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Ill and Handicapped HCBS Waiver - Iowa

The ill and handicapped waiver pays for services to aged, blind, or disabled people who otherwise would need care in a nursing facility, skilled nursing facility or an intermediate care facility for the mentally retarded (ICFMR).

To be eligible for the ill and handicapped waiver, all of the following requirements must be met:

·           A payment slot must be available.

·           The person must either be:

·                        Aged 65 or over and living in a county that is not served by the HCBS elderly waiver, or

·                        Blind or disabled, as determined by the receipt of social security disability benefits, or through the Department’s disability determination process.

·           The person must meet the eligibility requirements of the Supplementary Security Income (SSI) program, with the following exceptions:

·                        A person who is under 18 years of age, unmarried and not the head of a household is ineligible for SSI because of the deeming of a parent’s income and resources.

·                        A person who is married and is ineligible for SSI because of the deeming of the spouse’s income or resources.

·                        A person who is ineligible for SSI due to excess income and whose income does not exceed 300 percent of the maximum monthly SSI payment for one person.

·           The person must be certified by the Iowa Foundation for Medical Care (IFMC) in need of the level of care that would, but for the HCBS program, otherwise be provided in a nursing facility, skilled nursing facility, or intermediate care facility for the mentally retarded.

·           The person must have service needs that can be met by the ill and handicapped HCBS waiver program as determined by the service worker, client, and interdisciplinary team. At a minimum, a client must receive a unit of adult day care, counseling, homemaker, home health, nursing, or respite service per quarter.

The average monthly cost of all Medicaid expenditures, including ill and handicapped waiver services, shall not exceed the average monthly cost that Medicaid would incur without the waiver, based on the person’s level of care. Individual service costs that make up the average monthly cost of ill and handicapped waiver services cannot exceed an aggregate monthly cost of:

·           $852 for nursing level of care

·           $2,480 for skilled nursing level of care

·           $3,019 for Intermediate care for the mentally retarded

A waiver of the cost limit may be granted.

The person must be ineligible for Medicaid under other programs or coverage groups, with certain exceptions.

To be eligible under the ill and handicapped waiver, the person must be ineligible for Medicaid under other programs or coverage groups, with the exception of:

·           The Medically Needy program.

·           The State Supplementary Assistance in-home health-related program, when the person chooses the IH waiver instead of that program.

·           The HCBS MR waiver when the person is a child aged 17 or under with mental retardation who meets skilled nursing level of care.

·           Children eligible for Supplemental Security Income (SSI) under Section 8010 of Public Law 101-239

·           Cases approved by the Intradepartmental Board for Supplemental Security Income Deeming Determinations between 1982 and 1986.

If the client is eligible for Medicaid other than through these programs, the application is denied for the ill and handicapped waiver.

If the client wants HCBS ill and handicapped (IH) services and currently receives in-home health-related services, the client must choose one program or the other. The client is not eligible for both HCBS IH and in-home health-related services during the same time period. An in-home health-related provider may be able to continue providing care to a client who transfers to the HCBS IH program by providing consumer-directed attendant care, if the service worker includes consumer-directed attendant care in the case plan.

Public Law 101-239 allows the Social Security Administration to exclude the income and resources of parents in determining eligibility for SSI payments for certain disabled children aged 18 or under. The children affected by this provision are those who:

·           Previously received an SSI reduced benefit while in a medical institution, and

·           Would otherwise be ineligible for SSI because of parent’s income or resources, and

·           Are eligible for Medicaid under the home- and community-based waiver.

Limit on Number of Recipients:

The number of people who may be approved for the HCBS ill and handicapped waiver is subject to the number of clients to be served as set forth in the federally approved HCBS ill and handicapped waiver, currently 500. When the number of applicants exceeds the number of clients specified in the approved waiver, the applicant’s name shall be placed on a waiting list maintained by the Division of Medical Services. People on the waiting list shall be contacted to reapply as slots become available based on their order on the waiting list so that the number of approved persons on the program is maintained.

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 37-38c, 41-43

Regulation citations: 441 IAC Chapter 83, Division I; 83.2(1)"b"

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