MR #14.27: Transitioning Medically Fragile Technology Dependent (MFTD) Waiver Cases to Central Office 238

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services


 


 

10/16/2014


Summary: 

  • Medical cases for children approved for the Medically Fragile Technology Dependent (MFTD) waiver are approved and managed by Central Office (CO) 238, which is part of the Bureau of Local Office Transactions and Support Services (LOTS).
  • Beginning 10/15/14, CO 238 will delete a child who is currently included on a medical case in the Family Community Resource Center (FCRC), and open a medical case in CO 238. There will be no break in eligibility.
  • Children who are active in DCFS and TANF cases will remain in those cases, and will not have a separate medical case in CO 238.  
  • CO 238 will maintain MFTD coding on the adult caregiver's TANF case at the FCRC.
  • The Home and Community Based Care (HCBC) waiver is now referred to as the MFTD waiver. Manual terminology is revised.
  • CO 238 serves as the Department liaison with the Division of Specialized Care for Children (DSCC), and the HFS Bureau of Professional and Ancillary Services (BPAS) for children who are applying for or receiving services through the MFTD Waiver Program.
  • To receive services through the MFTD Waiver Program, the child must be determined disabled as defined by the Social Security Administration.
  • Family and nurse training is added to the list of MFTD Waiver Program services.
  • Refer customers who wish to apply for the MFTD waiver to DSCC. DSCC's toll-free number is 1-800-322-3722.

  1. The Medically Fragile Technology Dependent (MFTD) Waiver Program
    1. Inter-Agency Coordination and Roles
  2. CENTRAL OFFICE 238 MFTD WAIVER RESPONSIBILITIES
    1. Pending MFTD Waiver
    2. Denied MFTD Waiver
    3. Approved MFTD Waiver
    4. Terminated MFTD Waiver
  3. Central Office 238 Contact Information
  4. FCRC MFTD WAIVER RESPONSIBILTIES
    1. Referring Families to the MFTD Waiver Program
    2. Special TANF Policy for MFTD Waivers
      1. Pending waiver
      2. Active waiver
      3. Terminated waiver
    3. MANUAL REVISIONS

The Medically Fragile Technology Dependent (MFTD) Waiver Program

Medical cases for children approved for the Medically Fragile Technology Dependent (MFTD) waiver are approved and managed by Central Office (CO) 238, which is part of the Bureau of Local Office Transactions and Support Services (LOTS).

Beginning 10/01/14, CO 238 will delete a child who is currently included on a medical case in the Family Community Resource Center (FCRC), and open a medical case in CO 238 without a break in eligibility. Children who are active in DCFS and TANF cases will remain in those cases, and will not have a separate medical case in CO 238. However, CO 238 will maintain MFTD coding on the adult caregiver's TANF case at the FCRC.

The MFTD Waiver Program prevents persons under age 21 who may be satisfactorily treated at home at less cost to the State, from being institutionalized. The program is administered under a Federal waiver that allows the State to waive the income and assets of the child's parent(s) when determining eligibility, and to provide services which are not normally allowed under Medicaid. (Manual reference: PM 06-11-01

Most MFTD children receive in-home skilled nursing. Family and nurse training is added to the manual as a waiver service which is not available under regular Medicaid.

To receive waiver services, the child must:

  1. be determined eligible for Medicaid except for consideration of parental income; and
  2. be determined at risk of institutionalization due to his or her medical condition, and
  3. be determined disabled according to SSA standards.

A noncitizen child who does not meet immigration status for federal Medicaid is ineligible for the MFTD waiver.

The Home and Community Based Care (HCBC) waiver is now referred to as the MFTD waiver. Terminology is revised with this manual release.

For information on other Illinois waiver programs, see Home and Community Based Services Waiver Programs.

Inter-Agency Coordination and Roles

HFS and DHS work with the University of Illinois at Chicago's Division of Specialized Care for Children (DSCC) to coordinate the MFTD waiver. Agency roles are as follows:

  • DSCC accepts applications for the MFTD waiver and provides case management services.
  • The HFS Bureau of Professional and Ancillary Services (BPAS) determines if the child is at risk of institutionalization due to his or her medical condition.
  • The DHS Bureau of Local Office Transactions and Support Services (LOTS) Central Office 238 determines Medicaid eligibility and ensures that the child has been determined disabled according to SSA standards.

CENTRAL OFFICE 238 MFTD WAIVER RESPONSIBILITIES

To provide better service to the families of MFTD waiver children, and to relieve FCRC workload, Central Office 238 processes medical applications and maintains medical cases for children approved for the MFTD waiver. CO 238 serves as the Department liaison with DSCC, and with the HFS Bureau of Professional and Ancillary Services (BPAS). With the exception of children who receive TANF, or have active DCFS cases, medical cases for MFTD waiver children are to be maintained in CO 238.  

Pending MFTD Waiver

  1. DSCC sends "General Information for a Waiver Application" to CO 238 to notify the Department that a MFTD waiver is pending for a child.
  2. CO 238 notifies DSCC whether or not the child is already active for medical assistance.
  3. If the child does not have a medical case, DSCC provides a signed medical application, or confirmation that the family has applied through ABE to CO 238.
  4. If the child is not receiving SSI or SSA based on disability, CO 238 completes a referral to the Client Assessment Unit (CAU) with medical documents provided by DSCC.
  5. CO 238 notifies HFS BPAS if all Medicaid eligibility factors are met except for consideration of parental income.
  6. If the child's parent has an active or pending TANF case, CO 238 notifies the FCRC that a MFTD waiver is pending.

Denied MFTD Waiver

  1. CO 238 denies the medical application if the child:
    • does not meet nonfinancial requirements for medical assistance; or
    • is financially ineligible due to their own income.
  2. CO 238 denies the waiver application if:
    • the child's medical application is denied for the above reasons; or 
    • does not meet federal Medicaid immigration status; or 
    • is not considered disabled according to SSA standards.
  3. HFS BPAS denies the waiver application when it determines the child is not at risk for institutionalization due to their medical condition.
  4. If ineligible for the waiver, CO 238 determines medical eligibility according to regular Medicaid financial policy (considers parental income). If ineligible for medical assistance, CO 238 denies the medical application. If eligible, the application is approved and transferred to the FCRC.  

Approved MFTD Waiver

  1. When HFS BPAS notifies CO 238 that a child has been determined medically eligible for the MFTD waiver, CO 238;
    1. processes the child's medical application if it is pending in CO 238; or
    2. removes child from a medical assistance case at the FCRC, and sets up a new CO 238 case for child, unless the child is in an active TANF or DCFS case;
  2. Adds child back to FCRC SNAP unit if deleted from medical/SNAP case;
  3. Adds Item 80 Code 335 and Item 90 Code 540 to CO 238 case;
  4. Adds Item 80 Code 331, which stops the 60 month counter, to the TANF case of an adult who is caring for a child approved for the MFTD waiver, adjusts the TANF counter(s) if needed, sends YOUR TANF TIME LIMIT (Form 4335), and enters code 4 in Item 73 for the first adult in the TANF case;
  5. Adds Item 80 Code 331 as an informational code to a waiver child's TANF child-only case;
  6. Notifies FCRC administrator via email of any action taken on a case at their office; and
  7. Completes annual redeterminations of medical eligibility for the child's case under CO 238.

Terminated MFTD Waiver

  1. DSCC notifies CO 238 when a child no longer qualifies for waiver services. 
  2. If the child has died or has moved out of state, CO 238 cancels the child's medical assistance, and takes action for the child on cases maintained at the FCRC. Office 238 notifies the FCRC if the child is deleted from a SNAP household, or when a TANF child-only case is canceled.
  3. If the child has moved out of state, Office 238 notifies the FCRC if follow up action may be needed on a related family case.
  4. When a child is determined no longer eligible for the MFTD waiver, CO 238 determines eligibility for regular medical assistance using regular Medicaid policy. If financially ineligible, the CO 238 case is canceled. If eligible, the case is transferred to the appropriate FCRC.
  5. CO 238 removes Item 80 Code 331 from the child's and/or parent's TANF case, sends Form 4335 to the customer, and notifies the FCRC administrator.

Central Office 238 Contact Information

phone: (217) 524-4412
fax: (217) 785-8113
address: CO 238
LOTS, Harris II, 2nd Fl
100 S Grand Ave, East
Springfield, Il  62762

FCRC MFTD WAIVER RESPONSIBILTIES

Do not take any action to affect a child's medical eligibility under CO 238 unless requested to do so by CO 238.

If a family indicates their child is receiving services through the MFTD waiver, or has applied for the waiver through DSCC, check for a pending or active CO 238 case. If none found, or for more information, contact CO 238.

Referring Families to the MFTD Waiver Program

When the FCRC learns of a child who may be eligible for services through the MFTD waiver program, provide the customer with DSCC's toll free number: 1-800-322-3722. If DSCC finds that the child is potentially eligible for the MFTD waiver, DSCC contacts CO 238.

Special TANF Policy for MFTD Waivers

  1. A TANF applicant or customer automatically has a barrier to participation in work, training, or other self-sufficiency activities when they have a child living with them who is approved under the MFTD waiver program. A CAU family care barrier determination is not required. PM 21-01-04-b
  2. Item 80 Code 331 stops the 60 month counter for all adults in the case when they are caring for a child approved for the waiver. PM 03-06-01-e 
  3. An adult who has received 60 months of TANF may request an exception to the 60 month limit if they are caring for a child approved for the MFTD waiver.  PM 03-06-05-a.

Pending waiver

An applicant or client may request a barrier to participation in work, training, and other self-sufficiency activities based on having a child who might be eligible as a MFTD waiver child. Do not require participation in work, training, or other self-sufficiency activities while a request for a waiver determination is pending or is under appeal.

Active waiver

Revise the RSP to indicate care of MFTD waiver child. A person who has a waiver child may volunteer to participate in work, training, or other self-sufficiency activities, but do not require them to do so. If they volunteer, their participation does not override or negate the barrier.

Notify CO 238 when a waiver child loses eligibility for TANF. CO 238 will determine continuing eligibility for medical assistance in a CO 238 case.   

Terminated waiver

Review the customer's RSP. Include work and training or other self-sufficiency activities if no other barriers exist. Allow the customer the opportunity to request a family care barrier, as a child who no longer requires nursing and technology for survival may still have chronic health issues. Code Item 73 as appropriate.

MANUAL REVISIONS

[signed copy on file]

Michelle R.B. Saddler

Secretary, Illinois Department of Human Services

Julie Hamos

Director, Illinois Department of HealthCare and Family Services