Rule 23-208-5.1 - EligibilityA. Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver services are services covered by the Division of Medicaid as an alternative to institutionalization in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) which: 1. Are operated jointly with the Mississippi Department of Mental Health (DMH). The Division of Medicaid is the single state Medicaid agency having administrative responsibility in the administration and supervision of the ID/DD Waiver. DMH is responsible for the daily operation of the ID/DD Waiver, 2. Are available statewide, and 3. Carry no age restrictions for eligibility. B. All of the following eligibility requirements must be met to receive ID/DD Waiver services: 1. Applicant must require a level of care (LOC) found in an ICF/IID. 2. Applicant must qualify for full Medicaid benefits in one (1) of the following eligibility categories: a) Supplemental Security Income (SSI), b) Parents and Other Caretaker Relatives Program, c) Disabled Child Living at Home Program, e) Infants and Children Under Age Nineteen (19) who meet the applicable income requirements, f) Protected Foster Care Adolescents, g) Child Welfare Services (CWS) Foster Children and Adoption Assistance Children, h) Title IV-E Foster Children and Adoption Assistance Children, j) An aged, blind or disabled individual who meets all factors of institutional eligibility. If income exceeds the current institutional limit, the individual must pay the Division of Medicaid the portion of their income that is due under the terms of an Income Trust in order to qualify. 3. Applicant must have one (1) of the following: a) An intellectual disability based on the following criteria: 1) An IQ score of approximately seventy (70) or below, 2) A determination of deficits in adaptive behavior, and 3) Disability which manifested prior to the age of eighteen (18). b) A developmental disability, defined by the Division of Medicaid as a severe, chronic disability attributable to a mental or physical impairment including, but not limited to, cerebral palsy, epilepsy, or any other condition other than mental illness found to be closely related to an intellectual disability that results in impairments requiring similar treatment or services. A developmental disability must: 1) Have manifested prior to age twenty-two (22) and be likely to continue indefinitely, 2) Result in substantial functional limitations in three (3) or more of the following major life activities: (b) Understanding and use of language, (f) Capacity for independent living. 3) Include individuals with a developmental delay, specific congenital or acquired condition from birth to age nine (9) that does not result in functional limitations in three (3) or more major life activities, but without services and supports would have a high probability of having three (3) or more functional limitations later in life, and 4) Require a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of individually planned and coordinated assistance that is life-long or of an extended duration. c) Autism as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. C. Persons enrolled in the ID/DD Waiver can only be enrolled in one (1) home and community-based services (HCBS) waiver program at a time and must receive at least one (1) service a month to remain eligible for the ID/DD Waiver, and the provision of waiver services at least monthly or, if the need for services is less than monthly, the participant requires regular monthly monitoring which must be documented in the service plan. D. Persons enrolled in the ID/DD Waiver who elect to receive hospice care may not receive waiver services which are duplicative of any services rendered through hospice. Persons may receive non-duplicative waiver services in coordination with hospice services.23 Miss. Code. R. 208-5.1
42 USC § 1396n; 42 CFR §§ 435.217, 440.180, 441.301; Miss. Code Ann. §§ 43-13-115, 43-13-117, 43-13-121.Revised to reflect changes with the ID/DD Waiver renewal (eff. 07/01/2013) eff. 09/01/2015; Amended 9/1/2015Added Miss. Admin. Code Part 208, Rule 5.1.D. eff. 06/01/2016; Amended 8/1/2016