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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 65 15 DE Reg. 1718 (06/01/12) 20 DE Reg. 552 (01/01/17) 21 DE Reg. 574 (01/01/18) 20720.1 Daily Living Needs Individuals receiving Medicaid under the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver who receive Residential Habilitation services are allowed a deduction equal to the current Adult Foster Care (AFC) rate. The AFC rate is based on the current SSI income level plus the Optional State Supplement amount. Individuals receiving Medicaid under the Long-Term Care Community Services (LTCCS) program and residing in an Assisted Living Facility are given a deduction based on the Adult Foster Care rate less an amount payable for room and board. Individuals receiving Medicaid under the DDDS Lifespan Waiver who do not receive a residential habilitation service and individuals receiving Medicaid under the LTCCS program (excluding those residing in an Assisted Living Facility) are allowed a deduction equal to their total income, including income that is placed in a Miller Trust. All earned income in the form of wages shall be allowed to be protected. 15 DE Reg. 1718 (06/01/12) 21 DE Reg. 574 (01/01/18) 26 DE Reg. 957 (05/01/23) 20720.2 Support & Maintenance of Spouse and/or Children In order to be considered a dependent, the spouse and/or children must be claimed on the applicant's income taxes as a dependent. A spouse is the husband or wife of the applicant who is living with the applicant or was living with the applicant prior to institutionalization. If the applicant is responsible for the support and maintenance of the spouse and/or children, (i.e. provides them with food and shelter) the following calculations would be completed to determine the protected amount. An amount up to the current SSI payment standard may be protected for the spouse. Monthly allowances for dependents other than the spouse are based on the current TANF standard of need. If the spouse or other dependents have income their net income (gross income minus work expense and child care costs) should be deducted from the standards given above. Use standard SSI and TANF deductions. The amount remaining (if any) would then be protected for the dependent. Please note, spouses with income less than the SSI standard should be encouraged to contact the Social Security Administration Office to apply for benefits. 20720.3 Additional Protected Amounts Medical expenses not subject to payment by 3rd party, such as: 1. Health insurance premiums 2. Necessary medical or remedial care not covered under the Medicaid State Plan such as hearing aids, dentures, etc. NOTE: Medicare deductibles and co-insurance charges are paid by Medicaid directly. 20760 Redetermination A redetermination of eligibility must be performed annually. Medical eligibility is redetermined by the Managed Care Organization. Financial eligibility is redetermined by the Division of Medicaid & Medical Assistance (DMMA). 15 DE Reg. 1718 (06/01/12) 20775 Program Of All- Inclusive Care For The Elderly (Pace) Program of All-Inclusive Care for the Elderly (PACE) is a benefit that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. The PACE model was developed to address the needs of long-term care clients, providers, and payers. For most participants, the comprehensive service package permits them to continue living at home, while receiving services rather than be institutionalized. Through PACE, organizations are able to deliver all services covered by PACE which participants need rather than only those services reimbursable under the Medicare and Medicaid fee-for-service systems. This policy applies to all individuals that elect to receive their long-term care services through the PACE and request Medicaid payment for these services. 1. Participation in PACE is voluntary. 2. A PACE participant’s eligibility will be determined under rules applying to institutional groups. See DSSM 20000