Section 25.5-6-1905 - Eligibility(1) To be eligible for the community first choice option, an individual must:(a) Be eligible for the state medical assistance program;(b) Be in an eligibility group under the state medical assistance program that includes nursing facility services, or if in an eligibility group that does not include nursing facility services, have an income that is at or below one hundred fifty percent of the federal poverty level. The state department shall determine whether an individual is at or below one hundred fifty percent of the federal poverty level on an annual basis by applying the same methodologies that apply under the state medical assistance program, including the same less restrictive resource methodologies described in the federal "Social Security Act", 42 U.S.C. sec. 1902 (r)(2).(c)(I) Receive an annual determination that in the absence of the home- and community-based attendant services and supports provided pursuant to the community first choice option, the individual would require the level of care furnished in a hospital, a nursing facility, an intermediate care facility to an individual with intellectual disabilities, an institution providing inpatient psychiatric services to an individual under twenty-one years of age, or an institution for behavioral or mental health disorders for an individual sixty-five years of age or older if the cost could be reimbursed under the state medical assistance program.(II) The state department may, at its discretion, permanently waive the annual determination for an individual if the state department:(A) Determines there is no reasonable expectation of improvement or significant change in the individual's condition because of the severity of a chronic condition or the degree of impairment of functional capacity; and(B) Retains documentation of the reason for waiving the individual's annual determination requirement.(2) For the purposes of meeting the requirements of subsection (1)(b) of this section, an individual who qualifies for medical assistance pursuant to the special home- and community-based waiver eligibility group defined in the federal "Social Security Act", 42 U.S.C. sec. 1902 (a)(10)(A)(ii)(VI), shall meet all the requirements in 42 U.S.C. sec. 1915(c) and receive at least one home- and community-based waiver service per month.(3) Individuals receiving services through the community first choice option must not be precluded from receiving other home- and community-based long-term care services and supports through other state medical assistance program waivers, grants, or demonstration authorities.Added by 2023 Ch. 270,§ 1, eff. 5/25/2023.