Medical - Kansas Economic and Employment Services Manual

8214 Technology Assisted Waiver (HCBS/TA) - This waiver serves chronically ill and medically needy individuals under age 22 who are hospitalized or at imminent risk of hospitalization.

Individuals seeking coverage under this waiver will be referred directly to the Waiver Program Manager via the ES-3160 HCBS referral form. An assessment of the individual’s needs and development of a plan of care will be completed by a MATLOC Eligibility Specialist. The Waiver Program Manager will then complete the ES-3160 form, including the designated case manager, choice date, the date services are to commence, and return the form back to the eligibility specialist.

Ongoing case management will be provided by independent case managers. The case manager is responsible for providing information to the eligibility worker concerning the cost of care, a change in the plan of care or the individual’s living arrangement.  Eligibility workers are responsible for informing the case managers of the Medicaid eligibility decision, the amount of any client obligation, and of any change in eligibility or obligation. This communication between the case manager and the eligibility worker shall be via the ES-3160 and ES-3161 forms. The forms should be sent by fax to expedite delivery.

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.

8215 - Traumatic Brain Injury Waiver (HCBS/TBI) - This waiver serves individuals who have a traumatically acquired head injury which has caused structural brain damage resulting in residual deficits and disabilities and who would otherwise require care in a rehabilitation facility as determined by screening.  The local ADRC is responsible for determining if the head injury criteria have been met based upon screening assessments submitted by designated case managers.

This waiver serves persons between the ages of 16 and 65. Some persons may continue on the HI waiver past the age of 65, as approved by the waiver manager.
Designated case managers are responsible for assessing the need for HCBS/TBI services and, if appropriate, developing and maintaining a plan of care to meet the individual's needs.  Eligibility staff are responsible for referring the individual for assessment (if necessary) to the local ADRC. The ADRC will be responsible for linking the customer with a case manager and staff would then communicate directly with the case manager regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The case manager 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/ES-3161 forms shall be used for these purposes.

8216 Serious Emotional Disturbance Waiver (HCBS/SED) - This waiver serves children who are determined to meet severe emotional disturbance criteria and who are between the ages of 4 and 18, or between 18-22 if approved by the CMHC. The child must be determined to be clinically eligible based on the severity of his or her emotional disturbance and the related impact on the child's potential for functioning successfully in the available home and community environment without special supports. Generally the children served by this waiver would otherwise be admitted to a state mental hospital without the availability of waiver services.

The families of children who are assessed and found to meet clinical eligibility criteria will be offered a choice between state mental health hospitalization or HCBS services. If HCBS is chosen, a plan of care will be developed along with the cost of services.

Designated case managers in each of the Community Mental Health Centers (CMHC's) will be responsible for developing and maintaining a plan of care to meet the child's needs as well as provide ongoing case management. Final approval of clinical eligibility and the care plan rests with staff in the Commission on Mental Health/Developmental Disabilities.  Eligibility staff are responsible for referring the family and child to the appropriate CMHC for assessment (if necessary) and informing the case manager regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The case manager is responsible for referring the family for a Medicaid application (if necessary) and providing information to eligibility staff concerning the plan of care, the cost of care, and any changes in that care or the child's living arrangement. The ES-3160/ES-3161 forms shall be used for that purpose.

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.