TN 3 (08-92)

A. Background

Medicaid State home care plans are authorized under two provisions of the Social Security Act. Section 1915(c) authorizes the Secretary to allow States, under home and community based services programs, to provide services not normally covered under the State plan to individuals in the community who otherwise would be in an institution if those services were not available. For Medicaid purposes, the deeming rules are waived under section 1915(c).

Section 1902(e)(3) allows a State to amend its State plan to include some disabled children age 18 or younger living at home who would be eligible for Medicaid if in a medical institution. These children are considered to be SSI recipients for purposes of Medicaid entitlement.

Each State administers its own Medicaid program. Although home care plans authorized under section 1915(c) require CMS central office approval, each State develops its own plan(s) and methods of administering them. Currently, 46 States have some form of waiver allowing medical assistance for care of individuals at home.

B. Procedure

1. When to Verify

Verify Medicaid eligibility under a State home care plan when:

• a child is ineligible for SSI (or will be ineligible when he returns home from a medical institution) because of deemed parental income or resources; or a child is eligible (or would be eligible) for less SSI under the parental deeming rules than he would receive under the deeming waiver provision; and

• the disabled child received an SSI personal needs allowance while institutionalized; and

• the payee alleges the child is eligible for Medicaid under a State home care plan, or does not know, or there is any other evidence that the child may be covered under such a plan.

2. How to Verify

See regional instructions to determine whether a State has a home care plan that may allow waiver of the SSI deeming rules, and for instructions on verifying eligibility under a State home care plan.

3. What to Verify

Verify that the child is covered by a Medicaid State home care plan under either section 1915(c) or section 1902(e)(3) of the Social Security Act and the date coverage began.

Also verify whether there have been any changes in eligibility under the State home care plan during the review period, or whether any changes are expected in the near future.

C. References

SI BOS01310.207 Medicaid Eligibility Under A State Home Care Plan

SI CHI01310.207 Medicaid Eligibility Under a State Home Care Plan (RTN 373 -- 02/2008)

SI DAL01310.207 Verifying Medicaid Under a State Home or Community Based Care Plan (TN 4 -- 11/2005)

SI DEN01310.207 Verifying Medicaid Under a State Home or Community Based Care Plan

SI PHI01310.207 Medicaid Eligibility Under a State Home-Care Plan