Adult Dd Waiver Services: Participant Eligibility

IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 612 Page 147 The Department determines waiver eligibility. The participant must meet the following: (7-1-26) 01. Age. Be eighteen (18) years or older. (7-1-26) 02. Eligibility. The Department must determine whether: (7-1-26) a. The participant would qualify for ICF/IID level of care if the DD waiver services were not available; (7-1-26) b. The participant can reside safely and effectively in a non-institutional setting; and (7-1-26) c. The average annual cost of a participant’s waiver and other medical services do not exceed the average annual cost to Medicaid for ICF/IID care and other medical costs. (7-1-26) 03. DD Waiver Eligibility. Participants eligible for DD waiver services may instead choose admission to an ICF/IID. (7-1-26) 04. Redetermination. (7-1-26) a. Financial and medical redetermination are conducted annually or sooner at the request of the participant, self-reliance, a provider agency, or medical provider. (7-1-26) b. The redetermination process will assess the participant's continued need and eligibility for waiver services and discharge from the waiver services program. (7-1-26) 05. Notifications. The Department notifies participants of the eligibility decision after an assessment. Notification includes an individualized explanation of the decision and how they may appeal. (7-1-26) 06. Adult DD Waiver Limits. The number of Medicaid participants to receive waiver services under the Adult DD waiver is limited to the projected number of users in a CMS-approved waiver. Individuals applying for this waiver after the maximum is reached are placed on a waiting list to have their applications processed after September 30th for the new DD waiver year. (7-1-26)