Section 16.03.05.787 - HOME AND COMMUNITY BASED SERVICES (HCBS)An aged, blind, or disabled participant, who is not income eligible for SSI or AABD cash, in their own home or community setting, is eligible for Medicaid if they meet the conditions below and meets all requirements in one (1) of the waiver Sections 788 through 789 of these rules.
01.Resource Limit. Meets the AABD single person resource limit.02.Income Limit. Income of the participant must not exceed three (3) times the federal SSI monthly benefit for a single person. A married participant living at home with their spouse who is not an HCBS participant, may choose between the SSI, CP, and FSI methods. If their spouse is also an HCBS participant or lives in a nursing home, the couple may choose between the SSI and CP methods.03.Maintained in the Community. The applicant must be able to be maintained safely and effectively in their own home or in the community with the waiver services.04.Cost of Care. The cost of the participant's care must be cost effective as provided in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."05.Waiver Services Needed. The participant must need and receive, or be likely to need and receive, waiver services for thirty (30) consecutive days. The participant is ineligible when there is a break in need for, or receipt of, waiver services for thirty (30) consecutive days.06.Effective Date. Waiver services are effective the first day the participant is likely to need and receive waiver services. Medicaid begins the first day of the month in which the first day of approved waiver services are received.07.Annual Limit. The Department limits the number of participants approved for waiver services each year. A participant who applies for waiver services after the annual limit is reached, must be denied waiver services.Idaho Admin. Code r. 16.03.05.787