Services to Individuals with Disabilities / Chronic Illness

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 choose the CAC Waiver and meet all 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
• Has an assessed need for supports and services over and above those available through the MA State Plan?

Hospital Level of Care Criteria:

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 reasonably 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 Access for Disability Inclusion (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 choose the CADI Waiver and meet all 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 found to need level of care provided at the nursing facility level
• Has 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 through assessment of need at levels established by Minnesota Statute, 144.0724, Subdivision 11.

Hospital Level of Care Criteria:

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 BI or a neurobehavioral hospital.  To be eligible for the BI Waiver, a person must choose the BI Waiver and meet all 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 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:

• • Acquired brain injury including traumatic brain injury that is not congenital
  • Degenerative or genetic disease where cognitive impairment is present, becomes symptomatic on or after the person’s 18th birthday, and is not congenital
  • Documented brain impairment from an event, disease, or condition that is not congenital
  • Nursing Facility Level of Care criteria for Brain Injury-Nursing Facility (BI-NF) or
  • Neurobehavioral Hospital Level of Care criteria for Brain Injury-Neurobehavioral (BI-NB)

• Be able to function at a level that allows participation in rehabilitation
• Need a 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:

• • Have completed a BI Waiver Assessment and Eligibility Determination (DHS-3471)

Consumer Support Grant (CSG):

For individuals who have been assessed by a Public Health Nurse and are determined in need of PCA services and are eligible, the Consumer Support Grant may be a way to allow the family to use those authorized PCA services to arrange for and direct the care of the child.  This would mean the family decides what services or goods they need to assist the child with daily living skills, respite, or other needs.  There needs to be someone in the family who direct the cares for the child.

Family Support Grant (FSG):

The Family Support Grant (FSG) is an effective resource for children with disabilities who live or will live in their family home.  Many families with children with disabilities living at home incur higher than average expenses that are directly related to the child’s disability.

The Family Support Grant provides cash grants to families to offset some of these expenses and gives the families the flexibility to purchase an array of supports and services to meet the child’s needs.  The amount of and number of grants varies by county.  Families wishing to access the program need to complete an application form and provide information to certify the child has been certified disabled, a description of the family’s needs, and other information as needed to determine grant eligibility.

Eligibility:

• Under 21 years of age; AND
• Certified disabled;
• Living in their biological or adoptive family home; OR
• Residing in a treatment center, ICF/MCR, or other licensed residential service or nursing facility and would return to their family home if the grant were awarded.
• People who are receiving services through a Home and Community Based Waiver including CAC/CADI/TBI.  People receiving the DD waiver are not eligible for Family Support Grant dollars.

Income Criteria: Families with an annual adjusted gross income in 2008 of $88,170 or under are eligible for the Family Support Grant.

Personal Care Assistant (PCA) Services:

Personal Care Assistant 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 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