(1) Eligibility criteria for CSHS financial assistance are:
(a) an individual under the age of 22 who meets the definition of a child or youth with special health care needs (CYSHCN);
(b) a resident of the state of Montana and either a U.S. citizen or a qualified alien as defined under federal statute; and
(c) in need of a treatment or enabling services related to their disabling condition or risk category, which is recommended by a medical professional, where an out-of-pocket expense would be the responsibility of the family and no other means of payment is available to cover the out-of-pocket expenses.
(2) Family income must be verified to determine eligibility. CSHS will request documentation of income from the applicant.
(a) Family income may include one or more of the following:
(i) the income of both parents if the child resides with both parents;
(ii) the income of the parent with whom the child resides the majority of the year, including any child support received for the child, if the child resides with one parent in a single parent household;
(iii) if the parent with whom the child resides the majority of the year has remarried, the stepparent's income is imputed to the parent's income with whom the child resides the majority of the year; and
(iv) the income of individuals under the age of 19 who live in the home but do not attend school is imputed to the parent with whom the child resides the majority of the year.
(b) Family income does not include:
(i) money received from assets drawn down such as withdrawals from a savings account, an annuity, or for the sale of a house or car;
(ii) gifts, loans, one-time insurance payments, or lump sum compensation for an injury;
(iii) the first $2,000 of an enrolled tribal member's per capita payment; or
(iv) the first $2,000 of an enrolled tribal member's tribal land income.
(c) The following disregards are subtracted from the family's gross earned annual income:
(i) $1,440 per year for each family member whose earned income is counted;
(ii) $2,400 per year, regardless of the actual expense amount, for each individual for whom dependent care is paid out-of-pocket and the care is provided so a parent can work, look for work, or attend school; and
(iii) out-of-pocket expenses for health insurance premiums.
(d) A family whose income, less any out-of-pocket expenses for health insurance premiums, care expenses for children, disabled or elderly adults while adults are working, and earned income disregards is at or less than 300% of the federal poverty income guidelines and one of the following:
(i) ineligible for HMK Plus or HMK;
(ii) eligible for HMK Plus or HMK, but in need of services or financial assistance that are not covered by HMK Plus or HMK, or determined inaccessible but are covered by CSHS; or
(iii) potentially eligible for HMK Plus or HMK from information provided on the application, the family will be referred to the county office of public assistance for HMK Plus or HMK eligibility determination.
(3) Eligibility for program financial assistance will be determined within 30 days of receipt of the application by the department.
(4) Eligibility begins on the date an application is received by CSHS and continues for the duration of the federal fiscal year in which the application is received unless the age of the CYSHCN precludes them from participation or the CYSHCN no longer resides in Montana. Services provided up to six months prior to the date of eligibility are reimbursable by CSHS.
(5) A new or renewal application for a subsequent year must be submitted to the department in order for the department to determine if eligibility is to continue and must be completed and approved before any CSHS financial assistance in a subsequent year may be provided.
(6) A CYSHCN attending an interdisciplinary team pediatric specialty clinic funded by CSHS does not need to apply for financial assistance to cover the cost of clinic visits.