(1) Eligibility criteria for CSHS financial assistance are:

(a) a CYSHCN with either a disabling physical condition that can be substantially improved or corrected with surgery, or a condition or disease that can be cured, improved, or stabilized with medical treatment, or is suspected of having a disabling physical condition or a medical condition or disease;

(b) a CYSHCN is under 19 years of age or up to 22 years of age and has a qualifying condition for which long-term care is needed and approved by the interdisciplinary team or the program's medical advisor;

(c) a resident of the state of Montana and either a U.S. citizen or a qualified alien as defined under federal statute.

(2) Family income must be verified to determine eligibility. The department 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;

(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;

(iv) the first $2,000 of an enrolled tribal member's tribal land income;

(v) the interest earned on (4)(a), (4)(b), or (4)(c);

(vi) dependent care expenses which are deducted from income under the HMK Plus coverage group;

(vii) foster care income for any children unless the only children in the family are foster care; or

(viii) income of any individual with whom a child resides who has no legal obligation to support the child.

(c) Income information will be used by the department to project the family's income.

(d) A member of a family whose income, less any out-of-pocket expenses for health insurance premium, care expenses for children, disabled or elderly adults while adults are working, and earned income disregards is at or less than 250% 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 nonaccessible 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.

(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) CSHS financial eligibility will be determined in accordance with the financial eligibility guidelines contained in HMK's ARM 37.79.201, with the following exceptions:

(a) children may have health care coverage and the out-of-pocket expenses for health insurance premiums are deducted from household income; and

(b) CSHS financial eligibility is at or below 250% of the federal poverty income guidelines.

(7) A CYSHCN attending an interdisciplinary team pediatric specialty clinic does not need to apply for financial assistance.