Medicaid Policy
Medicaid Policy
A. What is a Home and Community Based Waiver (HCB)
1. HCB waivers allow Medicaid to cover extra services as an alternative to institutionalization.
a. The extra services allowed through a HCB waiver are services that are not provided through regular Medicaid benefit plans.
b. The individual would be at risk of institutionalization without the waiver services.
2. Utah has nine HCB waiver programs. They are:
o Physical Disabilities Waiver (PDW)
o Technology Dependent Waiver (TDW)
o Utah Community Supports Waiver (UCSW)
o Community Transitions Waiver (CTW)
o Acquired Brain Injury Waiver (ABIW)
o Aging Waiver (AW)
o New Choices Waiver (NCW)
o Medically Complex Waiver (MCC)
o Limited Supports Waiver (LSW)
3. The number of people who can be served on each waiver is limited.
4. For a list of services each waiver provides go to https://medicaid.utah.gov/ltc-2/.
B. Medical and Financial Process for HCB
HCB waiver has two eligibility components, a medical level of care assessment and a financial eligibility determination.
1. Level of Care Assessment (medical eligibility)
a. The individual needs to contact one of the waiver case management agencies and apply for waiver services with them (380-1).
b. The waiver case manager determines if the individual meets the level of care.
2. Financial eligibility determination
a. The individual must apply for Medicaid or if currently eligible, provide additional information needed to determine waiver eligibility.
b. The individual must meet the financial requirements for a HCB waiver.