23 Miss. Code. R. 208-7.1

Current through August 31, 2024

Rule 23-208-7.1 - Eligibility

A. The Division of Medicaid covers certain 1915(i) Home and Community-Based Services (HCBS) as an alternative to institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) through its State Plan. The State Plan services:

1. Offer broad discretion, not generally afforded, so that the needs of beneficiaries under the State Medicaid Plan may be addressed,

2. Are operated jointly with the Mississippi Department of Mental Health (DMH),

3. Are available statewide,

4. Carry no age restrictions, and

5. Are covered only for beneficiaries not enrolled in any HCBS Waiver program.

B. All of the following eligibility requirements must be met to receive 1915(i) State Plan services:

1. A beneficiary must have one (1) of the following:

a) An intellectual disability defined by the Division of Medicaid as meeting all the following criteria:

1) An IQ score of approximately seventy (70) or below,

2) A determination of deficits in adaptive behavior, and

3) Manifestation of disability prior to the age of eighteen (18).

b) A developmental disability defined by the Division of Medicaid as a severe, chronic disability which is a condition attributable to cerebral palsy, epilepsy, or any other condition other than mental illness found to be closely related to an intellectual disability, because it results in impairment of general intellectual functioning or adaptive behavior similar to that of an individual with an intellectual disability and requires similar treatment/services.

1) The condition is manifested prior to age twenty-two (22) and is likely to continue indefinitely.

2) The condition results in substantial functional limitations in three (3) or more of the following major life activities:

i) Self-care,

ii) Understanding and use of language,

iii) Learning,

iv) Mobility,

v) Self-direction, or

vi) Capacity for independent living and economic self-sufficiency.

3) The individual also requires a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of individually planned and coordinated assistance that is life-long or of an extended duration.

4) An exception to this definition is an individual, from birth to age nine (9), who has a substantial developmental delay or specific congenital or acquired condition. He or she may be considered developmentally disabled without meeting all of the above criteria if, without services and supports, there is a high probability of meeting those criteria later in life.

c) Autism as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.

2. Applicant must qualify for full Medicaid benefits in one (1) of the following categories:

a) SSI,

b) Low Income Families and Children Program,

c) Disabled Child Living at Home Program,

d) Working Disabled,

e) Children Under Age Nineteen (19) Under 100¢ of Poverty,

f) Protected Foster Care Adolescents,

g) CWS Foster Children and Adoption Assistance Children,

h) IV-E Foster Children and Adoption Assistance Children, or

i) Child under Age six (6) at 133¢ Federal Poverty Level.

23 Miss. Code. R. 208-7.1

Social Security Act § 1915(i); Miss. Code Ann. § 43-13-121.

New to correspond with SPA 2013-001 (eff. 11/01/2013) eff. 04/01/2014.