- (a) When determining eligibility for waiver services, if an individual requires a skilled level of care as defined in 20 CAR § 405-401, eligibility for Medicaid will be denied.
- (b) Likewise, if an individual has a serious mental illness, except as specified in 20 CAR § 405-402(a)(2) or has mental retardation, the individual will not be eligible for Medicaid unless the individual has medical needs unrelated to the diagnosis of serious mental illness or mental retardation and meets the criteria set out in 20 CAR § 405-402(a)(3), provided, however, that a diagnosis of severe mental illness or mental retardation will not bar eligibility for individuals having medical needs unrelated to the diagnosis of serious mental illness or mental retardation and meeting the criteria set out in 20 CAR § 405-402(a)(3).