(1) Financial eligibility for chemical dependency bureau medicaid substance dependency and abuse treatment is based on the household's monthly gross income.

(2) An applicant for medicaid substance dependency and abuse treatment shall complete a financial application using a form provided by the department. Applications may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 555 Fuller, P.O. Box 202905, Helena, MT 59620-2905.

(3) An applicant may be determined eligible for chemical dependency bureau medicaid substance dependency and abuse treatment services if the person:

(a) has a total gross family income at or below 200% of the most recently published federal poverty level (FPL) ;

(b) is a medicaid recipient in accordance with the eligibility standards adopted in ARM Title 37, chapter 82; or (c) is a children's health insurance plan (CHIP) beneficiary in accordance with the program eligibility standards in ARM Title 37, chapter 79.