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Home
and Community Based Waiver Programs:
Medically
Fragile / Technology Dependent Children
This
Utah Medicaid Waiver program assists medically fragile children
(up to age 21) to remain in their own homes, rather than
being placed in an institution. There is a limit on
the number of children allowed into the waiver program.
Applications are taken through the a Division of Family
Health Services case manager. None of the parent's
income or assets is counted in considering the child's eligibility.
Also, an intensive service plan is written for the child,
and all services are paid by Medicaid. To be eligible
for this program, children must meet specific medical criteria.
The income standard, after allowable deductions, is 100%
of the Federal Poverty Level, which is typically adjusted
annually. All of the child's income counts. The Federal
Poverty Level is available on the Internet at http://aspe.hhs.gov/poverty
Income
Eligibility Standards in Monthly Amounts (April
2005)
Household
Size *Monthly
Income
1
. . . . . . . . . . . $
798
*Deductions
Deduct
$500 from earned income, spousal and family allowance, health
and accident insurance premiums, medical expenses, and some
shelter costs.
*Spenddown
Medicaid
applicants whose income exceeds the monthly income standard
may be considered for the Medically Needy program, sometimes
referred to as the Spenddown Program. This program
allows a person who is otherwise eligible either to pay
"excess" monthly income to the state or to accept
responsibility for a portion of their monthly medical bills.
Asset
Limits
Nursing
home client - $2,000
For
married persons with a spouse in the home, assets are divided
between husband and wife. All assets are considered
to be jointly owned even if only one member of the couple
is shown as the owner. Special allowances for burial
spaces and funeral plans. As of January 2003,
the spouse at home is allowed to keep at least $18,132 of
the assets the couple owned when the client entered the
nursing home, and no more than $90,660. Current limits can
be found at the web site for the Centers for Medicare &
Medicaid Services: http://cms.hhs.gov/medicaid/eligibility/
Transfer
of Assets
Sanctions
apply if either (1) individual or spouse transfers assets
within 36 months, or within 60 months if a trust, of application
date for Medicaid, or (2) the individual transfers assets
at any time after eligibility is determined. Waiver services
are not paid during a sanction period
Retroactive
Coverage
Most
Medicaid programs allow an applicant to request coverage
for medical services for up to three months prior to the
month in which the person filed a Medicaid application.
A person who received medical, dental or mental health services
and subsequently qualifies for Medicaid may return to each
provider with a Medicaid Identification Card for the month
in which service was provided. A provider who has already
rendered services may subsequently choose to accept Medicaid
as payment in full or refuse to seek Medicaid payment
because the patient had not been determined eligible for
Medicaid at the time of service. If the provider accepts
Medicaid, Medicaid may pay for the service. If the
provider refuses Medicaid, the patient is responsible for
the charges.
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