Iowa Admin. Code r. 441-25.16
Current through Regsiter Vol. 46, No. 26, June 12, 2024
Rule 441-25.16 - Financial eligibility requirementsThe regional service system management plan shall identify basic financial eligibility standards for mental health and disability services as defined in Iowa Code sections 331.395 and 331.396A.
(1)Income requirements.a. Income requirements for adult mental health and disability services shall be as follows: (1) The person must have an income equal to or less than 150 percent of the federal poverty level.(2) A person who is eligible for federally funded services and other support must apply for such services and support.b. Income requirements for children's behavioral health services shall be as follows: (1) The child's family has countable household income equal to or less than 500 percent of the federal poverty level. Countable household income and family size shall be determined using the modified adjusted gross income methodology.(2) An eligible child whose family's countable household income is at least 150 percent and not more than 500 percent of the federal poverty level shall be subject to a cost share as described in subrule 25.16(3).(3) Verification of income. Income shall be verified using the best information available.1. Pay stubs, tip records and employers' statements are acceptable forms of verification of earned income.2. Self-employment income can be verified through business records from the previous year if they are representative of anticipated earnings. If business records from the previous year are not representative of anticipated earnings, an average of the business records from the previous two or three years may be used if that average is representative of anticipated earnings.(4) Changes in income. Financial eligibility shall be reviewed on an annual basis and may be reviewed more often in response to increases or decreases in income.(5) A child who is eligible for federally funded services and other support must apply for such services and support.(2)Resource requirements. There are no resource limits for the family of a child seeking children's behavioral health services. An adult seeking mental health and disability services must have resources that are equal to or less than $2,000 in countable value for a single-person household or $3,000 in countable value for a multi person household or follow the most recent federal supplemental security income guidelines. a. The countable value of all countable resources, both liquid and non-liquid, shall be included in the eligibility determination except as exempted in this subrule.b. A transfer of property or other assets within five years of the time of application with the result of, or intent to, qualify for assistance may result in denial or discontinuation of funding.c. The following resources shall be exempt:(1) The homestead, including equity in a family home or farm that is used as the individual household's principal place of residence. The homestead shall include all land that is contiguous to the home and the buildings located on the land.(2) One automobile used for transportation.(3) Tools of an actively pursued trade.(4) General household furnishings and personal items.(5) Burial account or trust limited in value as to that allowed in the medical assistance program.(6) Cash surrender value of life insurance with a face value of less than $1,500 on any one person.(7) Any resource determined excludable by the Social Security Administration as a result of an approved Social Security Administration work incentive.d. If an individual does not qualify for federally funded or state-funded services or other support but meets all income, resource, and functional eligibility requirements of this chapter, the following types of resources shall additionally be considered exempt from consideration in eligibility determination: (1) A retirement account that is in the accumulation stage.(2) A medical savings account.(3) An assistive technology account.(4) A burial account or trust limited in value as to that allowed in the medical assistance program.e. An individual who is eligible for federally funded services and other support must apply for and accept such funding and support.(3)Cost-share standards. A regional administrative entity must comply with cost-share standards as defined in Iowa Code sections 331.395 and 331.396A. a. Cost sharing is allowed for adults with income above 150 percent of the federal poverty level as defined by the most recently revised poverty guidelines published by the United States Department of Health and Human Services. Cost-share amounts for regionally funded adult mental health and disability services in this rule are related to core services as defined in Iowa Code section 331.397 and must be identified in the enrollment and eligibility section of the region's policy and procedures approved by the department.
b. Cost-share amounts for children's behavioral health services are applicable to core services as defined in Iowa Code section 331.397A. The family of a child receiving regional funding for behavioral health services shall be responsible for a cost-share amount based on the family's household income as follows: Family Income as a % of FPL | Cost Share % Paid by Family |
0 to 150% | 0% |
151 to 200% | 10% |
201 to 250% | 15% |
251 to 300% | 20% |
301 to 350% | 35% |
351 to 400% | 50% |
401 to 450% | 65% |
451 to 500% | 80% |
Over 500% | 100% |
(4)Cost-share standards required by any federal, state, regional, or municipal program. Any cost sharing or other client participation required by any federal, state, regional or municipal program in which the individual participates shall be required by the regional administrative entity. Such cost sharing includes, but is not limited to:a. Client participation for maintenance in a residential care facility through the state supplementary assistance program.b. The financial liability for institutional services paid by counties as provided in Iowa Code section 230.15.c. The financial liability for attorney fees related to commitment as provided by Iowa Code section 229.8.Iowa Admin. Code r. 441-25.16
ARC 1173C, IAB 11/13/2013, effective 1/1/2014Amended by IAB February 12, 2020/Volume XLII, Number 17, effective 3/18/2020