DHHS - Medicaid Policy Manual
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  Medicaid Policy                                                                 

 


380-2 Home and Community Based Waiver Services Financial Eligibility

Effective Date: June 1, 2024

Previous Policy

 

An applicant for a home and community based waiver must meet the financial requirement for the applicable waiver.

 

  1. HCB Medicaid Waiver application.
  1. An individual who is not currently on Medicaid must file a Medicaid application. Standard Medicaid application time frames apply (703-5).
  2. An individual currently eligible for Medicaid may need to provide additional information for the HCB waiver eligibility determination.
  1. General rules for a HCB Medicaid waiver application.
  1. Individuals must meet all eligibility requirements for a Medicaid coverage group selected under the waiver.
  2. Asset rules specific for HCB waivers
    1. The individual’s assets must not exceed $2000.
    2. When the waiver member is married and the spouse is not institutionalized or eligible for waiver services, apply Treatment of Assets for Institutionalized individuals rules in 573. The “spouse in the institution” is the spouse on the waiver. The assessment date is the date the individual first met the level of care requirement as stated on the original 927.
    3. If both members of a married couple are requesting waiver services, each person must pass the $2000 asset limit. Divide jointly-held assets equally between them. The asset provisions in 573 do not apply when both members want waiver services.
    4. Except for applicants and recipients of the New Choices Waiver, apply Transfer of Asset rules found in 575 to all waiver members.
    5. For applicants and recipients of the New Choices waiver, transfer of asset rules in 575 only apply to members who qualify under the Special Income Group (386-2).
  1. Application for the waiver
  1. When an individual applies for a waiver, the Medicaid eligibility agency must receive a completed form 927 from the referring waiver agency.
  2. The 927 is valid for an eligibility decision for 60 days from the date the individual meets the level of care criteria.
  3. If eligibility for the waiver has not been determined within 60 days of the level of care date, the form is no longer valid and a new 927 is required to complete the application process.
    • See policy 380-1 (B)(2) about requesting extensions to the 927 expiration.
  4. If a new 927 is required, do not hold up the eligibility process.
    1. Determine eligibility for a non-waiver Medicaid program.
    2. Notify the waiver agency worker immediately of the need for a new 927.
    3. Upon receipt of a new 927, determine waiver Medicaid eligibility based on the new level of care date on the new form.
  5. Return the completed 927 to the waiver agency.
  1. Waiver closure

Notify the waiver agency by completing the 927 with the closure date and reason.

Determine eligibility for any non-waiver Medicaid programs.