If the agency allows this as a deduction from income, the agency does not count it as the child's income when determining the family allocation amount in WAC, A monthly maintenance-needs allowance for the community spouse under WAC, A monthly maintenance-needs allowance for each dependent of the institutionalized client, or the client's spouse, as calculated under WAC, Incurred medical expenses which have not been used to reduce excess resources. Developmental Disabilities Administration Eligibility and Services Guide Contents Basic eligibility determination process You, your parent or a legal representative sends us the documents and evidence for determination. TFA will be transferred to the office where the S or L track case is located after 30 days of no TANF. CDT codes and descriptions only are copyright 2021, American Dental Association . for the DDA program . The only exception is the Alien Emergent Medical (AEM) Modified Adjusted Gross Income (MAGI) medical program under N21 and N25. Eligibility overview Parents & caretakers Age 65 & older, or Medicare eligible Aged, blind, or disabled Long-term care & hospice Learn about my coverage American Indians & Alaska Natives Patient review & coordination How do I use my coverage? The DDA case manager sends a DSHS 15-345 CSO/DDA Communication from barcode to inform the financial worker of DDA Waiver eligibility and the start date of services, type of service, change of service, if in an alternate living facility (ALF) such as an adult family home or DDA group home, the state daily rate of the facility, address of facility placement and other changes described in the instructions of the DSHS 15-345 form in barcode. HCS Home and Community based (HCB) waivers | Washington State Health If not, redetermine coverage under appropriate program (MAGI or classic). Since the family is not living under the same roof, CSD would maintain the ABD medical cases and the case would be separated, SSI related S01, S02 on DDA in home CFC or MPC services and HH member receiving TANF cash. The Hospice case is under 017 and HCS retains the spouse that is on HCS services. For MPC the start date of the service and the payment authorization date is the same date. No medical program maintained by HCS or DDA. The Kitsap County Developmental Disabilities Program provides a full array of services and supports that enhance the lives of children and adults with developmental disabilities in our community. Client not eligible for a MAGI, S01 or S02 and G03 rules need to be used for eligibility. A slot is approved for the state-funded nursing facility program by ALTSA HQ. This is to allow the community spouse to keep some assets and income necessary to maintain their home without requiring that the couple spend down all their assets to the individual resource limit of $2000. table below. WAC 388-823-0720 What evidence do I need of - Washington HCS must refer applications for MCS/HEN/ABD cash to CSD if a social service authorization date is not known. A person is not eligible for home and community based (HCB) waiver services if the person: Is subject to a penalty period of ineligibility for the transfer of an asset under WAC, Has a home with equity in excess of the requirements under WAC, Current income and resource standard charts are found at. Reduced fees through the Washington Department of Fish and Wildlife. Documents that support that you have a developmental disability, as described in DSHS Form 14-459 Eligible Conditions Specific to Age and Type of Evidence such as: Educational records Psychological records Medical records Send completed forms and documents to the mailing address on the back of the Request form or use the email addresses below. Note: HCS can only authorize services for a MCS client in a NF or in an alternate living facility under state residential services. CSD maintains MCS for persons not on HCS or DDA services. The HCS SW must authorize all nursing facility admissions before a nursing home award letter can be issued. DSHS DDA Waiver Services: What services are available, how to find providers, and more. Enrollment next steps Transportation services (nonemergency) Apple Health client booklets The HCS financial worker will set a tickler for 90 days to check the status. In addition this unit does: All HWD cases with the exception of HWD clients on HCS services. The Medical Care Services (MCS) program includes a chart to indicate which specific agency is responsible to determine financial eligibility for each medical program. Mental health clients receiving residential services paid for by Mental Health / Behavioral Health Organization (MH/BHO) in an ARTF. The financial eligibility for MPC is eligibility for a "noninstitutional" CN Medicaid program. Institutional status is described under WAC 182-513-1320. HBE manages the MAGI coverage. (Section 1924 of the Social Security Act). Once an individual is eligible to receive Medicare, the case is redetermined from the MAGI program to a ABD Classic Medicaid program. All applications for ABD/HEN/MCS for clients not in a nursing facility or a HCS social service imminent placement into an alternate living facility must go through CSD to complete an incapacity, duration and disability determination. ABD medical cases when no HH member is receiving DDA or HCS services including hospital applications under S track medical programs. May be on HCS or DDA MPC or CFC services. View our announcement for more information. (See applications for nursing facility care on the bottom of this clarifying page). 1619(b) clients are considered the same as an "SSI client". Some clients receive Hospice index services in addition to or instead of services in their home or a medical facility. Out-of-pocket medical expenses can be allowed as a deduction in post eligibility (another term for this is determining the client total responsibility toward the cost of care, or participation). (also called participation). Transitional Food Assistance (TFA) is 5 months of continuous eligibility once TANF cash is closed. You may still be eligible. Applicant or representative submits application forms and required evidence Request for DDA Eligibility Determination(14-151) Consent(14-012) Notice of Privacy Practices for Client Confidential Information(03-387) Eligible Conditions Specific to Age and Type of Evidence(14-459) CSD maintains TANF cash and Food. Individual regions may choose to keep these cases or transfer them out to CSD. AEM does not cover LTSS services. This chapter describes the general and financial eligibility requirements for categorically needy (CN) home and community based (HCB) waivers authorized by thedevelopmental disabilitiesadministration (DDA). 1. The Developmental Disabilities Guiding Values encompasses our vision and values for inclusive communities. The RHCs are federally certified as Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/ID), Nursing Facilities (NF) or a combination of both. The Developmental Disabilities Endowment Trust Fund. DDA case managers use the DSHS 15-345 DDA Communication in barcode. AFH/Meaningful Day Prog ram Manager . Transitional Food Assistance (TFA) is 5 months of continuous eligibility once TANF cash is closed. If RCL is authorized by a DDA CRM, the LTC specialty unit will determine eligibility, unless the client is active on CN or ABP. MPC is authorized by Home and Community Services (HCS) and Developmental Disabilities (DDA) administrations. Please contact Lori Rolley at HCS HQ, as HCA will need to adjust the provider payment. Eligibility | DSHS - Washington State Department of Social and Health In order to be considered for medical under MAGI methodology, you can't be on Medicare. DDA specialty unit maintains cases for people receiving DDA services in both in-home and residential settings and their food benefits. The other spouse is not on institutional medical, but is applying for an ABD medicalprogram HCS is responsible for the application and maintenance of the community spouse's application for ABD medical. Medicaid Personal Care (MPC) provides in-home services to assist with daily needs, such as bathing, toileting, cooking and eating. MSP when no HCS or DDA services are attached are managed by CSD. They DO pay room and board in an ALF. Noninstitutional Medicaid does not have a "post eligibility" component, therefore individuals living in the community on noninstitutional Medicaid do not "participate" toward the cost of their personal care. Children's Health Insurance Program (CHIP) N13/N33, Overview: long-term services and supports program administration chart, Community Options Program Entry System (COPES) authorized by HCS. Region 1 and 3 HCS must have a duration determination by CSD for ABD cash. TANF cash and Basic Food maintained by CSD. Developmental Disabilities Administration (DDA) (Internet site), Information on DDA Waiver programs.182-512-0150182-512-0050. See Working clients and long-term care programs (Waiver, Residing in a medical institution, or MPC). DDA will send a notice 6 months prior to your child turning 4. Families of program participants . 1619(b) is described in WAC182-508-0001 (2). Apple Health for Workers with Disabilities (HWD) Family Planning Only (FPO) Medically Intensive Children's Program (MICP) Veterans & family members Parents & caretakers Age 65 & older, or Medicare eligible Aged, blind, or disabled Long-term care & hospice American Indians & Alaska Natives All clients approved for DDA Home and Community Based (HCB) waivers or HCS Home and Community based (HCB) waiversWaiver services, Hospice services or in a medical institution 30 days or more have attained institutional status and are considered to be institutionalized as described in Medicaid law and the regulations used to implement these programs. This rate for the purpose of the G03 program is called the individual's total responsibility. Post-eligibility treatment of income rules do apply if a client is eligible under subsection (1)(c) of this section. HCS maintains all ABD medical, MSP, ABD cash or food benefits for clients on HCS services. The exception is when the service is for a DDA minor child and the parent is HOH for the food benefits. Need the level of care provided in an intermediate care facility for the intellectually disabled (ICF/ID); Have attained institutional statusunder WAC. Shared case. HCB Waiver and institutional under the L trackis always maintained by HCS or DDA Specialty Unit financial workers. HCS services either in home or in an alternate living facility. If the NF/HCC hospice admission is less than 30 days, the short stay screen is used to issue the NF/HCC hospice award letter and the case remains a L21/L22. HCS does not maintain L track/SSI related cases for minor children on DDA services. No TANF cash attached. Developmental Disabilities Administration (DDA) | DSHS HCSmaintains hospice admissions into a SNF less than 30 days. Please report broken links or content problems. Long Term services and supports Personal Needs Allowance (PNA) chart, Lump sums income and Long Term Services and Supports (LTSS), Standards - Long-term care (LTC) Long Term Services and Supports (LTSS) and PNA amounts, Overview - Long Term Services and Supports chart for responsibilities and program administration, Working clients on long-term services and supports, Developmental Disabilities Administration (DDA), Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. If discharge date is unknown or anticipated to be longer than six months, the case will be transferred to HCS for ongoing maintenance. Parent A is on CFC L51 authorized by DDA. S01 or S02 cases on CFC or MPC maintained by the DDA LTC specialty unit. Clients on MCS or ABD cash on DDA services are maintained by the DDA LTC specialty unit. Shared case. Brochures. Denied coverage? CSD maintains TANF cash and food. Staff will need to contact the HCA MEDS unit to update the AEM approval coding on the ALAS screen to reflect the institutional placement. NF admits for clients who receive DDA services. No TANF cash. Medicaid Personal Care | Washington State Health Care Authority TIP: DDA requires a re-determination of eligibility at age 4, so you will need to re-apply for DDA services before that happens. N track medical under MAGI is always maintained by the Health Benefit Exchange (HBE). (The spouse of an LTC applicant who is not applying for or receiving LTC services). SDX indicates continue Medicaid on SDX 1 in the Med Elig field. HCS maintains ABD medical cases when a HH member is receiving HCS services or an ABD medicalclient residingin a NF 30 days or more. This is a reprint of the official rule as published by the Office of the Code Reviser. Attention Deficit Disorder Association Autism Internet Modules (AIM) Autism Outreach Project Autism Project - WA Department of Health Autism Research at the National Institute of Child Health and Human Development (NICHD) Reports. Hospital applications. They DO pay room and board if residing in an adult family home, boarding home or DDA group home. AEM programs do not cover Medicaid Personal Care (MPC) services. Hospice program rules because a client is in a Nursing facility or Hospice Care Center 30 days or more and client is not eligible under MAGI. Eligibility for the L22 program must be done through the DDA/HCS financial worker. Indicate M for MPC service in ACES under the HCB type field. The exception is individuals receiving medical under the G03 program. This is called the post eligibility process. Roads to Community Living (RCL) Not a Waiver, but uses waiver rules for eligibility if a client is not eligible for another CN or ABP program. This category also describes the rules and procedures used to determine aperson's eligibility for noninstitutional medical assistance provided in an ALF. (DDA) Eligibility Determination Activity To apply for a determination of eligibility by the Developmental Disability Administration (DDA), you must fill out . TANF cash and basic food is maintained by CSD. CSD manages the food benefits for the HH when there is a DDA minor child in the household. The medical authorizing HCS/DDA MPC or NF services are in the N track, which is maintained by the HBE. Eligibility overview Parents & caretakers Age 65 & older, or Medicare eligible Aged, blind, or disabled Long-term care & hospice Learn about my coverage American Indians & Alaska Natives Patient review & coordination How do I use my coverage? Eligibility for these coverage groups is determined by the Health Benefit Exchange through the Washington Healthplanfinder portal. (N21*, N25*), SL Track (L01, L02, L95, L21, L22) on DDA services and HH member receiving TANF/SFA cash and food. Its very important to request the services you need, so that you can be contacted when theres an opening for that program or service. How to Apply To apply for a determination of DDA eligibility, visit the Washington State Department of Social and Health Services website where you will find detailed instructions and the forms you need in the Eligibility Application Packet. Additional affordable housing options L Track (L01, L02, L95, L21, L22) on DDA services and HH member receiving TANF/SFA cash and food. No medical program maintained by HCS or DDA. If you call for an application, some information will be taken over the phone. DDA Eligibility and Services Guide: 07/21/2021: DDA Out-of-Home Services FAQ: Created Date: 12/13/2022 2:04:27 PM . Classic Medicaid are programs for individuals that are aged, blind or disabled (ABD). Hospice agencies must send notices within 5 business days of election. Individuals must meet the functional criteria based on the social service assessment and financial eligibility based on eligibility for a noninstitutional CN or ABP Medicaid program. If RCL is authorized by a HCS social worker, the HCS financial worker will determine eligibility, unless the client is active on CN or ABP. SSI deemed eligible clients (countable income is under the SSI standard after DAC, Pickle/COLA exclusion and SSI closed due to the receipt of DAC, COLA) do not pay toward the cost of personal care. Children's Intensive In-home Behavioral Support (CIIBS) authorized by DDA. All childcare is managed through CSD. TANF and associated food managed by CSD, SSI related: S01, S02, S95, S99, not on HCS or DDA services Food benefits, either alone or with an active N track medical. Do not ignore this reminder! DDA Eligibility Determinations 7,749 9,040 9,697 11,033 last 5 . A NFLOC determination is not needed when a client enters a NF and is active on a HCB Waiver under a L21 or L22. (ABD medical MAC/MPC or CFC or DDA Waiver). HCS maintains the foodbenefits for the couple. Client is active on N25 AEM medical in a hospital setting requiring discharge to a nursing home. You may still be eligible. HCS processes food benefits or ABD cash for persons on ABD medical or MCS medical and on HCS services. If not, redetermine coverage under appropriate program (MAGI or classic). For behavioral health placements or MPC in an ALF, the ACES program is a G03. Applying for DDA Services in Washington State - Informing Families Institutional rules are used for Hospice clients residing in a medical institution 30 days or more. The entire household is on basic food. Room and board is a term that refers to a client's responsibility toward food and shelter in an alternate living facility (ALF). MPC clients are not considered institutionalized. Medicaid personal care (MPC) is a state-plan benefit available to a client who is determined: Functionally eligible for MPC services under WAC. Eligibility for K track programs is determined by HCA. HWD on HCS services. DSHS and HCA forms, WACs, Rule Making and Useful Links, HCA Program standard for income and resources. DDA LTC specialty unit maintains all HWD cases not on HCS services. ABD medical hospital applications go through CSD unless there is a known NF or ALF placement date. Contact . Age Three and Older: Request a determination of eligibility. A key difference for an institutionalized person is that eligibility is determined using only that person's income, and not the income of their spouse or children. Rule: No TANF cash, and on HCS services via ABD medical or MCS 14-084 referral to CSD Incapacity/SSI facilitator is required for ABD cash request in R1 and R3 HCS. Developmental Disabilities Administration - SOAR Behavior Services D02/D26 Foster Care cases remain with 076 until they age out, usually at age 26. This is because the standard that is used to make them eligible for a CN program has been raised based on having to pay all of their countable income minus the PNA to the provider. If there are previous versions of this rule, they can be found using the Legislative Search page. HCS maintains both cases when one spouse is on HCS services and the other spouse is on a DDA services. MPC services may be provided to a client residing at home, in a department-contracted adult family home (AFH), or in a licensed assisted living facility that is contracted with the department to provide adult residential care services. HCS retains case during hospitalization unless notified by Sandy Spiegelberg that no slot is being held for HCS services in the community or nursing home. If DDA waiver services are closed by DDA, DDA must inform the financial worker via the DSHS 15-345 in barcode. How do I notify SEBB that my loved one has passed away? Social service specialists and case managers must consult financial service staff prior to switching a MPC case to a waiver case to make sure the individual is eligible under waiver rules. . Please report broken links or content problems. Not every client receiving DAC income is eligible for this exclusion. If countable income is over the SSI standard after the exclusion then all income is counted in post eligibility in determining service participation for DDA Waiver clients living in an ALF. The exception to this is HWD (S08), BHO placements in residential (G03), institutional children (K track) and Hospice where L track is needed for eligibility. Clients continue to receive CN Medicaid as long as they meet resource criteria. Institutional medicaid rules must be used for clients who live in a medical facility for 30 days or more. AEM must be preapproved by HCA. DDA LTC specialty unit determines behavior health admissions into an ARTF if eligibility rules under the G03 program are needed for eligibility because the client is not eligible for another CN, ABP, MN program. LTC programs are managed by both Home and Community Services (HCS) staff and by financial staff in the DDA/LTC specialty unit. In January 2014, under the Medicaid expansion, single adults and parents with income at or below 138% FPL will also be eligible for health care coverage using MAGI methodologies. A client who resides in an alternate living facility (ALF) listed in subsection (2) of this section: Keeps a personal needs allowance (PNA) under WAC, Pays room and board up to theroom and board standard under WAC, A client who receives MPC services under the health care for workers with disabilities (HWD) program under chapter, A clientmay have to pay third-party resources as defined under WAC, Current PNA and room and board standards are found at, Foster care medical authorized and maintained by the Health Care Authority. HH members on N track medical LTC L track cases (L01, L02, L95, L21, L22, L04, L24) on HCS services and HH member receiving TANF/SFA cash and food. View our announcement for more information. These exclusions are described in the Overview chapter. The financial worker is responsible to determine the financial eligibility for Classic Medicaid. A client on HCB waiver services does not pay more than the state rate for cost of care.