Section R414-307-4 - Special Income GroupThis section sets forth financial eligibility requirements for the special income group that apply to individuals seeking Medicaid coverage for services under an HCBS waiver as defined in 42 CFR 435.217.
(1) If the individual's spouse meets the definition of a community spouse, the eligibility agency shall apply income and resources as defined in Section 1924 of the Social Security Act and in Section R414-305-3.(2) If the individual does not have a spouse, or the individual's spouse does not meet the definition of a community spouse, the eligibility agency may only count the individual's resources to determine eligibility.(a) If both members of a married couple who live together apply for waiver services and meet the criteria for the special income group, the eligibility agency shall count one-half of jointly held assets as available to each spouse.(b) Each spouse must pass the medically needy resource test for one person.(c) The eligibility agency may only count income determined under the most closely associated cash assistance program to decide if the individual passes the income eligibility test for the special income group.(d) The eligibility agency may not count income of the individual's spouse except for contributions from the spouse.(e) If the individual is a minor child, the eligibility agency may not count income and resources of the child's parents to decide if the child passes the income and resource tests for the special income group.(f) The eligibility agency shall count contributions from a parent, including court-ordered support payments as income of the child.(g) The individual's income cannot exceed three times the payment that would be made to an individual with no income under Subsection 1611(b)(1) of the Social Security Act.(h) The eligibility agency shall apply the transfer of assets in accordance with Section 1917 of the Social Security Act.(i) The individual's cost-of-care contribution is determined by deducting from the individual's total income, the post-eligibility allowances for the specific waiver for which the individual qualifies.(j) The eligibility agency shall determine financial eligibility for the special income group for an individual based on the level-of-care date on a valid waiver referral form as defined in Subsection R414-307-3(6).(k) The eligibility agency shall determine eligibility for earlier months using the community Medicaid or Institutional Medicaid rules that apply to the individual's situation.Utah Admin. Code R414-307-4
Amended by Utah State Bulletin Number 2015-14, effective 7/1/2015Amended by Utah State Bulletin Number 2024-03, effective 1/22/2024