Targeted Case Management
Contact: Jill Enyart
Director of Medicaid Services
841-0333 ext. 145
Contact: LaNeece Jardon
Targeted Case Manager
841-0333 ext. 103
Home and Community Based Services Physically Disabled Waiver (HCBS/PD)
The HCBS/PD program covers persons who are 16 – 64 years of age, are determined to be physically disabled according to Social Security disability standards, are financially eligible for Medicaid, and who are in need of long-term care services to accomplish the normal rhythms of the day. This program provides in-home care services to individuals who meet the criteria. To be eligible to receive HCBS/PD waiver services, a consumer must meet all of the following requirements:
- The consumer must be at least 16 years of age but less than 65 years of age. (*Consumers turning age 65 on July 1, 2002 or after this date may remain on the HCBS/PD waiver if they so choose as long as they continue to meet the eligibility criteria.)
- The consumer must be financially eligible for Medicaid as determined by SRS Economic Employment Support Specialists.
- The consumer must be determined physically disabled by Social Security Administration standards.
- The consumer must meet the Medicaid long-term care threshold based on an assessment completed with the Uniform Assessment Instrument (UAI) by a certified Independent Living Counselor AND have a determined need for personal assistance to accomplish the "normal rhythms of the day."
- As of November 1, 1999, the Long Term Care Services Threshold Guide score used to determine eligibility for the HCBS/PD waiver is 26 or greater.
- If 20 years of age or younger, the consumer must receive a KAN Be Healthy screening on a yearly basis.
- Community Developmental Disability Organizations (CDDOs) are required to assess all persons with developmental disabilities for the MR/DD waiver. If the individual does not meet the level of care necessary for services on the MR/DD waiver and the consumer also has a physical disability, the CDDO may provide a "denial of services" letter so the HCBS Physically Disabled Waiver Policies & Procedures Eligibility Effective Date: 04.01.02 2 Eligibility PD wavier provider agency can then assess the individual for the appropriateness of PD waiver services.
- For any consumer to be eligible for HCBS, they must be eligible for Medicaid. If a consumer fails to provide the necessary information to determine and verify Medicaid eligibility, and subsequently their Medicaid case is denied or closed, they are not eligible for HCBS services. In this instance, 10 days notice is not required for the closure of an HCBS case, as Medicaid will no longer pay for services. Services will not be reimbursed if the consumer does not have Medicaid eligibility.
- If an individual with ongoing services fails to submit their annual financial eligibility paperwork to SRS by the due date, the EES Specialist will notify the individual and the ILC of the potential termination of Medicaid. Services will be suspended until eligibility is reinstated. The EES Specialist has the authority to reinstate services if all necessary paperwork is received within the month of closure or the following month. Should eligibility be reinstated during this time, the individual will have continued eligibility and will not be placed on the PD waiver waiting list. If the required paperwork is not returned in the time allotted, they will no longer be eligible to receive services.