Eligibility Online Manual

M1002B2 Acquired Brain Injury Waiver

Purpose:  This section will assist in determining eligibility for the Acquired Brain Injury HCBS Waiver.


Current Policy Effective Date:  January 1, 2022

Date Last Reviewed:  

Previous Policy: October 1, 2019

POL M1002B2:  DETERMINING ELIGIBILITY FOR ACQUIRED BRAIN INJURY WAIVER 

1.    Applicants Must Meet Basic Eligibility

Refer to Section M600 for information on basic eligibility factors.

2.    Applicants Must Meet Medical Necessity Requirement

3.    Applicants Meet Disability Requirements

Applicants meeting Medical Necessity Requirement fulfill the disability requirement.

4.    Applicants Must Be Age 21 Through 64

Clients may continue to be eligible, beyond the age of 64, if they are eligible before their 65th birthday.

5.    SSI Eligibles Do Not Need To Submit Application

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

6.    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 gross countable income is above the maximum income standard.

7.    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.

8.    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 an resource transfer is exempt and to Section M804 for information on related penalties.

9.    Benefits Begin First Day Of Month Using Plan Of Care Approval 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:

Reference:

Define Group:    42 CFR 435.217

                        42 CFR 435 Subpart F

Income:             42 CFR 435 Subpart K

Assets:             42 CFR 435 Subpart L

Clarifying Information:

SSI Eligibles Do Not Require An Application. 

Client Pays No Patient Contribution.

Worker Responsibilities:

Determining Countable Income

1. Refer to Section M901 to determine if income is countable.

Determining Countable Resources

1. Refer to Section M801 to determine if resources are countable.

Calculating Nonexempt Resource Transfer Penalty

1. Refer to Sections M803 and M804 for information on exempt resources and related penalties.

Closing Cases

1. Send 15 day closure notice when an adverse action has occurred.