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HCBS Waiver Non-Financial Eligibility - Iowa

When a person who is not already eligible for Medicaid requests waiver services, Medicaid eligibility is established using existing coverage groups, including the facility coverage groups.

People must qualify under an FMAP-related or SSI-related coverage group to qualify for waiver services, depending on the waiver type. In the elderly waiver and the ill and handicapped waiver, only SSI-related coverage groups can be assigned to the client. If the client does not qualify under these types of groups, waiver services cannot be provided. For the other waivers, eligibility can be determined under either SSI-related or FMAP-related criteria.

Note: The QMB, SLMB, QDWP, and Medically Needy coverage groups do not cover waiver services and other facility care. Medicaid coverage must be established under another coverage group to cover the waiver.

In addition to the nonfinancial eligibility requirements for SSI-related Medicaid, all waiver applicants must meet the institutional level of care requirements specific to that waiver. This corresponds to the requirements for Medicaid applicants in medical institutions.

If the person is under SSI limits, he or she must apply for SSI at the Social Security Administration unless the application was previously denied in the past year and circumstances have not changed. If the person would be eligible for Social Security disability, the person must apply for this as well.

Each person applying for waiver services must have a level of care determination done before eligibility can be determined. The level of care certification verifies that the person needs care in a medical facility.

Each waiver has specified levels of care. To be determined eligible for waiver services, the applicant must meet the level of care applicable to the waiver for which the person is applying.

 Waiver    Level of Care

AIDS/HIV    Nursing facility

     Skilled nursing facility

     Hospital

Brain Injury   Intermediate care facility for the

     mentally retarded

     Nursing facility

     Skilled nursing facility

Elderly    Nursing facility

     Skilled nursing facility

Ill and Handicapped  Nursing facility

     Skilled nursing facility

     Intermediate care facility for the

     mentally retarded

Mental Retardation  Intermediate care facility for the

     mentally retarded

Physical Disability  Nursing facility

     Skilled nursing facility

     Intermediate care facility for the

     mentally retarded

See Also:

·           HCBS Waivers Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter N, pages 9-11

Regulation citations: 441 IAC 83.2(1)"a" and "d", 83.22(1)"c" and "d", 83.42(1)"b", 83.43(1)"c", 83.61(1)"b" and "c", 83.82(1)"b" and "f", 83.102(1)"e" and "h"

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