Section 16.03.13.190 - INDIVIDUALIZED BUDGETThe Department will assign budgets based on the criteria under IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."
01.Budget Amount Notification. The Department notifies each participant of their set budget amount as part of the eligibility determination or annual redetermination process. The notification will include how the participant may appeal the set budget amount.02.Annual Re-Evaluation of Adult Individualized Budgets. Individualized budgets will be re-evaluated annually. At the request of the participant, the Department will also re-evaluate the set budget amount when there are documented changes in the participant's condition that results in a need for services that meet medical necessity criteria, and that is not reflected on the current inventory of individual needs.03.Annual Re-Evaluation of Children's Individualized Budgets. Individualized budgets will be re-evaluated annually. At the request of the participant, the Department will also re-evaluate the set budget amount when there are documented changes that may support placement in a different budget category under IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits," Section 527.Idaho Admin. Code r. 16.03.13.190