Medicaid Community Choices Waiver Program


What Is A 1095

Medicaid HCBS Waivers Webinar 7272018
  • Form 1095-B is a tax document that includes information about the health coverage provided for one or more months during the year to you, your spouse and individuals you can claim as dependents.
  • This form relates only to coverage provided by state Medicaid and CHIP agencies.
  • The healthcare law requires health coverage providers, including state Medicaid and CHIP agencies, to provide these documents to the IRS and covered individuals.
  • Receipt of this form does not create a federal tax return filing requirement with the IRS. Please check and the Form 1040 instructions to determine if you have a federal income tax return filing requirement.
  • Keep Form 1095-B with your records. You do not need to attach the form to your income tax return.
  • For more information about Form 1095-B, and other health care tax documents, please visit
Please note: Effective April 1st, 2021, Wyoming Medicaid will no longer require 40 qualifying work quarters for Lawful Permanent Residents.

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    Ccw Participant Services And Eligibility

    Initial and Ongoing Eligibility Requirements for the Community Choices Waiver

    Applicants for, and current participants of the Community Choices Waiver must meet residency, level of care, and financial eligibility requirements. Please review the CCW Program Fact Sheet and Application, which is found below, for additional information.

    Applying for the Community Choices Waiver

    1. Review the Participant Handbook for eligibility and level of care assessment information

    3. Select a case management agency.

    4. Complete the Community Choices Waiver Application.

    5. A Public Health Nurse will contact you to schedule the LT101 level of care institutional assessment. Please be available to meet with the PHN.

    Resources for Participant Rights

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    Who Can Get Coverage

    This waiver enables states to tailor services to meet the needs of a particular target group. Within these target groups, states are also permitted to establish additional criteria to further target the population to be served on a HCBS waiver. For example, the population can be targeted by age or diagnosis, such as autism, epilepsy, cerebral palsy, traumatic brain injury, or HIV/AIDS. Eligible individuals must demonstrate the need for a Level of Care that would meet the states eligibility requirements for services in an institutional setting. States choose the maximum number of people that will be served under a HCBS Waiver program.

    Medicaid Expansion Shrinks Distance To Care Improves Equityyour Browser Indicates If You’ve Visited This Link

    Medicaid Home and Community

    Medicaid expansion may have an impact on transportation for healthcare access among underserved groups, according to an article published in Health Affairs. “As expected, nonmetropolitan areas were those registering the strongest policy effect because distances to the closest health care provider are,

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    Big Sky Waiver Services

    consist of a nurse and social worker and provide a holistic approach to care planning. They look at each individuals medical and psycho-social needs and then develop a plan of care based on the persons needs and choices. Each Case Management Team has a fixed number of individuals they can serve per year. The following are examples of services that may be available through the Big Sky Waiver Program:

    • Adult Residential Living
    • Specialized Medical Equipment and Supplies
    • Services for Individuals with Traumatic Brain Injury

    South Carolina Community Choices Home And Community Based Medicaid Waiver Program

    TheCommunity Choices waiverserves the frail elderly and persons with physical disabilities who meet the nursing facility level of care criteria. The direct administration comes through thirteen SCDHHS offices around the State, each of which covers designated counties of South Carolina. Case managers working in these 13 offices are responsible for ensuring that participants are aware of their service options and can make informed choices as to which form of service delivery they prefer. The Community Choices waiver provides participant directed options for supervision of services. The Community Choices waiver offers a continuum of service options capable of meeting the needs of all waiver participants, both those who choose agency directed services and those who choose self-directed services.


    Services include: personal care, attendant care, companion services, environmental modifications, home-delivered meals, adult day health care, respite care, personal emergency resonse system , limited incontinence supplies,


  • Health: An applicant must meet theNursing Home Level of Care.
  • Practical Considerations

    There is currently a waitlist and the state significantly limits the number of enrollees to below to waiver programs maximum available slots.

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    Who Can Receive Hcbs Benefits

    In general, states can create Home and Community-Based Services programs to benefit disabled individuals of any age or to benefit the elderly, so long as the beneficiaries are eligible for Medicaid. However, not all Medicaid-eligible populations are eligible for HCBS benefits. States have created HCBS programs to target particular populations, and so eligibility for HCBS benefits varies from state to state.

    Most states have more than one HCBS program, targeting different groups of people and offering different levels of service. For example, Oregon operates six different HCBS waiver programs, offering different benefits to groups like children and adults with physical disabilities, children and adults with developmental disabilities, and those over age 65. Other states have HCBS programs that target populations by diagnoses, like HIV/AIDS, traumatic brain injury, or autism. Your state’s Medicaid agency can tell you what HCBS waiver programs it offers.

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    The MI Choice Waiver program

    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.

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    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.

    Problems Associated With Medicaid Waivers

    Medicaid waivers arent considered an entitlement. Whereas someone in need of nursing home care would be automatically entitled to a place in a facility, the HCBS waiver program is deemed a privilege rather than a right. As such, most people spend several years on a waiting list before they receive care.

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    Mi Choice Waiver Program


    Learn about our responses to Coronavirus and find the latest program guidance. > > Resources > > For Health Professionals

    MI Choice Waiver Documents and Provider Information

    Nursing homes used to be the only choice for older or disabled persons who needed help caring for themselves. Today there are many choices that allow individuals to live independently while receiving nursing facility level of care in their home or in a community setting.

    One program run by Michigan Medicaid is the MI Choice Waiver Program. It began in 1992 as the Home and Community Based Services for the Elderly and Disabled waiver program. We now know it as the MI Choice Waiver Program, or simply, “the waiver.”

    Through MI Choice, eligible adults who meet income and asset criteria can receive Medicaid-covered services like those provided by nursing homes but can stay in their own home or another residential setting. The waiver became available in all Michigan counties October 1, 1998. Each participant can receive the basic services Michigan Medicaid covers, supports coordination, and one or more of the following services in the waiver:

    • Adult day health
    • Chore services
    • Personal emergency response systems
    • Private duty nursing/respiratory care

    Region 1A Service Area: Cities – Detroit, Hamtramck, Highland Park, Grosse Pointe, Grosse Pointe Park, Grosse Pointe Shores, Grosse Pointe Woods, Grosse Pointe Farms, Harper Woods

    What Is The Mi Choice Medicaid Waiver

    1915(c) HCBS Medicaid Waiver Program Expenditures per ...

    The MI Choice Medicaid Waiver is a program funded through the Michigan Department of Health & Human Services to provide in-home and community-based services to frail, elderly or physically disabled adults who would otherwise require nursing home care. For those who would prefer to stay in their own home, the MI Choice Waiver staff will help explain their long-term options and arrange for the healthcare services they need. Services are funded through MDHHS and provided at no charge to participants meeting the programs medical and financial guidelines.

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    Home And Community Based Services Statewide Transition Plan

    On January 16, 2014, the Centers for Medicare and Medicaid Services released a final rule regarding Home and Community-Based Services Setting requirements. The final rule establishes an outcome-oriented definition of home and community-based settings, as opposed to previous definitions that were based solely on a setting’s location, geography or physical characteristics. The intent of this is to ensure individuals in Medicaid’s HCBS waiver programs receive services and supports in the most integrated setting and have full access to the benefits of community living.

    The final rule requires that all home and community-based residential settings meet certain qualifications including:

    • Community Integration and Access
    • Ensure Individual Rights of Privacy, Dignity, and Respect
    • Freedom from Coercion and Restraint
    • Optimized Autonomy and Independence
    • Individual Choice

    The Departments of Social Services and Human Services worked collaboratively to review the final rule. Per the requirements of the final rule, South Dakota Medicaid developed a transition plan for HCBS settings in South Dakota to be approved by CMS. The Departments are working closely with providers to ensure a smooth transition and continued compliance with the new rules.

    Who Is Eligible For An Hcbs Waiver Program

    The good news is that all states have some type of HCBS waiver program. But states create HCBS programs to target specific populations with particular needs, so eligibility for HCBS programs will vary from state to state.

    Most states have more than one HCBS program, and each one will target different groups of the population and offer varying levels of service. Generally, states offer HCBS waivers to elderly people , physically disabled people, adults and children with developmental disabilities, and medically fragile people . Some states also offer HCBS programs to individuals based on a diagnosis, such as HIV/AIDS, traumatic brain injuries, or autism.

    Even so, not everybody within these groups is automatically eligible for Medicaid waiver programs they must also require a certain level of care. Usually, the individual needs to meet medical criteria that would require them to be in a nursing home or other institution if they didnt receive in-home or community care. This is because Congress created HCBS waivers specifically to help keep people in their own homes and communities instead of receiving institutional care, so benefits arent awarded to people who arent at risk of institutionalization. The rules about the institutional level of care vary from state to state, but the majority of states require medical evidence of diagnosis as well as a professional assessment regarding the applicants ability to safely complete the activities of daily living.

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    What Is The New Choices Waiver

  • Must be a least 21 years of age.
  • Must have resided in a nursing home for a minimum of 90 days and be medically eligible for Medicaid long term care or, must have resided in a nursing home for a minimum of 30 days on a Medicare stay and be eligible for Medicaid long term care at the end of the Medicare stay.
  • Medicaid or Medicare must have paid for the nursing home stay for a minimum of 30 days immediately prior to discharge on New Choices Waiver.
  • What Is A Medicaid Waiver Your Guide To Medicaid Home And Community Based Services

    Coalition for Community Choice: New HCBS Guidance Announcement

    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.

    South Carolina Waiver Factsheet

    SC Community Choices

    Provides adult day health care, case management, personal care I, personal care II, respite- institutional, adult day health care transportation, adult day health care-nursing, attendant care, companion care- agency, companion care-individual, home accessibility adaptations- environmental modifications, home delivered meals, personal emergency response system- installation, personal emergency response system- monitoring, pest control, residential personal care II, respite- CRCF, respite- in-home, specialized medical equipment and supplies, and telemonitoring for individuals aged 65 no max age and individuals with physical disabilities ages 18 64.

    SC Community Supports Waiver

    Provides adult day health care services, personal care services, respite care services, waiver case management , incontinence supplies, adult day health care nursing, adult day health care transportation, assistive technology and appliances assessment/consultation, assistive technology and appliances, behavior support services, career preparation services, community services, day activity, employment services, environmental modifications, in-home support services, personal emergency response systems , private vehicle assessment/consultation, private vehicle modifications, support center services for individuals w/ID ages 0 – no max age

    SC Head and Spinal Cord Injury

    SC HIV/AIDS Waiver

    SC ID and Related Disabilities

    SC Mechanical Ventilator Dependent

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    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 percent 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 percent.

    What To Do If You Are Denied

    What You Need To Know About the Medicaid Waiver Program ...

    If you are denied Home and Community-Based Services, you have the right to appeal. Look carefully at the denial notice to see your appeal deadline, and make sure you file your appeal before that date. Also, review the notice to find out why you were denied so that you can start preparing your arguments before your hearing. You may need to get more medical records or witnesses, and that will take time.

    If your state Medicaid agency says that you do not meet the “institutional level of care,” find out how your state defines the level of care needed to qualify for Medicaid coverage for nursing home care. It should be in the state regulation that is listed on your denial notice. If it isn’t, you may have to ask your state Medicaid agency for the information. You will need to know what the standard is so that you can show that you meet it.

    You may want to find an attorney to represent you in your appeal. You can contact your local legal aid office to find out if they represent clients in Medicaid appeals, or contact a lawyer. Federal Medicaid rules also allow you to use a relative, friend, or any other spokesperson that you choose to help you with your appeal, or you can represent yourself. Find out more about appeals in Nolo’s article on Medicaid appeals.

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