A&D Waiver Services: Eligibility

The number of Medicaid participants to receive waiver services under the A&D HCBS waiver is limited to the projected number of users identified in the Department's approved waiver. Participants who apply for waiver services after the waiver maximum is reached are placed on a waiting list and will have their applications processed after the new waiver year begins. The earliest waiver approval date for these participants is the first date of a new waiver year. Participants are eligible when they meet the following criteria: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 542 Page 120 01. Age. Are eighteen (18) years of age or older. (7-1-26) 02. Disabling Condition. Have a disabling condition that impairs their mental or physical function or independence; (7-1-26) 03. Non-Institutional Setting. Can be maintained safely and effectively in a non-institutional setting; (7-1-26) 04. Require Services. In the absence of such services, require the level of care provided in a NF; (7-1-26) 05. Average Daily Cost. Cannot exceed the participant’s waiver and other medical services for the average daily cost of NF care; (7-1-26) 06. Non-Use. A participant who does not use a waiver service for thirty (30) consecutive days will be terminated from the waiver program unless services were inaccessible; and (7-1-26) 07. Admission to a NF. A participant determined by the Department to be eligible for services under the waiver may elect to not utilize waiver services and may choose admission to a NF. (7-1-26) 08. NF Level of Care, Adults. Based on assessment results, the level of impairment of an individual is established by the Department. (7-1-26)