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Consumer Eligibility
1.
Persons in need of mental health
services:
People
who have a current diagnosis of a
mental
illness as defined in the Diagnostic
and
Statistical, Manual Fourth Edition (DSM IV).
Diagnoses
which fall into this category include,
but
are not limited to, the following:
Schizophrenia
Major Depression
Manic Depressive (bipolar) Disorder
Adjustment Disorder
Personality Disorder
Also
included are organic disorders such as:
Dementia’s
Substance-Induced Disorders
“Other” organic disorders
Including
physical disorders such as:
Brain Tumors
Excluded:
V Code Diagnoses
Psychoactive Substance Use Disorders
Developmental Disorders
2.
Persons with Chronic Mental Illness:
People 18 and
over with persistent mental or
emotional
disorders that seriously impair their
functioning
relative to such primary aspects of
daily
living as personal relations, living arrange-
ments,
or employment. People with Chronic
Mental
Illness will typically have histories that
meet
at least one of the treatment history criteria
and
at least two of the functioning history criteria.
A.
Treatment
History Criteria:
1. Have
undergone psychiatric
treatment more intensive than
outpatient care more than once
in a lifetime (ex.
emergency
services, alternative home care,
partial hospitalization or inpatient
hospitalization.)
OR
2. Have experienced at least one
episode of continuous, structured
supportive residential care other
than hospitalization.
AND
B.
Functioning
History Criteria:
People
with Chronic Mental Illness
will meet at
least two of the following
criteria on a continuous or intermittent
basis for at least two years:
1.
Are
unemployed, employed
in a sheltered setting or have
markedly limited skills and a poor
work history.
2.
Required
financial assistance
for out-of-hospital maintenance and
may be unable to procure this
assistance without help.
3.
Show
severe inability to establish
or maintain a personal social
support system.
4.
Require
help in basic living skills.
5.
Exhibit
inappropriate social behavior
which results in demand for
intervention by the mental health or
judicial system.
3. Persons with mental Retardation:
People with mental retardation
have significantly
Sub-average
general intellectual functioning existing
concurrently with deficits in adaptive behavior,
manifested
during the developmental period. All
of
the
following criteria must be met:
A.
A
score of approximately 70 intelligence
quotient (IQ) or below, as obtained
by
assessment with one or more of the
individually administered general
intelligence tests developed for the
purpose of assessing intellectual
functioning.
B.
Deficits
in adaptive behavior, defined
as the effectiveness or degree with
which
individuals meet the standards of
persons
independence and social
responsibility
expected for age and cultural group.
4. Persons with developmental
disabilities:
People with developmental disabilities have
severe,
chronic conditions that:
A. Are attributable to
a mental or physical
impairment or combination of mental
and physical impairments
B. Are manifested
before the person attains
the age of 22
C. Result in substantial
functional limitations
in three or more of the following
areas of
major life activities:
self care
receptive and expressive
language
learning
mobility
self-direction
capacity for
independent living
economic self
sufficiency
D. Reflect the person’s need for a
combination
and sequence of special, interdisciplinary or
generic care, treatment, or other
services that
are of lifelong or extended duration
and are
individually planned
and coordinated; except
that such term, when applied to
infants and
young children means individuals
from birth
to age 5, inclusive, who have
substantial
developmental delay or
specific congenital or
acquired conditions with a high
probability
of resulting in
developmental disabilities if
services are not provided.
5.
Financial Eligibility
(General):
Resources
should not exceed $2000 for single
person,
$3000 per married couple. Persons are
allowed
one vehicle and a homestead.
Definition
of
resources and exclusions will follow federal SSI
standards.
Income, in general, should not exceed 150% of
federal poverty guidelines. The first $500 of
monthly earnings from vocational programs is
excluded.
The cost of client participation for
residential services will be subtracted from
income in determining eligibility for vocational
services.
For 2005, 150% of poverty
level is $1,196.00
monthly for one person;
$1,604.00
for two persons.
The sliding fee scale
adopted by the Lee County Board
Supervisors will
determine eligibility for outpatient
mental health
services.
Consumers in
sheltered workshop employment are required
to pay for a portion
of their transportation when it is funded
by the county. This will amount to 20% of their wages not
to
exceed four dollars
per day; consumers in on-the-job training
will pay a maximum
flat payment of $3.50 per day, dependent
on distance
transported.
Lee County is considered payer of last
resort. Persons with
private insurance coverage must utilize
that coverage prior to
requesting payment from county
funds. Similarly, State or Federal
payment coverage, such as Veterans or Title XIX benefits must be
used prior to qualifying for
County payment. The county will not
pay costs which private or other
governmental insurers have
deemed excessive.
For MHAP eligible consumers the County position
is that
MHAP eligible
persons, whether voluntary or involuntary,
use only those facilities
approved by the MHAP provider
selected by the State. This restriction only applies to MHAP
authorized services. Since
the state has selected the MHAP
provider and has approved their
guidelines for treatment, the
County will no longer be
responsible for consumer bills if the
MHAP provider decertifies the
consumer. It is understood that the
MHAP provider only decertifies a consumer if a lesser restrictive
treatment, with accompanying
funding, is available to that consumer.
The County agrees with the MHAP
provider that the institution
or facility may choose to retain the consumer for treatment, but the
financial responsibility for this
decision will be that of the facility
not the County. Nothing in this plan shall supersede the
County’s
responsibility to pay for services under Iowa Code Chapters 229,
230, 232 so long as the
provisions of those statutes are otherwise
complied with by DHS and it’s
mental health subcontractors
including MBC of
Iowa.
Consumers are required to
disclose information regarding their
resources for payment at time of
application; failure to do so may
be the basis for denial of
benefits and/ or require repayment.
Eligibility for County owned disability housing will follow the
priorities contained
in the Administrative Plan adopted by the
Lee County Board of
Supervisors (see appendix 5). Rents
will be charged for
these units based on unit size:
$175.00 per person per month for three
bedroom units
$200.00 per person per month for two
bedroom units
$250.00 per person per month for one
bedroom units.
Within limits allowed by statute, Lee County will
attempt to
recover a portion of
the costs charged to the County by the Mental
Health Institutes.
Costs recovered will amount to 10% of
the gross
family income above
150% of federal poverty level, adjusted to
family size. The
County will not attempt to recover amounts in
excess of the amounts
charged to the county by the hospital.
Some specific services may have different
eligibility guidelines;
see chart below. HCBS services will follow State and
Federal rules.
Regardless
of financial eligibility, services will not be funded unless
need exists for that
service, it is provided by an approved provider,
and it is provided in
the most cost effective manner available to meet
the needs of that
consumer.
6.
Financial Eligibility for Material Support Services
Material Support Services include:
Rent
Utility
Funeral
Medical Assistance
for persons who meet the
diagnostic eligibility criterion of this plan.
Eligibility for Material
Support Services replaces eligibility for Lee
County
General Assistance. Material Support
Services are not
intended
to replace or supplement similar services funded through
Medicare,
Medicaid, Veterans Assistance or other private or
governmental
service programs.
Financial Eligibility for Material
Support Services for persons with
Mental Illness requires that
monthly gross income be at or below
the current payment standard for
the Family Investment Program,
based on household size, and that
non-exempt resources be below
$500 per household.
Financial Eligibility for
Material Support Services for persons in
the other diagnostic groups
covered by this plan requires income
at or below the current SSI
payment level and resources at or
below the current SSI limits.
Material Supports funds are a | 
SERVICES & INFORMATION