469 NAC 4-008.02
The following individuals are exempted from the copayment requirement:
1. Individuals age 18 or younger;
2. Pregnant women through the immediate postpartum period (the immediate postpartum period begins on the last day of pregnancy and extends through the end of the month in which the 60-day period following termination of pregnancy ends);
3. Any individual who is an inpatient in a hospital, long term care facility (NF or ICF/MR), or other medical institution if the individual is required, as a condition of receiving services in the institution, to spend all but a minimal amount of his/her income required for personal needs for medical care costs;
4. Individuals residing in alternate care, which is defined as Assisted Living facilities, centers for the developmentally disabled, adult family homes and Licensed Mental Health Centers;
5. Individuals who are receiving waiver services, provided under a 1915(c) waiver, such as the Community-Based Waiver for Adults with Mental Retardation or Related Conditions; the Home and Community-Based Model Waiver for Children with Mental Retardation and Their Families; or the Home and Community-Based Waiver for Aged Persons or Adults or Children with Disabilities;
6. Individuals with a Share of Cost (over the course of the Share of Cost cycle, both before and after the obligation is met);
This includes individuals who are subject to a monthly TMA or MIWD premium payment.
7. Individuals who receive assistance under SDP (program 07); and
8. Individuals who are subject to a monthly TMA or MIWD premium.
{2/14/09}