Purpose: This section will assist in determining whether an individual is eligible for the Comprehensive and Support HCBS Waiver.

Current Policy Effective Date: August 1, 2025

Date Last Reviewed:

Previous Policy: January 1, 2022

POL M1002B1: DETERMINING ELIGIBILITY FOR COMPREHENSIVE AND SUPPORT WAIVERS

1. Applicants Must Meet Basic Eligibility

Refer to Section M600 for information on basic eligibility.

2. Applicants Must Meet Level Of Care Requirement

Applicants must be approved for ICF-MR level of care.

3. Applicants Meet Disability Requirements

Applicants meeting the level of care requirement fulfill disability requirement.

4. SSI Eligibles Do Not Need To Submit Applications

If SSI is lost, an application will be required to redetermine eligibility.

5. Applicants Must Meet Income Requirements

Require the countable income to be within the maximum income standard per month. Refer to Medicaid Table 1A to see income standards. Refer to Section M901 to determine if income is countable. Provide an Income Trust Packet when the countable income is above the maximum income standard.

6. Applicants Must Meet Resource Requirements

Require the countable resources to be within the maximum resource limit. Refer to Medicaid Table 7 to see resource standards. Refer to Section M801 to determine if resources are countable.

7. Some Services Withheld For Nonexempt Resource Transfers

Nonexempt resources cannot be transferred for less than fair market value during the look-back period prior to application or when clients are receiving benefits.

Refer to Section M803 to determine if a resource transfer is exempt and Section M804 for information on related penalties.

8. Applicants May Have Eligibility For 12 Continuous Months

The eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.

9. Benefits Begin First Day Of Month Using Plan Of Care Date

10. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

A review is not required for SSI clients.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

11. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client does not complete review. Client dies. Client determined no longer eligible.