How To Apply For Medicaid Waiver Program

Complete And Submit The Application For A Medicaid Waiver

1135 Medicaid Waiver Request Video

Because there are so many types of Medicaid, you should find your local Medicaid office at this link, and then find the application for the specific eligibility group you want to apply underin this case its likely the Home and Community Based Services waiver, also known sometimes as 1915 waivers.

In most states an application can be submitted three ways: in person, by traditional mail, or online. Applying online is generally faster than submitting physical documents through the mail or in person.

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

Appendix I: Financial Accountability

The state must describe how it makes payments for waiver services, ensures the integrity of these payments and complies with applicable requirements for federal financial participation. The information will include the following financial elements:

financial integrity and accountability

exclusion of Medicaid payment for room and board

payment for rent and food expenses of an unrelated live-in caregiver and

individual co-payments for waiver services and other cost sharing.

Objective: DADS must be able to answer how Texas maintains financial accountability in the waiver.

Also Check: Virginia Medicaid Provider Enrollment Phone Number

Benefits Of Medicaid Waivers

For those who are a part of an HBCS program, the biggest benefit is they get to stay in their own home or community, instead of being sent to a care institution. Staying at home has been shown to have many quality of life benefits, especially for seniors who get to age in place. Home is comfortable and familiar, allowing those to feel at ease compared to the jarring change of environment that a nursing home or other residential facility can bring. Not only has this been shown to improve recovery time after an injury or surgery, but its also been shown to improve mental health and reduce complications from dementia.

According to the American Association of Retired Persons, almost 90% of people over 65 say they want to stay in their own homes for as long as possible as they age. Relatives often prefer that their loved one stays at home as long as possible too, because theyll be in a community they know and are comfortable with, rather than alone and unhappy in an institution.

The federal government isnt complaining, either, because the cost of care in the home or an assisted living facility is cheaper than a nursing home often by up to 50%.

Mainecare Notice Of Agency Waiver Renewal Me0995 Home And Community Based Services For Adults With Other Related Conditions

How To Apply For Medicaid Waiver In Indiana

The Division of Policy posts all proposed and recently adopted rules on MaineCares Policy and Rules webpage. This website keeps the proposed rules on file until they are finalized and until the Secretary of State website is updated to reflect the changes. The MaineCare Benefits Manual is available on-line at the Secretary of States website.

Below, please find a MaineCare Notice of Agency Waiver Renewal. You can access the complete details at .

_____________________________________________________________________________

Notice of Agency Waiver Renewal

AGENCY: Department of Health and Human Services, MaineCare Services

RULE TITLE OR SUBJECT: Chapter 101, MaineCare Benefits Manual, Section 20, Home and Community Based Services for Adults with Other Related Conditions

WAIVER: ME.0995: Home and Community Based Services for Adults with Other Related Conditions

CONCISE SUMMARY: The Department is planning to submit a renewal of the Adults with Other Related Conditions waiver, known in Maine as Section 20, Home and Community Based Services for Adults with Other Related Conditions. This waiver submission incorporates permanent updates to the waivers appendices. Some of the proposed appendix updates contained in the waiver renewal include:

General:

Throughout the waiver, updates have been made for compliance with the HCBS Settings Rule.

Where applicable, revisions for consistency with ME.0159 , Section 21).

What Needs To Change

While we know that patients with BH diagnoses drive total healthcare costs, studies are starting to demonstrate that there is potential opportunity to bend the cost curve by focusing on the impact of BH on the total cost of care.

BH service line leaders must work with their organizations managed care leaders to prioritize the negotiation of rates and reimbursement structures that are aligned with the care model investments being made to increase access to BH services. This will also likely include the need to lobby state Medicaid and managed Medicaid payers for the inclusion of BH care management codes.

Payers need to use their claims data to not only understand the downstream savings opportunity associated with OP BH services but also to justify shifting reimbursement dollars so that investments can be made in expanding access to care settings focused on prevention and treatment.

Without those investments and incentives, inpatient and crisis management care will continue to be the primary treatment options.

CHANGEIN PEDIATRIC MENTAL HEALTH STARTS AT THE TOP.

Heres how Rady Childrens Hospital developed an integrated behavioral health/primary care model.

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

A Definition Of Medicaid Waivers

A Medicaid waiver is a provision in Medicaid law which allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage, or improving care for certain target groups such as the elderly or women who are pregnant.

Thanks to these waivers, states can provide services to their residents that wouldnt usually be covered by Medicaid. For instance, in-home care for people who would otherwise have to go into long-term institutional care.

What Is A Medicaid Waiver Your Guide To Medicaid Home And Community Based Services

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Page Reviewed/Updated: Aug. 26, 2022

The financial burden of long-term care is daunting for many, particularly those with low income and limited resources. Thankfully, all across the United States, there are programs available to help people get the long-term care they need to live fulfilling lives.

One such program is Medicaid Home and Community Based Services a Medicaid waiver that helps people stay in their home instead of receiving care in a nursing home or other institution.

But Medicaid and its waiver programs can be difficult to understand, and applying for coverage can be a confusing process for many to navigate. So let us help you discover everything you need to know about Medicaid waivers and how to access home and community-based services.

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What Are The Different Types Of Medicaid Waiver

There are several different types of Medicaid waivers, all of which serve different purposes. All waivers, no matter what type or state, are under the authority of Sections 1115 and 1915 of the Social Security Act.

In this article, were going to be focusing on HCBS waivers and how they can help people get better and more appropriate long-term care in their own homes.

What Care Is Provided Under An Hcbs Waiver Program

As outlined above, the purpose of an HCBS waiver is to let states provide care to certain individuals in the community, rather than putting them into institutional care. Beneficiaries may live in their own home, at a relatives home, or in a senior living community that isnt a nursing home.

Those who are accepted into their states HCBS waiver program will receive a range of medical and non-medical care, which can vary depending on the individuals needs and situation, as well as state guidelines. This may include:

Personal care services and supervision, at home or in an assisted living facility
A home health aide

Assistance transitioning from a nursing home into the community
Access to senior centers or adult group day care
Transport to and from non-emergency medical appointments

Non-medical transportation services
Personal emergency response systems

Services provided may vary on a case by case basis and will be affected by the state in which the beneficiary resides.

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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.

How To Choose Mental Health Insurance Companies For Credentialing

Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:

Increasing caseload

Increasing revenue per appointment

Working with a specific demographic

For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.

Are you looking to increase the number of sessions you do? Work with lower paying but higher supplying networks like Medicaid.

Want higher income per client? Look at the Blue Card network .

And if you dont even know what Blue Card programs apply to your state or you need a free customized quote thats specific to your needs, we are happy to help. You can reach out about that at our mental health credentialing services page.

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Addiction And Recovery Treatment Services

Virginia Premier offers many services for people struggling with substance use. This includes alcohol and drug use. Addiction is a medical illness, just like diabetes. Many people face addiction. All of them can benefit from treatment.

Virginia Premier covers these ARTS services:

inpatient acute detoxification hospitalization
substance abuse intensive outpatient treatment

outpatient substance abuse treatment
substance abuse peer specialist services

You can get these services at no cost.

Medication-assisted treatment options are also available, even for addiction to non-prescription drugs. Peer services are provided by someone who has had similar issues and who is in recovery. Case management services are also available.

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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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.

Indianas Family Supports Medicaid Waiver

An Introduction to Indiana’s Medicaid Waiver Program

The Family Supports Waiver is the basic entry point to receive waiver services for a child or adult with a developmental disability . Applications for the Family Supports Waiver are accepted through the Bureau of Developmental Disabilities Field Services Office .The Family Supports Waiver- Fast Facts: Limit of an individuals budget at $17,300 Provides a newer service called Participant Assistance and Care which provides another level of support for the individual in their own home or in the family home Provides Case Management as a distinct activity to waiver participants and Allows eligible individuals ages 18 through 24, who have aged out, graduated, or permanently exited from their school setting, to enter waiver services without waiting, if funded slots are available. The local BDDS office will determine who qualifies.Below are all services that are approved under Indianas Family Supports Waiver as of August 1, 2020: Adult Day Services Case Management Day Habilitation Environmental Modifications Extended Services Facility Based Support Psychological Therapy Recreational Therapy Remote Supports Respite Specialized Medical Equipment and Supplies Speech/Language Therapy Transportation Services: Level 1, 2, and 3 Workplace Assistance

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Why Is Medicaid Hard To Bill For Mental Health Providers

For the same reason that Medicare is hard to bill, except that each state has their own contract instead of each region . As such, your states Medicaid policy is up to them.

Each state may have their own system that they have built that might be slow and require many enrollments as well, or they might contract out the insurance coverage to existing commercial insurance companies.

Example: What you think is UHC is actually Medicaid via UHC and while youre in-network with UHC, youre out of network with their Medicaid network your claims get denied.

Make sure you understand exactly which Medicaid panels you are enrolling with, including if youre in-network with their commercial or Medicaid or HMO or PPO or EPO plans.

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People Who Qualify For Medicaid Typically Require More Intensive Services

People on Medicaid have higher rates of mental illness than people in the general population and use mental health services at a higher rate than people who have other types of insurance. They also have high rates of comorbid medical disorders.

Medicaid Statistics

The following statistics are all provided by the Medicaid and CHIP Payment and Access Commission . According to MACPAC:

About 10 percent of people on Medicaid have serious mental illness, relative to 3 percent of people with private insurance and 5 percent of people with no insurance.
About 24 percent of people on Medicaid received mental health treatment in the past year, relative to 14 percent of people with private insurance and 10 percent of people with no insurance.
About 44 percent of people on Medicaid had fair or poor health status in the past year, compared to 13 percent of people with private insurance and 24 percent of people without insurance.

This means that Medicaid is an important link that connects essential medical and mental health services with the people who need them most.

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Stakeholder Engagement Of Core Focus Groups

Focus Group Q	Focus Group E
Primary objective is to design the waiver Quality Improvement Strategies and Continuous Quality Improvement Initiatives	Primary objective is to identify case management activities and timeliness safeguards for interest-free case management and eligible providers of CM/HCBS and required responsiblities of partnering entities.	Primary Objective is to identify and define HCBS services to maintain and promote community integration civen the changing needs of target population	Primary ojective is to identify and define waiver entry eligibility, health, safety and well-being criteria