Section R539-1-7 - Medicaid Waiver Eligibility and Enrollment for the Comprehensive Support Waivers(1) Matching federal funds may be available through a comprehensive support waiver that provides an array of home and community-based services for a person with an intellectual disability or related condition, physical disability, or brain injury. (a) A person must meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services.(b) A person must meet a waiver level of care as determined by the division.(2) As described in Subsections 62A-5-102(3) and 62A-5-102(4), the division provides a waiver service within an appropriation from the Legislature. (a) Except as described in Subsection R539-1-7(2)(d), the division determines waiver enrollment by the most critical need ranking.(b) The division shall use a need assessment tool to determine a person's need score.(c) Ordering of each person's need score identifies the most critical need ranking.(d) The Emergency Services Management Committee may approve enrollment in a comprehensive support waiver as described in Section R539-2-9.(3) Pursuant to Rule R414-510, if the Department of Health determines that sufficient funding is available, an eligible individual may receive a waiver service by transitioning out of an ICF into a comprehensive support waiver.(4) Pursuant to Rule R414-502, the Department of Health may find a person meeting nursing facility level of care eligible for funding through a comprehensive support waiver.(5) Any person offered enrollment in a Medicaid waiver may choose not to participate. If an eligible person chooses not to participate in a waiver, the person shall receive only the state funded portion of their assessed need as described in Section R539-1-9.Utah Admin. Code R539-1-7
Amended by Utah State Bulletin Number 2016-22, effective 10/25/2016Amended by Utah State Bulletin Number 2020-08, effective 4/8/2020Amended by Utah State Bulletin Number 2020-22, effective 11/9/2020Amended by Utah State Bulletin Number 2022-05, effective 2/22/2022