Hcbs: Participant Eligibility

01. Federal and State Eligibility Requirements. To be enrolled in an HCBS waiver or State Plan option program, a participant must meet the following eligibility requirements: (7-1-26) a. An independent assessment; (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 540 Page 119 b. A state-approved person-centered plan; (7-1-26) c. Annual eligibility redetermination; and (7-1-26) d. Other state-established criteria for determining Medicaid eligibility. (7-1-26) 02. Failure to Meet Requirements. A participant who does not meet eligibility criteria is subject to termination of enrollment. (7-1-26) 03. Conditions for Termination. The Department will terminate participant enrollment if they: (7-1-26) a. Do not have an identified need for a waiver or State Plan option service; (7-1-26) b. Elect not to use services offered under the HCBS waiver or State Plan option; (7-1-26) c. Decline to engage in person-centered planning; (7-1-26) d. Do not meet other HCBS eligibility requirements; or (7-1-26) e. Are non-responsive to three or more contact attempts by the Department or its designee. (7-1-26) 04. Continuous Eligibility for Children Under Age Nineteen. Continuous health care assistance eligibility for children under age nineteen (19), as provided in IDAPA 16.03.01, does not apply for a participant under the age of nineteen (19) who is enrolled in an HCBS waiver or State Plan option program or who has accessed Medicaid coverage through an HCBS waiver or State Plan option program. (7-1-26) SUB AREA: AGED AND DISABLED (A&D) WAIVER SERVICES (Sections 540-548)