8210 Description of Waiver Programs - Policy regarding specific functional criteria are found in the appropriate waiver manual. The following HCBS and model waiver programs are currently operated in the State.
8211 Frail Elderly Waiver (HCBS/FE) - This waiver serves individuals who are elderly (65 or older) and who meet the long term care clinical threshold .
Persons who are assessed and found in need of long term care will be offered either HCBS services only or, if appropriate, a choice between nursing facility or HCBS services. If HCBS services are chosen, a plan of care will be developed and the cost of services determined. Cost cap exceptions may be granted when the HCBS cost exceeds the average Medicaid reimbursement for nursing facility or other institutional services if warranted by the customer's care needs and approved by the care coordinator and the agency.
Designated care coordinators for this waiver are responsible for developing and maintaining a plan of care to meet the individual's needs. Eligibility staff are responsible for referring the individual to the appropriate ADRC for assessment (if necessary) and informing the care coordinator regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the individual for Medicaid application (if necessary) and providing information to eligibility staff concerning the plan of care, the cost of the care, and any changes in that care or in the client's living arrangement. The ES 3160/3161 forms shall be used for these purposes.
8212 Physical Disabled Waiver (HCBS/PD) - This waiver serves individuals who have been determined physically disabled by Social Security disability standards and found in need of long term care services to accomplish the normal rhythms of the day. Those individuals between 21 and 64 whose primary diagnosis is severe and persistent mental illness (SPMI), severely emotionally disturbed (SED), or mentally retarded/developmentally disabled (MRDD) are excluded from this waiver.
This waiver serves persons between the ages of 16 and 64. Persons on the PD waiver on their 65th birthday may remain on the PD waiver. No other persons may receive PD services past the age of 64. Persons who elect to remain on the PD waiver past the age of 64 may move to the FE waiver in the future. Persons choosing the FE waiver may not move back to the PD waiver at a later point.
NOTE: The eligibility worker shall assume the person will remain on the PD waiver. Do not male a change until notification from the care coordinator is received.
As with the HCBS/FE waiver, persons who are assessed and found in need of long term care will be offered either HCBS services only or, if appropriate, a choice between HCBS or nursing facility services. If HCBS is chosen, a plan of care will be developed along with the cost of services.
Designated care coordinators are responsible for developing and maintaining a plan of care to meet the individual's needs. The eligibility staff are responsible for referring the individual for assessment (if necessary) and informing the care coordinators regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the individual for Medicaid application (if necessary) and providing information to EES concerning the plan of care, the cost of the care, and any changes in that care or in the client's living arrangement. The ES-3160/3161 forms shall be used for these purposes.
8213 - Intellectual and Developmental Disability Waiver (HCBS/I/DD) - This waiver serves individuals who are 5 years of age or older and are intellectually or developmentally disabled and who meet the criterion for ICF/IID level of care as determined by screening. The Substance Abuse, Mental Health and Developmental Disabilities Commission is responsible for determining eligibility for ICF/MR level of care based on screening assessments submitted by recognized Community Developmental Disability Organizations (CDDO's).
Eligibility staff are responsible for referring all clients who are potentially in need of ICF/IID level of care to the appropriate CDDO for screening. The ES-3160 form shall be used for all referrals.
Ongoing case management will also be provided by the local CDDO's. Eligibility staff are responsible for informing the appropriate center concerning the Medicaid eligibility decision, the amount of any client obligation, and any changes in obligation or eligibility. The CDDO case manager is responsible for providing information to eligibility staff concerning the plan of care, the cost of the care, and any changes in that care or in the client's living arrangement. The ES-3160/3161 forms shall be used for these purposes.
NOTE: Children who are eligible under the waiver and have received SSI benefits in an institutional setting are potentially eligible for a $30/month SSI benefit as though they were institutionalized. The family is to be referred to Social Security if the child meets all waiver criteria and will be Medicaid eligible.