Rule 23-208-4.2 - EligibilityA. Eligibility is limited to individuals with the following disease(s) or condition(s): 1. Traumatic brain injury which the Division of Medicaid defines as an insult to the skull, brain, or its covering resulting from external trauma, which produces an altered state of consciousness or anatomic, motor, sensory, or cognitive/behavioral deficits. 2. Spinal cord injury which the Division of Medicaid defines as a traumatic injury to the spinal cord or cauda equina with evidence of motor deficit, sensory deficit, and/or bowel and bladder dysfunction. The lesions must have significant involvement with two (2) of the above three (3) deficits. B. The extent of injury must be certified by the physician. C. Brain or spinal cord injury that is due to a degenerative or congenital condition, or that result, intentionally or unintentionally, from medical intervention is excluded. D. Individuals must be certified as medically stable by their physician. The Division of Medicaid defines medically stable as the absence of all of the following: 1. An active, life threatening condition requiring systematic therapeutic measures. 2. Intravenous drip to control or support blood pressure. 3. Intracranial pressure or arterial monitoring. E. Individuals must qualify for full Medicaid benefits in one (1) of the following Categories of Eligibility (COE): 1. Supplemental Security Income (SSI), 2. Parents and Other Caretaker Relatives Program, 3. Disabled Child Living at home program, 5. Infants and Children under age nineteen (19) who meet the applicable income requirements, 7. Protected Foster Care Adolescents, 8. Child Welfare Services (CWS) Foster Children and Adoption Assistance Children, 9. IV-E Foster Children and Adoption Assistance Children, or 10. An aged, blind or disabled individual who meets all factors of institutional eligibility. If income exceeds the current institutional limit, the individual must pay the Division of Medicaid the portion of their income that is due under the terms of an Income Trust in order to qualify. F. Persons enrolled in the TBI/SCI Waiver who elect to receive hospice care may not receive waiver services which are duplicative of any services rendered through hospice. Persons may receive non-duplicative waiver services in coordination with hospice services.23 Miss. Code. R. 208-4.2
42 USC § 1396n; 42 CFR §§ 435.217, 440.180, 441.301; Miss. Code Ann. §§ 43-13-115, 43-13-117, 43-13-121.Revised eff. 08/01/2016; Added Miss. Admin. Code Part 208, Rule 4.2.F. eff. 06/01/2016; Amended 8/1/2016