(1)To be eligible for the community first choice
option, an individual must:
(a)Be eligible for the state medical assistance program;
(b)Be in an eligibility group under the state medical assistance program that
includes nursing facility services, or if in an eligibility group that does not include
nursing facility services, have an income that is at or below one hundred fifty
percent of the federal poverty level. The state department shall determine whether
an individual is at or below one hundred fifty percent of the federal poverty level on
an annual basis by applying the same methodologies that apply under the state
medical assistance program, including the same less restrictive resource
methodologies described in the federal Social Security Act, 42 U.S.C. sec. 1902
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(1) To be eligible for the community first choice
option, an individual must:
(a) Be eligible for the state medical assistance program;
(b) Be in an eligibility group under the state medical assistance program that
includes nursing facility services, or if in an eligibility group that does not include
nursing facility services, have an income that is at or below one hundred fifty
percent of the federal poverty level. The state department shall determine whether
an individual is at or below one hundred fifty percent of the federal poverty level on
an annual basis by applying the same methodologies that apply under the state
medical assistance program, including the same less restrictive resource
methodologies described in the federal Social Security Act, 42 U.S.C. sec. 1902
(r)(2).
(c) (I) Receive an annual determination that in the absence of the home- and
community-based attendant services and supports provided pursuant to the
community first choice option, the individual would require the level of care
furnished in a hospital, a nursing facility, an intermediate care facility to an
individual with intellectual disabilities, an institution providing inpatient psychiatric
services to an individual under twenty-one years of age, or an institution for
behavioral or mental health disorders for an individual sixty-five years of age or
older if the cost could be reimbursed under the state medical assistance program.
(II) The state department may, at its discretion, permanently waive the
annual determination for an individual if the state department:
(A) Determines there is no reasonable expectation of improvement or
significant change in the individual's condition because of the severity of a chronic
condition or the degree of impairment of functional capacity; and
(B) Retains documentation of the reason for waiving the individual's annual
determination requirement.
(2) For the purposes of meeting the requirements of subsection (1)(b) of this
section, an individual who qualifies for medical assistance pursuant to the special
home- and community-based waiver eligibility group defined in the federal Social
Security Act, 42 U.S.C. sec. 1902 (a)(10)(A)(ii)(VI), shall meet all the requirements in
42 U.S.C. sec. 1915(c) and receive at least one home- and community-based waiver
service per month.
(3) Individuals receiving services through the community first choice option
must not be precluded from receiving other home- and community-based long-term
care services and supports through other state medical assistance program
waivers, grants, or demonstration authorities.