Docstoc

HOME AND COMMUNITY BASED SERVICES _HCBS_ MEDICAID WAIVERS

Document Sample
HOME AND COMMUNITY BASED SERVICES _HCBS_ MEDICAID WAIVERS Powered By Docstoc
					                                       HOME AND COMMUNITY BASED SERVICES (HCBS) MEDICAID WAIVERS
Medicaid is a health care program for low income Coloradans. Applicants must meet eligibility criteria for one of the Medicaid Program categories in order to qualify for benefits. Major
program categories include Aid to Families with Dependent Children/Medicaid Only, Colorado Works/TANF (Temporary Assistance for Needy Families), Baby Care/Kids Care, Aid to
the Needy Disabled, Aid to the Blind, and Old Age Pension. To apply for Medicaid, contact your local County Department of Social/Human Services.

Waiver programs provide additional Medicaid benefits to specific populations who meet special eligibility criteria. This chart summarizes those benefits and criteria, and tells you how to
apply for Medicaid under a waiver. For some people, a waiver is the only way to qualify for Medicaid.

Clients must meet financial, medical, and program criteria to access services under a waiver. The applicant's income must be less than $1,911.00 (300%, or three times, the Supplemental
Security Income allowance) per month and countable resources less than $2,000 for a single person or $3,000 for a couple. The applicant must also be at risk of placement in a nursing
facility, hospital, or ICF/MR (intermediate care facility for the mentally retarded). To utilize waiver benefits, clients must be willing to receive services in their homes or communities. A
client who receives services through a waiver is also eligible for all basic Medicaid covered services except nursing facility and long-term hospital care. When a client chooses to receive
services under a waiver, the services must be provided by certified Medicaid providers or by a Medicaid contracting managed care organization. The cost of waiver services cannot be
more than the cost of placement in a nursing facility, hospital, or ICF/MR.

Each waiver has an enrollment limit. There may be a waiting list for any particular waiver. Applicants may apply for more than one waiver, but may only receive services through one
waiver at a time. Anyone who is denied Medicaid eligibility for any reason has a right to appeal. Talk to your County Department of Social/Human Services if you wish to exercise your
right to appeal.

               This chart was produced by the Community Based Long Term Care Section, Colorado Department of Health Care Policy and Financing.                                                                                                                       Effective: April 2008
                                                                                                                                                                                                         HCBS WAIVER
                                                                                                                                                               HCBS                                     for PERSONS who
                                                                            CHILDREN'S                 CHILDREN’S                                            WAIVER for          HCBS WAIVER                   are                                           SUPPORTED
                                                      HCBS –                EXTENSIVE                 HABILITATION                 HCBS WAIVER              PERSONS with          for PERSONS               ELDERLY,                                            LIVING              WAIVER for PERSONS
                     CHILDREN'S HCBS              CHILDREN WITH              SUPPORT                  RESIDENTIAL                 for PERSONS with            MENTAL             LIVING WITH               BLIND, AND              PEDIATRIC                   SERVICES             DEVELOPMENTALLY
 NAME OF                 WAIVER                   AUTISM WAIVER              WAIVER                 PROGRAM WAIVER                 BRAIN INJURY               ILLNESS                  AIDS                 DISABLED            HOSPICE WAIVER                  WAIVER                  DISABLED
 WAIVER             (CHILDREN'S HCBS)              (HCBS-CWA)*              (HCBS-CES)                 (HCBS-CHRP)                    (HCBS-BI)              (HCBS-MI)           (HCBS-PLWA)               (HCBS-EBD)             (HCBS-PHW)                  (HCBS-SLS)                (HCBS-DD)
What is the        To provide Medicaid            To provide Medicaid     To provide Medicaid      To provide residential         To provide a home         To provide a         To provide a home      To provide a home       To provide Medicaid       To provide to persons    To provide to persons with
primary            benefits in the home or        benefits in the home    benefits in the home     services for children and      or community based        home or              or community           or community based      benefits in the home      with developmental       developmental disabilities
purpose of         community for disabled         or community for        or community for         youth in foster care who       alternative to            community based      based alternative to   alternative to          for children who          disabilities supported   services and supports out of
this waiver?       children who would             children with a         children with            have a developmental           hospital or               alternative to       hospital or nursing    nursing facility care   would otherwise be        living in the home or    the family home which allow
                   otherwise be ineligible for    medical diagnosis of    developmental            disability and                 specialized nursing       nursing facility     facility care for      for elderly, blind,     ineligible for curative   community.               them to continue to live in
                   Medicaid due to excess         Autism who are          disabilities or          extraordinary needs.           facility care for         care for persons     persons living with    and disabled            treatments while                                   the community.
                   parental income and/or         most in need due to     delays, that are         Children must be at risk for   persons with brain        with major           HIV/AIDS.              persons.                receiving palliative
                   resources. Children must       the severity of their   most in need due to      institutionalization.          injury.                   mental illness.                                                     care.
                   be at risk of nursing          disability. Children    the severity of their
                   facility or hospital           must meet additional    disability. Children
                   placement.                     targeted criteria.      must meet additional
                                                                          targeted criteria.
What ages          Birth through age 17           Birth through age 5     Birth through age 17     Birth to 21 years of age       Age 16 through 64         Age 18 and older     All ages               Age 18 and older        Birth through age 18      Age 18 and older         Age 18 and older
are served?
Who is             Disabled children in the       Children medically      Children with            Children from birth to 21      Persons with brain        Persons with a       Persons with a         Elderly persons with    Children critically ill   Persons who can          Persons who require
served?            home at risk of nursing        diagnosed with          intensive behavioral     years of age who are placed    injury as defined in      diagnosis of         diagnosis of           a functional            who can be safely         either live              extensive supports to live
                   facility or hospital           Autism with             or medical needs         through a County               the Colorado Code         major mental         HIV/AIDS.              impairment (aged        cared for in the home     independently with       safely, including access to
                   placement.                     intensive behavioral    who are at risk of       Department of Social           of Regulations with       illness.                                    65+) or blind or        and at risk of being      limited supports or      24-hour supervision, and
                                                  needs who are at risk   institutionalization.    Services, have a               specific diagnostic                                                   physically disabled     placed in either a        who, if they need        who do not have other
                                                  of                      Children, birth          developmental disability       codes.                                                                persons (aged 18-       hospital or a nursing     extensive supports,      resources for meeting those
                                                  institutionalization.   through age 4, must      and extraordinary service                                                                            64).                    facility.                 are already receiving    needs.
                                                                          have a developmental     needs, and for whom                                                                                                                                    that high level of
                                                                          delay. Children, 5       services cannot be provided                                                                                                                            support from other
                                                                          through 17, must         at the county negotiated                                                                                                                               sources, such as
                                                                          have a developmental     rate.                                                                                                                                                  family.
                                                                          disability.

                   1,308 children                 75 children             375 children             299 children                   400 persons               2,883 persons        110 persons            19,981 persons          200 persons               3,012 persons            4,007 persons
What is the
active
enrollment
cap on the
program?
Where to           County Department of           Community Centered      Community Centered       County Department of           Single Entry Point        Single Entry         Single Entry Point     Single Entry Point      Single Entry Point        Community Centered       Community Centered Boards
apply?             Social or Human Services,      Boards                  Boards                   Social or Human Services       (SEP) Agencies            Point (SEP)          (SEP) Agencies         (SEP) Agencies          (SEP) Agencies            Boards
                   Options For Long Term                                                           for children and youth in                                Agencies
                   Care - also known as                                                            out-of-home placement
                   Single Entry Point
                   Agencies (SEP), or
                   Community Centered
                   Boards
Is there a         Yes                            Yes                     Yes                      Yes                            Yes, for nursing          No                   No                     No                      No                        Yes                      Yes
waiting list?                                                                                                                     facility level of care
                                                                                                                                  in the Supported
                                                                                                                                  Living Program
What are the       Nursing facility or hospital    Diagnosed with        Intermediate care        Children/youth must be         Hospital or nursing       Nursing facility     Nursing facility or    Nursing facility        Hospital level of care    Intermediate care        Intermediate care facility for
medical            level of care.                   Autism                facility for the         determined to be at risk of    facility level of care.   level of care.       hospital level of      level of care.          with a life limiting      facility for the         the mentally retarded level of
criteria?                                          Under 6 years of      mentally retarded        institutionalization in an                                                    care.                                          illness where death is    mentally retarded        care.
                                                    age                   level of care.           intermediate care facility                                                                                                   highly probable before    level of care.
                                                                                                   for the mentally retarded                                                                                                    adulthood.
                                                                                                   level of care by his/her
                                                                                                   physician
Who                 Case manager                  Case Manager           Client                  County Department of          Client                   Client              Client                Client                 Family or legal          Client                  Client
determines          Family                                                Case manager             Social or /Human              Case manager             Case manager        Case manager          Case manager            guardian                 Case manager            Case manager
the eligible        Primary physician                                     Family or legal          Services                      Family or legal          Family or legal     Family or legal       Family or legal                                  Family or legal         Family or legal guardian
persons                                                                     guardian                                                guardian                  guardian             guardian               guardian                                          guardian
needs?                                                                                                                             Inpatient
                                                                                                                                    interdisciplinary
                                                                                                                                    team
What waiver         Case management               Case Management        Specialized            The waiver is designed to       Adult day services       Adult day           Adult day             Adult day services     Counseling Services      Specialized             Day habilitation
services are        In home support               Behavioral              Medical                assist children/youth to        Specialized               services             services              Alternative care       Expressive Therapy        Medical Equipment        (specialized day,
available?           services (IHSS)                therapies               Equipment &            acquire, retain, and/or          Medical                  Alternative care    Personal               facilities             Palliative/Supportive     & Supplies               community access)
                                                                            Supplies               improve self-help,               Equipment &               facilities           Emergency             Community               Care                     Counseling and          Residential habilitation (24
                                                                           Community              socialization, and adaptive      Supplies                 Personal             Response               transition services    Respite care              therapeutic services     hour individual or group)
                                                                            Connection             skills necessary to live in     Behavioral                Emergency            System                Personal                                         Dental services         Transportation
                                                                            Services               the community with a plan        management                Response            Homemaker              Emergency                                        Day habilitation        Specialized medical
                                                                           Home                   to include the following        Day treatment             System               services               Response System                                   services                 equipment and supplies
                                                                            modifications          services:                       Home                     Home                Non-medical           Home                                              (specialized,           Supported employment
                                                                           Personal assistance     Cognitive services             modifications             modifications        transportation         modifications                                     community access)       Skilled nursing
                                                                           Professional            Communication services        Mental health            Homemaker           Personal care         Homemaker                                        Hearing services        Behavioral services
                                                                            services (incl.         Community Connection           counseling                services            Private duty           services                                         Home                    Dental
                                                                            behavioral)              Services                      Non-medical              Non-medical          nursing               In home support                                   modifications           Vision
                                                                                                    Counseling and                 transportation            transportation                              services (IHSS)                                  Personal assistant
                                                                                                     therapeutic services          Personal care            Personal care                              Non-medical                                       services
                                                                                                    Emergency assistance          Respite care             Respite care                                transportation                                   Supported living
                                                                                                     training                      Substance Abuse                                                      Personal care                                     consultation
                                                                                                    Independent living             Counseling                                                           Respite care                                     Transportation
                                                                                                     training                      Supported Living                                                                                                       Vision services
                                                                                                    Personal care services         Program                                                                                                                Employment (pre-
                                                                                                    Self-advocacy training        Transitional Living                                                                                                     vocational and
                                                                                                    Supervision services          Personalized                                                                                                            supported
                                                                                                    Travel services                Emergency                                                                                                               employment)
                                                                                                                                    Response System

Who selects         Family                        Family                 Family                  County Department of          Client                   Client              Client                Client                 Family                   Client                  Family
the service                                                                                          Social Services                                                                                                             Client                                            Client
providers?
What type of       Individualized care plan       Individualized care     Individualized care      Individualized care plan       Long-term care plan       Long-term care       Long-term care         Long-term care plan     Individualized care       Individualized care      Individualized care plan
plan is used?                                     plan                    plan                                                                              plan                 plan                                           plan                      plan
Who                 Approved Case                 Community              Community               County Department of          Single Entry Point       Single Entry        Single Entry          Single Entry Point     Single Entry Point       Community               Community Centered
provides case        Management Agencies            Centered Boards         Centered Boards          Social Services                (SEP) Agencies            Point (SEP)          Point (SEP)            (SEP) Agencies          (SEP) Agencies            Centered Boards          Boards
management?         Approved Community                                                                                                                       Agencies             Agencies
                     Centered Boards
What               Department of Health           Department of Health    Department of            Department of Human            Department of             Department of        Department of          Department of           Department of Health      Department of            Department of Human
state/federal      Care Policy and                Care Policy and         Human Services,          Services, Division of Child    Health Care Policy        Health Care          Health Care Policy     Health Care Policy      Care Policy and           Human Services,          Services, Developmental
organizations      Financing; Centers for         Financing; Centers      Developmental            Welfare Services               and Financing;            Policy and           and Financing;         and Financing;          Financing; Centers for    Developmental            Disabilities Services;
administer         Medicare and Medicaid          for Medicare and        Disabilities Services;   Department of Health Care      Centers for Medicare      Financing;           Centers for            Centers for             Medicare and              Disabilities Services;   Department of Health Care
this program?      Services                       Medicaid Services       Department of Health     Policy and Financing;          and Medicaid              Centers for          Medicare and           Medicare and            Medicaid Services         Department of Health     Policy and Financing;
                                                                          Care Policy and          Centers for Medicare and       Services                  Medicare and         Medicaid Services      Medicaid Services                                 Care Policy and          Centers for Medicare and
                                                                          Financing; Centers       Medicaid Services                                        Medicaid                                                                                      Financing; Centers       Medicaid Services
                                                                          for Medicare and                                                                  Services                                                                                      for Medicare and
                                                                          Medicaid Services                                                                                                                                                               Medicaid Services
What laws          C.R.S. 25.5-6-901, as          C.R.S. 25.5-6-801–      C.R.S. 27-10.5-401,      C.R.S. 25.5-5-306(1) (1995     C.R.S. 25.5-6.701-        C.R.S. 25.5-6-       C.R.S. 25.5-6-501-     C.R.S. 25.5-6-301-      C.R.S. 25.5-5-305 as      C.R.S. 27-10.5-101 –     C.R.S., 27-10.5-101 – 103,
and                amended; 42 C.F.R.             805, as amended         as amended; C.R.S.       Supp); C.R.S. 27-10.5-         706, as amended; 42       601-607, as          508, as amended;       313, as amended; 42     amended;                  103, as amended;         as amended; C.R.S. 25.5-6-
regulations        441.300 – 310;                                         25.5-6-401-411, as       102(11) (1995 Supp)            C.F.R. 441.300 - 310      amended; 42          42 C.F.R. 441.300      C.F.R. 441.300 –                                  C.R.S. 25.5-6-401-       401-411, as amended; 42
govern the                                        Department of Health    amended; 42 C.F.R.                                                                C.F.R. 441.300 –     – 310                  310                     Department of Health      411, as amended; 42      C.F.R. 441.300 – 310
program?           Department of Health           Care Policy and         441.300-310              Department of Human            Department of             310                                                                 Care Policy and           C.F.R. 441.300 – 310
                   Care Policy and                Financing,                                       Services, Child Welfare        Health Care Policy                             Department of          Department of           Financing, 10.C.C.R.                               Department of Human
                   Financing, 10.C.C.R.           10.C.C.R. 2505-10,      Department of            Services, 10.C.C.R. 2505-      and Financing,            Department of        Health Care Policy     Health Care Policy      2505, Section 8.504       Department of            Services, Developmental
                   2505-10, Section 8.506         Section 8.519           Human Services,          10, Section 8.508              10.C.C.R. 2505-10,        Health Care          and Financing,         and Financing,                                    Human Services,          Disabilities Services, 2 CCR-
                                                                          Developmental                                           Section 8.515             Policy and           10.C.C.R. 2505-        10.C.C.R. 2505-10,                                Developmental            503-1; Department of Health
                                                                          Disabilities Services,                                                            Financing,           10, Section 8.496      Section 8.485                                     Disabilities Services,   Care Policy and Financing,
                                                                          2 CCR 503-1;                                                                      10.C.C.R. 2505-                                                                               2 CCR 503-1;             10.C.C.R. 2505-10, Section
                                                                          Department of Health                                                              10, Section 8.509                                                                             Department of Health     8.500
                                                                          Care Policy and                                                                                                                                                                 Care Policy and
                                                                          Financing,                                                                                                                                                                      Financing, 10.C.C.R.
                                                                          10.C.C.R. 2505-10,                                                                                                                                                              2505-10, Section
                                                                          Section 8.503                                                                                                                                                                   8.500.90
State contact      Lois Jacobs                    Michelle Cason          Sheila Peil, DDS         Judy Kissel                    Brittany Kipp             (Vacant)             (Vacant)               Casey Dills             Liz Svedek                John Miles, DHS          Al Orlofsky, DHS
person?            HCPF                           HCPF                    303-866-7467 or          DHS                            HCPF                      HCPF                 HCPF                   HCPF                    HCPF                      303-866-7459 or          303-866-7460 or
                   303-866-4770                   303-866-3895            Jay Kauffman, DHS        303-866-4393                   303-866-4654              303-866-2883         303-866-2883           303-866-2148            303-866-3674              Jay Kauffman, DHS        Jay Kauffman, DHS
                                                                          303-866-7455                                                                                                                                                                    303-866-7455             303-866-7455

				
DOCUMENT INFO