R539-1-7. Eligibility and Enrollment

(1) Matching federal funds may be available through an HCBS waiver. (a) A person shall meet financial eligibility for Medicaid benefits as determined by the Department of Workforce Services. (b) A person shall meet a waiver level of care as determined by the division. (i) Pursuant to Rule R414-502, the division may find a person meeting nursing facility level of care eligible for funding through the: (A) Acquired Brain Injury Waiver; (B) Limited Supports Waiver; or (C) Physical Disabilities Waiver. (ii) The division may find a person meeting intermediate care facility level of care eligible for funding through the: (A) Community Supports Waiver; (B) Community Transitions Waiver; or (C) Limited Supports Waiver. (c) After ensuring the person meets the waiver level of care, the division shall submit a Form 927 to the Department of Workforce Services requesting a determination of financial eligibility. (d) Noncompliance with Department of Workforce Services eligibility determination process requirements shall result in a funding reduction as described in Subsection R539-1-8(3). (2)(a) The division shall use a need assessment tool to determine a person's need score. (b) The adjusted critical need score equals the person's total critical need score minus the time spent waiting component. (3) Ordering of each person's need score identifies the most critical need ranking. (4) Except as described in Subsections (5) through (8), the division determines waiver enrollment by the most critical need ranking. (5) Pursuant to Section 26B-6-402, the division determines waiver enrollment in the Limited Supports Waiver by: (a) offering enrollment in order of time spent waiting; and (b) identifying a person through: (i) an adjusted critical needs score at or below the person's age group threshold; and (ii) no immediate need for out-of-home residential support services. (6) A person shall be enrolled in the Limited Supports Waiver only if the person's assessed needs can be safely met within the individual budget limit. (7) When authorized, pursuant to Section R414-510-3, a person shall be enrolled in the Community Transitions Waiver. (8) The Emergency Services Management Committee may approve enrollment in the: (a) Acquired Brain Injury Waiver; (b) Community Supports Waiver; or (c) Physical Disabilities Waiver. (9) If the division determines that sufficient funding is available, a person may receive a waiver service by diverting a person from an ICF into the Community Supports Waiver. (10)(a) Any person offered enrollment in an HCBS waiver may choose not to participate. (b) If an eligible person chooses not to participate in a waiver, the person shall receive only the state funded portion of their assessed needs.