Section R414-307-8 - Home and Community-Based Services Waiver for Individuals 65 Years of Age 65 and Older(1) Medicaid eligibility for home and community-based services for individuals 65 years of age and older is limited to individuals eligible for Aged Medicaid who could qualify for skilled nursing home care.(2) A member's resources must be equal to or less than the Medicaid resource limit applicable to an institutionalized person. The treatment of spousal impoverishment resources for married and institutionalized individuals in Section R414-305-6 apply to a married individual.(3) An eligible member may be required to pay a contribution toward the cost-of-care to receive home and community-based services.(4) The eligibility agency shall determine a member's cost-of-care contribution as follows:(a) The eligibility agency shall count the individual's income unless such income is excluded under other federal laws that exclude certain income from being counted to determine eligibility for federally-funded, needs-based medical assistance.(b) The eligibility agency shall count a spouse's income only if the member receives a cash contribution from a spouse.(c) The eligibility agency shall deduct the following amounts from the individual's income: (i) a personal needs allowance for the individual equal to 100% of the federal poverty level for one person;(ii) for individuals with earned income, up to $125 of gross-earned income;(iii) monthly shelter costs not to exceed $300. This deduction includes mortgage, insurance, property taxes, rent, and other shelter expenses;(iv)(A) a deduction for monthly utility costs equal to the standard utility allowance the state uses under Subsection 5(e) of the Food Stamp Act of 1977.(B) If the waiver member shares utility expenses with others, the allowance is prorated accordingly;(v) in the case of a married individual with a community spouse, a deduction for a community spouse and dependent family members who live with the community spouse in accordance with Section 1924 of the Social Security Act;(vi)(A) in the case of an individual who does not have a community spouse or whose spouse is also eligible for institutional or waiver services, an allowance for a dependent family member that is equal to one-third of the difference between the minimum monthly spousal needs allowance defined in Section 1924 of the Social Security Act and the family member's monthly income.(B) If more than one individual who qualifies for a Medicaid home and community-based waiver or Institutional Medicaid coverage contributes income to the dependent family member, the combined income deductions of such individuals cannot exceed one-third of the difference between the minimum monthly spousal needs allowance and the family member's monthly income;(vii) health insurance premiums for the waiver-eligible member paid by the member, or medical expenses incurred by the member in accordance with Section R414-304-11.(d) The income deduction to provide an allowance to a spouse or a dependent family member cannot exceed the amount the individual gives to the spouse or dependent family member.(e) The remaining amount of income after the deductions is the individual's cost-of-care contribution.(5) The individual shall pay the contribution to cost-of-care to the eligibility agency each month to receive home and community-based services.(6) Section R414-305-9 concerning transfers of assets applies to individuals seeking eligibility or receiving benefits under this home and community-based services waiver.Utah Admin. Code R414-307-8
Amended by Utah State Bulletin Number 2024-03, effective 1/22/2024