Disabilities and Chronic Illness Services for Age 65 and Under

Minnesotans with disabilities or chronic illnesses who need certain levels of care may qualify for the Minnesota home and community-based waiver programs. Home and community-based waiver programs are available to persons who meet the eligibility criteria include:

 

Community Alternative Care (CAC) Waiver:

This waiver is for chronically ill and/or medically fragile persons who need the level of care provided in a hospital. To be eligible for the CAC Waiver, a person must meet all of the following criteria:

  • Be eligible for Medical Assistance (MA)
  • Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process
  • Be under the age of 65 years at the time of opening to the waiver
  • Be determined by the case manager/service coordinator to need hospital level of care
  • Be certified by the primary physician to meet the level of care provided in a hospital
  • Have an assessed need for supports and services over and above those available through the MA State Plan

 

Hospital Level of Care Criteria:

To meet the requirements for a Hospital Level of Care, a person must meet all four of the following:

  • Need skilled assessment and intervention multiple times during a 24 hour period to maintain health and prevent deterioration
  • Due to their health condition, has both predictable health needs and the potential for status changes that could lead to rapid deterioration or life threatening episodes
  • Require a 24 hour plan of care that includes a backup plan that reasonable assures health and safety in the community
  • Without the provision of services under the CAC waiver, would require frequent or continuous care in a hospital

 

Community Alternatives for Disabled Individuals (CADI) Waiver:

This waiver is for people with disabilities who require the level of care provided in a nursing facility. To be eligible for the CADI waiver, a person must meet all of the following criteria:

·         Be eligible for Medical Assistance

·         Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process

·         Be under the age of 65 years at the time of opening to the waiver

·         Be found to need level of care provided at the nursing facility level

·         Have an assessed need for supports and services over and above those available through the MA State Plan

 

Nursing Facility Level of Care Criteria:

To meet the requirements for a Nursing Facility Level of Care, a person must demonstrate the need for assistance because of one or more of the following:

  • Need for restorative and rehabilitative or other special treatment
  • Unstable health
  • Need for complex care management
  • Functional limitation
  • Existence of complicating conditions
  • cognitive or behavioral condition
  • Frailty or vulnerability

 

Traumatic Brain Injury (TBI) Waiver:

This waiver is for people with traumatic or acquired brain injuries who need the level of care provided in a nursing facility that provides specialized services for persons with a TBI or a neurobehavioral hospital. To be eligible for the TBI Waiver, a person must meet all of the following criteria:

·         Be eligible for Medical Assistance

·         Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process

·         Be under the age of 65 years at the time of opening to the waiver

·         Be diagnosed with one of the following documented primary or secondary diagnoses of brain injury or a related neurological condition that resulted in significant cognitive and significant behavioral impairment:

o   Acquired brain injury including traumatic brain injury that is not congenital

o   Degenerative or genetic disease where cognitive impairment is present, becomes symptomatic on or after the person’s 18th birthday, and is not congenital

·         Be able to function at a level that allows participating in rehabilitation

·         Be in need of  service that is only available through the TBI Waiver or requires a higher level of service than is available through the other waivers due to cognitive and behavior impairments

·         Meet one of the following:

o   Nursing Facility Level or Care criteria for Traumatic Brain Injury-Nursing Facility (TBI-NF) or

o   Neurobehavioral Hospital Level of Care criteria for Traumatic Brain Injury-Neurobehavioral (TBI-NB)

·         Have completed a TBI Waiver Assessment and Eligibility Determination (DHS-3471)

 

Personal Care Assistant Services:

Personal Care Assistance Services are provided to assist and support persons with disabilities living independently in the community. This includes the elderly and others with special health care needs. PCA Services are provided in the recipient’s home or in the community when normal life activities take him/her outside of the home. Services may only be provided when:

  • Medically necessary
  • Prior authorized
  • A PCA Assessment establishes the need for PCA Services
  • A physician has signed the Physician Statement of Need
  • Approved in the recipient’s Service Plan
  • Documented in the recipient’s PCA Care Plan
  • Provided by a PCA under the direction of a qualified professional, the recipient, or their responsible party

 

Long Term Care Consultation:

A Long Term Care Consultation (LTCC) is a meeting between the case manager and the consumer who is being assessed. During the meeting a number of questions are asked to help the case manager learn about the abilities of the consumer as well as areas in which they may need assistance. There are questions about health status and independence in areas of daily living. The case manager is able to describe services that are available as well as give names of providers of those services. Information is shared about public programs that can fund services and the eligibility requirements. There may be a pre-admission screening for nursing home placement for long term stays or short term recovery placement. Case managers can also assist with people who are able to and want to leave the nursing home to return to more independent living.

 

To make a referral for services, call 320-564-2211 and ask to speak to the intake worker for Social Services.