Medicaid Policy                                                                 

380-1 Home and Community Based Waiver Medicaid Eligibility

Effective Date: June 1, 2024

Previous Policy

 

An applicant for a home and community based waiver must meet the level of care requirements for the applicable waiver.

 

A.  Need for Level of Care

 

1.    The waiver agency will evaluate waiver applicants for the level of care requirements.  The waiver case manager completes the form 927 to verify that the individual meets the level of care provided in a nursing home.

 

2.    The agencies that will determine the need for the level of care are:

 

o      Division of Services for People with Disabilities (DSPD),

o      Division of Family Health and Preparedness (DFHP),

o      Area Agency on Aging (AAA),

o      Office of Long Term Care Services and Supports (OLTSS).

 

B.  General Rules for the Form 927

 

1.    The 927 must be signed and completed by the waiver agency worker.  The form has two required dates which are:

 

a.    The date the individual meets the level of care requirements.

b.    The expiration date that applies only for a new 927 associated with an application, which will be 60 days from the level of care date.

 

2.    For a new application, the 927 is valid for an eligibility decision when it meets the following requirements.

o      The eligibility decision is made within 60 days of, but not before the date the individual meets the level of care, and

o      The benefit effective date must start before the end of the 60 day period. The benefit effective date will go back to the first day of the month subject to the exceptions defined in 711. 

• An extension to the 60 day time limit may be granted if there are delays outside the applicant’s control. Send extension requests to DHHS to be evaluated for a 60 day time limit extension.

3.    For reviews of ongoing eligibility, the form 927 remains effective until the waiver agency tells us the member no longer meets the criteria.

o Follow the review eligibility rules in section 721.

 

4. For retroactive months, before waiver services begin, do not determine the member as a waiver-eligible until the month they meet the level of care criteria as shown on a valid form 927.

o   Follow the retroactive eligibility rules in section 705.

 

5. For waiver closure or denial, if the member does not meet waiver Medicaid eligibility rules, the member is not eligible.  

o   In either case, inform the waiver agencies as soon as possible by using Form 927.  Coordinate all case closures with the waiver agencies.