12 Colo. Code Regs. § 2509-5-7.403
Current through Register Vol. 47, No. 22, November 25, 2024
Section 12 CCR 2509-5-7.403 - SPECIAL NEEDS DETERMINATION [Rev. eff. 5/1/12]The special needs allowance is an additional resource that can be used to increase the level of income a child can have and still be eligible for Medicaid.
A. In order to be eligible for the special needs allowance, as outlined in the Need Standard in the Income Maintenance staff manual (9 CCR 2503-1), the family must meet the following criteria:
Criterion #1:
The child may be at imminent risk of out-of-home placement because one or more of the following conditions exist:
1. Abandonment by or incarceration of parents/relatives/caretakers;2. Abuse/neglect - as defined in the Children's Code;3. Domestic violence - as defined in Section 18-6-800.3, C.R.S.;4. Conditions that exist to such a degree for either the child or caretaker so that the caretaker is unable to care for the child: a. Substance abuse; drug exposed infants5. Beyond control of parents;6. Danger to self, others, or community;7. Infant or young child of teen parent in placement;8. Delinquency - adjudicated delinquent meeting current out-of-home placement criteria written pursuant to Section 19-2-907 and 19-2-212, C.R.S.;9. Relinquishment or termination of parental rights;10. Child returning home from out-of-home placement or moving to less restrictive level-of-care. Criterion #2:
The county department has custody of the child and the child is receiving court-ordered services.
B. Children in out-of-home placement who would meet IV-E eligibility, except that their income exceeds 185 percent of the Colorado Works needs standard, can be eligible for Medicaid if: 1. They meet the special needs criteria; and,2. They are deprived of parental support and have less than $1000 in resources; and,3. Their income is less than 185 percent of the combination of the needs standard and the maintenance cost of the placement.C. For children in out-of-home placement who are not Title IV-E eligible and whose income exceeds the need standard can be Medicaid eligible if: 1. They meet the special needs criteria; and,2. Their income is less than the maintenance cost of the placement. If the special needs allowance is the same as the maintenance cost of placement in the facility in which the child is placed, then deprivation of parental support is not required.D. The county shall meet all other reporting requirements for children in placement who are determined eligible for Medicaid under the special needs allowance.E. For children in their own homes or receiving Core Services Program:1. Special needs criteria must be met and the child must be in the custody of the county department and receiving court-ordered services.2. There must be deprivation of parental support and the family must have incurred an additional expenditure for items included in the Colorado Works need standard due to the special problems of the child or family.3. The special needs allowance must be related to one of the following components of the need standard: 4. The inclusion of the special needs allowance could make a family that currently has income in excess of the Colorado Works need standard eligible for Colorado Works and Medicaid. They must meet other Colorado Works program requirements.5. The county department Colorado Works section shall compute the special needs allowance. The services section shall develop the service plan and verify those items which may be included in the special needs allowance. The costs of these items shall be reasonable and needed as a result of child or family problems, and be for the purpose of maintaining the child in the home and avoiding out-of-home placement.F. The county department shall obtain prior authorization for the inclusion of the special needs allowance from the Office of Self Sufficiency at the state department.G. The county department shall maintain the authorization from the Office of Self-Sufficiency and receipts verifying expenditures in the assistance payments case record.H. The county department services section shall notify the assistance payments section when the child or family is no longer eligible for a special needs allowance.I. The county department shall document in the case record how the special needs requirements are met. The county director shall approve the determination of Medicaid.38 CR 23, December 10, 2015, effective 1/1/201640 CR 17, September 10, 2017, effective 10/1/201740 CR 21, November 10, 2017, effective 12/1/201741 CR 21, November 10, 2018, effective 12/1/201842 CR 17, September 10, 2019, effective 10/1/201942 CR 23, December 10, 2019, effective 1/1/202043 CR 21, November 10, 2020, effective 12/1/202044 CR 21, November 10, 2021, effective 11/1/202144 CR 23, December 10, 2021, effective 12/30/202146 CR 09, May 10, 2023, effective 6/1/2023