Medicaid Waiver for Home and Community Based Services 525-05-25-10
(Revised
1/1/15 ML #3428)
View Archives
In order for services to be payable under
the provisions of the Medicaid Waiver for Home and Community Based Services,
the person receiving the service must meet all of the following:
- Recipient of Medicaid Program
under the State Plan for Medical Assistance as set forth in Service Chapter
510-05, Medical Assistance Eligibility Factors;
- Age 18 or older and physically
disabled as determined by the Social Security Administration or the State
Review Team, or be at least 65 years of age;
- Eligible to receive care
in a skilled nursing facility;
- Participate to the best
of their ability in a comprehensive assessment to determine what services
are needed and the feasibility of receiving home and community-based services
as an alternative to institutional care.
- Have Person Centered Plan of Care SFN 404, developed and approved by the applicant/client or legal
representative and HCBS case manager that adequately meets the health,
safety, and personal care needs of the recipient;
- Voluntarily choose to participate
in the home and community-based program after discussion of available
options. This
is documented by completion of Explanation of Client Choice, SFN 1597;
-
Service/care is delivered
in the recipient’s private family dwelling (house or apartment) or recipient
is receiving a community-based service of adult foster care, adult day
care, non-medical transportation, or adult resident service. Congregate/group
meals may be available or meals may be eaten off site.
With the exception of institutional respite, Medicaid Waiver funds may not be used to provide care in any institutional setting i.e. nursing home or hospital.
- Must receive services on
a monthly basis.
- Not eligible for and/or
receiving services through other Medicaid Waivers or private funding sources.
- The applicant/client(s)
impairment is not the result of a mental illness, intellectual disability
or a closely related condition.
