD)." Medical redetermination will be made at least annually by the Department, or sooner at the request of the participant, the self-reliance staff, provider agency, or physician. The sections cited implement and are in accordance with Idaho's approved State Plan with the exception of deeming of income provisions. (3-17-22)b. The redetermination process will assess the following factors: (3-17-22)i. The participant's continued need and eligibility for waiver services; and (3-17-22)ii. Discharge from the waiver services program. (3-17-22)07.Home and Community-Based Waiver Participant Limitations. The number of Medicaid participants to receive waiver services under the home and community-based waiver for developmentally disabled participants will be limited to the projected number of users contained in the Department's approved waiver. Individuals who apply for waiver services after the waiver maximum has been reached will be placed on a waiting list and will have their applications processed after September 30th for the DD waiver of each new waiver year. (3-17-22)Idaho Admin. Code r. 16.03.10.702