Elderly And Disabled Waiver Program

Prior Approval For Cap/c And Cap/da

Effective Feb. 5, 2017, N.C. Division of Medical Assistance implemented a prior approval process for the Community Alternatives Program for Children and Disabled Adults home and community-based services waivers for Level Of Care and CAP waiver services. A PA record was created and electronically transmitted to NCTracks for each new LOC determination decision made after Feb. 5, 2017, and for each currently approved CAP waiver service for all currently eligible CAP beneficiaries. .

Stakeholder Engagement Of Core Focus Groups

Elderly Blind And Disabled Waiver

A waiver is an extra set of Health First Colorado benefits that you could qualify for in certain cases. These benefits can help you remain in your home and community. Waivers have extra program rules and sometimes have waitlists.

The Home and Community-Based Services Waiver for persons who are Elderly, Blind, or Disabled provides assistance to people ages 65 and older who have a functional impairment, or are blind, or to people ages 18-64 who are physically disabled or have a diagnosis of HIV or AIDS, and require long-term supports and services in order to remain in a community setting. Effective April 1, 2014 this program incorporated services formerly provided under the Persons Living with AIDS/HIV program.

• EBD services work with or add to the services that you receive through the Health First Colorado State Plan and other federal, state, and local public programs.
• EBD also works with the supports that families and communities provide.
• If you receive services through the EBD waiver, you are also eligible for all Health First Colorado covered servicesexcept nursing facility and long-term hospital care.

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Parents On Medicaid Waiver Allege Disparity In Funds

A group of parents with children enrolled in a state Medicaid waiver program that provides funds to individuals and families of some of the most medically vulnerable individuals in the state are alleging that they have not been receiving the full amount of funds theyre entitled to under the program.

Institutional Respite And/or In

This is provided to participants on a short-term basis because of the absence of or need for relief for the primary care giver. This can be provided in the home or other licensed respite care centers. Transition Assistance – This is provided to a beneficiary currently residing in a nursing facility who wishes to transition from the nursing facility to the E & D Waiver.

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About Medicaid For Elderly Or Adults With Disabilities

Medicaid covers adults with intellectual and development disabilities as well as adults with physical disabilities. Medicaid also covers elderly individuals who may need additional services to help them live as independently as possible. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and individual will have an assessment regarding the level of care required to help meet individuals needs and care.

Individuals who are elderly or live with a disability can be eligible for Medicaid coverage if they meet the following criteria:

• Be a U.S. citizen or eligible non-citizen
• Have a disability diagnosis under the Social Security Act
• Be over the age of 65 years

Those with Developmental Disabilities can receive services specific to their disability when they meet certain criteria.

Medicaid/Medicare Participants

A dual eligible beneficiary is someone over the age of 21, has Medicare A, B, and D and is eligible for enhanced Medicaid. There are two programs available for dual eligible beneficiaries, Medicare Medicaid Coordinated Plan and the Idaho Medicaid Plus Program. For more information, visit the Medicaid/Medicare Participants page.

To be eligible for Medicaid for the Aged, Blind and Disabled program, you cannot own resources in excess of the resource guidelines.

Resources that count toward eligibility:

• Other resources

Resources that do not count include:

Elderly And Disabled Waiver Program

The Elderly and Disabled Waiver Program assists individuals who are elderly and/or functionally impaired to remain in their homes and/or communities. For eligible consumers, EDWP offers community-based services as an alternative to nursing facility placement.

To be eligible for EDWP, clients must be physically impaired, in need of care, and Medicaid eligible.

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Medicaid Waiver For Home And Community Based Services

North Dakota’s Medicaid Home and Community Based Services Waiver is an agreement between the Center for Medicare & Medicaid Services and the state’s Medicaid Agency, the North Dakota Department of Human Services. This waiver helps eligible individuals who would otherwise require nursing home services to remain in their homes or communities. It gives eligible people options, if their needs can be met in their homes.

LINK to CURRENT Medicaid Home and Community-Based Services 1915 Waiver

Over The Financial Limits

For some families, while their income and assets exceed the eligibility limits, they still cannot afford the cost of care. There is the option of working with a professional Medicaid planner to bring their assets and income in line with the requirements. These individuals are knowledgeable about Medicaid law nuances in each state and can help to restructure an individuals or familys excess income into Miller income trusts and maximize exempt assets. Find assistance to prepare for Medicaid.

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Who Is Eligible For Cap/da

• A disabled adults 18 years old and older.
• An individual who is determined to require a level of institutional care under the State Medicaid Plan.
• An individual who needs at least one or more CAP/DA home- and community-based service based on a reasonable indication of need assessment that must be coordinated by a CAP/DA case manager.

How To Make A Cap/da Referral

Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.

If you are a CAP/DA case management entity or a qualified home- and community-based provider, a referral can be completed in the e-CAP system.

A referral may also be made by calling or faxing the completed referral form to 919-715-0052

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Services Available Through Edwp Include:

• Adult Day Health
• Daytime care and supervision in an adult day center

• Alternative Living Services
• Alternative residence for persons unable to remain independent in their own homes

• Emergency Response Services
• In-home electronic support system providing two-way communication between isolated persons and a medical control center

• Home-Delivered Services
• Skilled nursing services, as well as physical, speech and occupational therapy

• Personal Support Services or Extended Personal Support Services
• Assistance with meal preparation, bathing, and light house keeping

• Consumer-Directed Personal Support Services
• Consumer hires and supervises worker of choice after 6 months of traditional personal support services

• Out-of-Home Respite Care
• Out-of-home overnight respite care in an approved facility with 24-hour supervision

• Home Delivered Meals

Aged And Disabled Waiver

The Aged and Disabled Waiver allows individuals who are aged, blind, or disabled to remain in their home as an alternative to nursing facility placement. Home and community-based services are provided through the A& D Waiver to supplement informal supports for people who would require care in a nursing facility if HCBS or other supports were not available.

Individuals must meet HCBS waiver eligibility and Medicaid eligibility guidelines in order to be eligible for a Medicaid HCBS waiver. To be eligible, individuals must:

• Be aged, blind, or otherwise disabled

• Reside in or transitioning into an HCBS-compliant setting

• Have income no greater than 300% of maximum Supplemental Security Income amount

• Meet nursing facility level of care

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Annual Community Alternatives Program Consumer

North Carolina Medicaid held annual training and educational sessions in consumer-direction during the months of July and August 2018. The annual trainings were for individuals currently participating in the consumer-direction program and for those individuals interested in participating in the consumer-direction program. The educational and enrichment trainings will consist of:

• Overview of consumer-direction

Listening sessions were held across North Carolina from Oct. 24 through Nov. 8, 2017

Summary of trends from comments:

• Additional waiver slots
• Management of behavioral health services to meet mental health and substance abuse needs
• Expansion of waiver services to meet changing demographic of target population
• Innovative strategies to meet needs for transportation

The Division of Medical Assistance held five listening sessions across North Carolina to allow interested stakeholders to participate in a collaborative dialogue focused on key areas of the waiver renewal. These sessions were held in the months of March and April in the cities of Raleigh, Kannapolis, Lenoir, Hendersonville and Greenville , and included 125 stakeholders.

During the sessions, focus groups concentrated on topics to determine how well the programs are working, areas for improvement, and creative ways to meet the needs of patients who receive CAP/DA services. Common comment trends included:

Admission To The Program

There is not an age requirement for this program, however a recipient must be financially eligible for Medicaid and meet the programs level-of-care criteria. Once accepted, a case manager will work with the client to develop a care plan based on the clients needs and choices. Services available through the Medicaid Waiver program, include: case management, personal care, homemaker, companion services, respite care, adult day health or nutrition/frozen meals.

Financial Eligibility for program:

• Individuals receiving Supplemental Security Income

• SSI related protected groups deemed to be eligible for SSI/Medicaid

• Individuals whose income is less than 300% of the SSI Federal Benefit Rate and cannot have resources in excess of $2,000

• Federal or State Adoption Subsidy Individuals

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Elderly And Persons With Disabilities Waiver

When given a choice, many seniors and adults with disabilities prefer to stay in the familiar surroundings, which is often their own home. The Elderly and Persons with Physical Disabilities Waiver program is here to help make this possible. This program provides services to help qualified older adults and persons with disabilities live in their own homes or community, instead of a nursing home.

For program information and instructions for application, download the packet below.

Who Is Eligible For The Elderly And Disabled Waiver

The Elderly and Disabled Waiver program provides home and community-based services to individuals age 21 years old and older who, but for the provision of such services, would require the level of care provided in a nursing facility. Beneficiaries of this waiver must qualify for Medicaid as Supplemental Security Income beneficiaries or meet the income and resource eligibility requirements for income level up to 300% of the SSI federal benefit rate and meet medical criteria of the program.

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Community Alternatives Program For Disabled Adults Waiver Application Submitted

The Community Alternatives Program for Disabled Adults Waiver Application was submitted to The Centers for Medicare & Medicaid Services Trareview and approval on March 1, 2019.

to view the CAP/DA Renewed Application.

NC Medicaid has requested from CMS an extension period to continue to administer the CAP/DA waiver through CMS review and approval process.

During the public comment period , a total of 300 comments were received. From those comments three sections were updated in the draft waiver application, Appendix B, C and D. The updates were made only to provide additional clarity the intended business processes were not changed. to view a summary of the comments.

What Is Nursing Facility Level Of Care

Level of care is the minimum needs an individual must have to be considered eligible for HCBS waiver services. A nursing facility level of care is required for a person to be admitted into a nursing facility. Level of care is evaluated when a person applies for Medicaid and then at least once a year after that. The initial level of care determination is made by the Area Agency on Aging. The waiver case manager will complete an annual level of care evaluation for waiver services.

For the purposes of nursing facility level of care, a person must have one of the following:

• An unstable, complex medical condition, which requires direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain
• Need for direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, central intravenous access
• Need for direct assistance for special routines or prescribed treatments from others, such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen
• Need for medical observation and physician assessment due to a changing, unstable physical condition
• Other substantial medical conditions.

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Technology Assisted Waiver For Adults

The TA waiver provides services to individuals age 21 or older with complex skilled medical conditions who are ventilator dependent or have a tracheostomy and who would otherwise require care in a long-term care setting to remain in the community. The plan of care and case management services are based on individual client needs. ADSS provides targeted case management for the TA program. Services include private duty nursing, personal care/attendant service, medical supplies, assistive technology, and targeted case management.

Apply For Elderly And Disabled Waiver Program

This waiver program, formerly called the Community Care Services Program , provides in-home and community-based services as an alternative to a nursing home.

• A Medicaid waiver provides recipients certain services not normally covered by Medicaid for a person with intellectual, developmental, physical disabilities. These services can take place in the persons home or in the community.
• The Elderly and Disabled Waiver Program serves frail, elderly, and disabled Georgians. It provides coordinated services in their home or community.
• The Elderly and Disabled Waiver Program can provide adult day care, alternative living services, personal care, home delivered meals, and respite care for family caregivers.

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Top Rated Assisted Living Communities By City

For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services Waivers or Waiver Funded Services.

Community Cares Services Program

Generally people utilizing the CCSP Program through Georgia Health Services are elderly and unable to live alone. They do not need the level of care found in a nursing home but do require some assistance with everyday living. CCSP recipients have a monthly income between $400 and $2523 per month.

Persons served through the CCSP Program must be eligible for Medicaid and meet the following requirements:

• Have cognitive and or physical impairments/limitations which make it difficult to perform normal daily living activities and live independently
• Have health needs that can be met in the community with services offered by the program and within established individual cost guidelines.

What does this mean? If your loved one has Medicaid , meets the above criteria, and has an income less than $2523 dollars per month, they may qualify for the CCSP or SOURCE Program and obtain residency in a licensed personal care home.

How much does it cost? Residents using CCSP pay the personal care home $689 per month and a cost share determined by CCSP and DFCS.

Why do we have to pay a Cost Share? Cost Shares are used to offset the amount not paid by the State of Georgia for ALS Services. CCSP and DFCS determine the cost share.

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What Is Consumer Directed Services

Consumer-direction is a service delivery model that allows a CAP/DA Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:

• Freely choosing who will provide care to meet medical and functional needs
• Independently recruiting, hiring, supervising, and firing an employee
• Independently setting a pay rate for an employee
• Assigning work tasks for the employee based on medical and functional needs

Community Alternatives Program For Disabled Adults Waiver Application Stakeholder Sessions

The CAP/DA unit within NC Medicaid held informational webinars for stakeholders in Jan. 2019 to learn about the proposed changes included in the waiver application and gave stakeholders an opportunity to make comments.

Comments pertaining to the renewal CAP/DA waiver application may also be forwarded to or by calling 919-855-4343. An electronic version of the renewal application is available on the NC Medicaid, NCTracks and e-CAP websites and a paper version can be accessed at each county Department of Social Services office.

NC Medicaid engaged stakeholders through statewide listening sessions, focus groups, work sessions, public comments and information sharing. The recommendations gathered from these stakeholder engagements informed the design of the proposed renewal CAP/DA HCBS waiver.

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Elderly And Disabled Waiver

The Elderly and Disabled Waiver program is administered and operated by the Office of Long Term Care. Case Management services are provided by the Planning and Development Districts. The case management team is composed of a registered nurse and a licensed social worker who are responsible for identifying, screening and completing an assessment on individuals in need of at-home services.