The PAS/ISSA agency and responsible case manager/Service Facilitator should assist the applicant, guardian or family in completing the forms and compiling the necessary documentation and background information, including the verification of income and assets, to apply for Medicaid and to maintain continuous Medicaid enrollment. The application may either be brought in or mailed to the local DHS Family Community Resource Center (FCRC) office, formerly known as the DPA/DHS local office.
Redetermination of Medicaid Eligibility
The FCRC caseworker conducts redeterminations of Medicaid eligibility annually or as necessary. Responsible case managers or Service Facilitators and individuals are responsible for ensuring that enrollment is reauthorized in a timely manner. Providers may not be paid for covered waiver services during time periods when the individual's Medicaid enrollment lapses.
If necessary, providers are also responsible for completing Notice of DHS Community-Based Services form to document for the DHS FCRC caseworker that the individual initially meets or continues to meet his/her Medicaid spend down obligation.
For individuals who have spenddown obligations, DHS has developed a file transfer process to document a waiver participant's continuing spenddown met status. In most situations, this file transfer takes the place of the Notice of DHS Community-Based Services (HFS-2653) after the first few months of service. The provider is responsible for completing the HFS-2653 in situations when the automated process does not have necessary information.
Redetermination of Waiver Programmatic Eligibility
The Medicaid waiver requires an annual redetermination of individual waiver eligibility by the Individual Service and Support Advocate (ISSA), who is a Qualified Intellectual Disability Professional (QIDP) and is independent of the providers of direct services. The redetermination must include a review of all eligibility factors. The purpose of the review is to verify continued eligibility for the Medicaid waivers and to establish continuing need for an ICF/DD level of service.
The ISSA must document results of the annual redetermination with the Redetermination of Medicaid Adult Waiver Eligibility form. This completed form must be maintained in the Independent Service Coordination agency files, subject to periodic review.
The ISSA must also enter the annual waiver programmatic eligibility (active treatment) determination and date in the Reporting of Community Services (ROCS) software and transmit it to DHS in a timely manner. DHS will reject payment for ISSA services unless an annual re-determination has been transmitted within the past 12 months.
The Individual Service and Support Advocacy (ISSA) Guidelines contain specific guidance on these requirements and process.
The DHS Family Community Resource Center (FCRC) determines Food Stamp eligibility. The responsible case manager or Service Facilitator should assist the applicant, guardian or family in completing the forms and compiling the necessary documentation and background information, including the verification of income, assets, shelter and medical costs, to apply for Food Stamps and to maintain Food Stamp eligibility.
Notifying DHS of Changes in Participant Status
The responsible case manager or Service Facilitator must notify the DHS Division of DD and the DHS Family Community Resource Center (FCRC) of the following changes in the individual's status:
- Change of address: Address changes are done on the client data in ROCS and by telephone/mail to the FCRC.
- Change in Social Security (SSI/SSDI) benefits or other earned or unearned income:
- Benefits and income changes must be done on the client income screen in ROCS and by telephone/mail to the FCRC, no later than five calendar days after the change.
- DHS requires that SSI (SSDI) benefits received by individuals receiving residential services be applied toward the residential costs. Individuals may retain a monthly personal allowance.
- Death: Notification of death must be done on the Service Termination Approval Request form, on the ROCS client data screen in ROCS and by telephone/mail to the FCRC, no later than five calendar days after the change. Deaths must also be reported to the Office of the Inspector General according to their requirements.
The responsible case manager or Service Facilitator must also notify the local Social Security Office of changes in address or earned income, of placement into or from a long-term care facility, including Intermediate Care Facility for Developmental Disabilities (ICFDD), state-operated facility and nursing facility, or death. Notification for individuals who receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits must be made as soon as possible to facilitate necessary updates or adjustments in the amount of the SSI or SSDI benefit.
The Notice of DHS Community-Based Services (HFS 2653 form), may be used to notify the local DHS FCRC of changes in the costs of services, types of services or termination of services that affect the amount that may be applied toward the spenddown obligation. Notification of these changes must be made no later than five calendar days after the change.