SI DEN01310.207 Verifying Medicaid Under a State Home or Community Based Care Plan

A. Background

Sections 1902(e)(3) and 1915(c) of the Social Security Act allow States to develop medical assistance programs for certain groups of individuals to provide them with home or community based care.

In the Denver Region, only South Dakota provides Medicaid assistance to disabled children under the authority of section 1902(e)(3) of the Act. These children are sometimes referred to as TEFRA 134 children, and they receive regular Medicaid services under a provision of the State's Medicaid State Plan (i.e., a waiver is not required). Essentially, section 1902(e)(3) permits States to provide Medicaid assistance to children living at home if it is less expensive than providing similar care in an institution.

In the Denver Region, all six States provide Medicaid to children under 1915(c) home or community based waivers. In addition, there are other 1915(c) waivers that cover disabled and aged individuals. These programs are separate from the normal State Medicaid program and are commonly referred to as "home or community based waivers." Medicaid does not pay for room and board under these waivers. Such programs have been approved by the Center for Medicare and Medicaid Services (formerly Health Care Finance Administration) as a mechanism for States to provide home or community based services, not commonly covered under Medicaid, as an alternative to institutional care. The State can target certain groups such as disabled children. Such home or community based programs are usually limited to a certain number of recipients that can be served at any one time.

The following is a list by State of section 1915(c) home or community based waivers currently in existence in the Denver Region under which an SSI recipient/claimant may qualify:

1. Colorado

  • Home Care Services for Elderly, Blind, and Disabled (waiver #0006.90.R3)

  • Habilitation Services for Developmentally Disabled and Mentally Retarded (waiver #0007.91R3)

  • Home Care Services for Persons Living with AIDS (waiver #0211.90.R1)

  • Home Care Services for Chronically mentally Ill (waiver #0268.90)

  • Personal/Respite Care for Individuals with Brain Injury (waiver #0288.90)

  • Supported Living Services (waiver #0293.90)

  • Habilitation Services for Children with Developmental Disabilities (waiver #0305.90)

  • Case Management for Disabled Children (waiver #4157.90.R1)

  • Case Management for Children with Developmental Disabilities (waiver #40179.90)

  • Personal Assistance for Children Needing Extensive Support (waiver #40180.90)

2. Montana

  • Case Management and Home Care for Elderly and Disabled (waiver #0148.90.R1)

  • Intensive Support/Care for Developmentally Disabled (waiver #0208.90.R1)

  • Community Supports, Personal Care, Transportation, etc. (waiver #03710

3. North Dakota

  • Case Management and Care for Developmentally Disabled and Mentally Retarded (waiver # 0037.90.R3)

  • Case Management and Care for Aged and Disabled (waiver # 0054.90.R2)

  • Case Management and Care for Individuals with Traumatic Brain Injuries (waiver # 0273.90)

4. South Dakota

  • Service Coordination and Habilitation for the Mentally Retarded and Developmentally Disabled (waiver # 0044.90.R3)

  • Home Care and Adult Day Health for the Elderly (waiver #0189.90.R1)

  • Assistive Daily Living Supports for the Severely Disabled (quadriplegic) (waiver #0264.90)

  • Service Coordination for Children with Developmental Disabilities (waiver #0338)

5. Utah

  • Respite, Habilitation, and Support Coordination for the Developmentally Disabled and Mentally Retarded (waiver #0158.90.R2)

  • Case Management and Home Care Services for the Aged (waiver #0247.90.R1)

  • Case Management and Home Care Services for Individuals with Acquired Brain Injury (waiver #0292.90)

  • Attendant Care for Individuals with Physical Disabilities (waiver #0331)

  • In-home Based Treatment for Technology Dependent and Medically Fragile Children (waiver #40183)

6. Wyoming

  • Case Management and Personal Care for the Developmentally Disabled (waiver #0226.90.R1)

  • Case Management and Personal Care for the Elderly and Physically Disabled (waiver #0236.90.R1)

  • Case Management and Personal Care for the Developmentally Disabled and Mentally Retarded up to Age 21 (waiver #0253.90.R1)

  • Case Management to Disabled Individuals under Age 21 Who Require Transplants (waiver #40184.90)

  • Assisted Living, Chore and Attendant Care (waiver #0369)

  • Case Management and Care for Individuals with Acquired Brain Injury (waiver #0370)

B. Policy

  1. Disabled children who are eligible for a Medicaid State home care plan under either a secti