Eligibility Criteria 525-05-25

HCBS Program Eligibility Determination 525-05-25-05

(Revised 1/1/07 ML #3057)

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1. Application for services in service chapter shall be made to the county social service board in the county in which the applicant resides utilizing "Application for Services," SFN 1047.
2. An applicant is eligible for these programs if the Case Management process (assessment of needs and care plan development) determines that the applicant meets functional and financial eligibility criteria for HCBS programs and requires those tasks/activities allowable within the scope of the services.
3. Authorization to Provide Service, SFN 1699 is required as a standard form for care plan implementation.  The SFN 1699 identifies the specific tasks/activities the provider is authorized to perform for the eligible client and sets forth the scope of the service the client has agreed and understands will be provided.
4. To be eligible for the Medicaid Waiver for Home and Community Based Services,or the Expanded SPED program, the client must be an approved recipient of Medical Assistance.  The Medicaid Waiver client must also receive a Waivered service on a monthly basis. HCBS Case Management is not sufficient.
5. The client is eligible for covered services under the Medicaid Waivers, the SPED program, and/or ExSPED program once all eligibility criteria have been met. Continued eligibility is monitored under HCBS Case Management. At any time there is a question as to whether the client continues to meet functional or financial eligibility criterion, the HCBS case manager is to substantiate eligibility.

The authorization of services cannot begin until a level of care screening date, SPED Pool effective date, or ExSPED Pool effective date is processed.