Services to Individuals with Disabilities / Chronic Illness

Minnesotans with disabilities or chronic illnesses who need certain levels of care may qualify for the Minnesota home and community-based waiver programs. A MnCHOICES  Assessment is required to access the Home and community-based waiver programs. If eligibility requriments are met, the waiver programs available include:

Community Alternative Care (CAC) Waiver:
This waiver is for chronically ill and/or medically fragile persons who need the level of care provided in a hospital.  To be eligible for the CAC Waiver, a person must choose the CAC Waiver and meet all of the following criteria:

  • Be eligible for Medical Assistance (MA)
  • Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process
  • Be under the age of 65 years at the time of opening to the waiver
  • Be determined by the case manager/service coordinator to need hospital level of care
  • Be certified by the primary physician to meet the level of care provided in a hospital
  • Has an assessed need for supports and services over and above those available through the MA State Plan

Hospital Level of Care Criteria:
A person must meet all four of the following:

  • Need skilled assessment and intervention multiple times during a 24 hour period to maintain health and prevent deterioration
  • Due to their health condition, has both predictable health needs and the potential for status changes that could lead to rapid deterioration or life threatening episodes
  • Require a 24 hour plan of care that includes a back up plan that reasonably assures health and safety in the community
  • Without the provision of services under the CAC waiver, would require frequent or continuous care in a hospital

Available Services:

  • Case Management
  • Case Management Aide
  • Consumer Directed Community Supports (CDCS)
  • Extended Home Care Services
  • Family Counseling and Training
  • Foster Care
  • Homemaker
  • Modifications and Adaptations
  • Nutritional Therapy
  • Prescription Drugs (no longer a covered service)
  • Respite
  • Specialized Supplies and Equipment
  • Transportation
  • Transitional Services

Community Access for Disability Inclusion (CADI) Waiver:
This waiver is for people with disabilities who require the level of care provided in a nursing facility.  To be eligible for the CADI waiver, a person must choose the CADI Waiver and meet all of the following criteria:

  • Be eligible for Medical Assistance (MA)
  • Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process
  • Be under the age of 65 years at the time of opening to the waiver
  • Be found to need level of care provided at the nursing facility level
  • Has an assessed need for supports and services over and above those available through the MA State Plan

Nursing Facility Level of Care Criteria:
To meet the requirements for a Nursing Facility Level of Care through assessment of need at levels established by Minnesota Statute, 144.0724, Subdivision 11.

Available Services:

  • Adult Day Care/Adult Day Care Bath
  • Assisted Living
  • Assisted Living Plus
  • Case Management
  • Case Management Aide
  • Consumer Directed Community Supports (CDCS)
  • Extended Home Care Services
  • Family Training, Education, and Counseling
  • Foster Care
  • Home Delivered Meal
  • Homemaker
  • Independent Living Skills (ILS)
  • Modifications and Adaptations
  • Prevocational Services
  • Residential Care Services
  • Respite
  • Specialized Equipment and Supplies
  • Supported Employment Services
  • Transportation
  • Transitional Services

Brain Injury (BI) Waiver:
This waiver is for people with traumatic or acquired brain injuries who need the level of care provided in a nursing facility that provides specialized services for persons with a BI or a neurobehavioral hospital.  To be eligible for the BI Waiver, a person must choose the BI Waiver and meet all of the following criteria:

  • Be eligible for Medical Assistance (MA)
  • Be certified disabled by Social Security or through the State Medical Review Team (SMRT) process
  • Be under the age of 65  at the time of opening to the waiver
  • Be diagnosed with one of the following documented primary or secondary diagnoses of brain injury or a related neurological condition that resulted in significant cognitive and significant behavioral impairment:
    • Acquired brain injury including traumatic brain injury that is not congenital
    • Degenerative or genetic disease where cognitive impairment is present, becomes symptomatic on or after the person’s 18th birthday, and is not congenital
    • Documented brain impairment from an event, disease, or condition that is not congenital
  • Be able to function at a level that allows participation in rehabilitation
  • Be in need of a service that is only available through the TBI Waiver or requires a higher level of service than is available through the other waivers due to cognitive and behavior impairments
  • Meet one of the following:
    • Nursing Facility Level of Care criteria for  Brain Injury-Nursing Facility (BI-NF) or
    • Neurobehavioral Hospital Level of Care criteria for Brain Injury-Neurobehavioral (BI-NB)
  • Have completed a BI Waiver Assessment and Eligibility Determination (DHS-3471)

Available Services:

  •  Adult Companion Services
  •  Adult Day Care/Adult Day Care Bath
  •  Assisted Living
  •  Assisted Living Plus
  •  Behavioral Programming
  •  Case Management
  •  Case Management Aide
  •  Chore Services
  •  Cognitive Remediation Training
  •  Consumer Directed Community Supports (CDCS)
  •  Extended Home Care Services
  •  Family Training, Education, and Counseling
  •  Foster Care
  •  Home Delivered Meals
  •  Home Health Aide, Extended
  •  Homemaker
  •  Independent Living Skills (ILS)
  •  ILS Therapies
  •  Mental Health
  •  Mental Health Psychological Testing
  •  Modifications and Adaptations
  •  Night Supervision Services
  •  Prevocational Services
  •  Residential Care Services
  •  Respite
  •  Specialized Equipment and Supplies
  •  Structured Day Program
  •  Supported Employment Services
  •  Transitional Services
  •  Transportation

Services authorized under all waiver program plans must help a person avoid institutionalization and/or function with greater independence in the community and meet authorization guidelines set by the federally approved State Waiver Plans.  Waiver services must be within the allowable budget of the county.

Each home and community-based waiver program requires certain questions be asked about services:

  • Are the services necessary to ensure the health, welfare, and safety of the person?
  • Are the services selected by the person an alternative to institutionalization?
  • Is the service covered by any other funding source?
  • Have all options been assessed and does this option meet the individual desires, needs, and preferences of the person?
  • Is the cost of the service considered reasonable and customary?

Consumer Support Grant (CSG):
For individuals who have been assessed by a Public Health Nurse and are determined in need of PCA services and are eligible, the Consumer Support Grant may be a way to allow the family to use those authorized PCA services to arrange for and direct the care of the child.  This would mean the family decides what services or goods they need to assist the child with daily living skills, respite, or other needs.  There needs to be someone in the family who direct the cares for the child.

Family Support Grant (FSG):
The Family Support Grant (FSG) is an effective resource for children with disabilities who live or will live in their family home.  Many families with children with disabilities living at home incur higher than average expenses that are directly related to the child’s disability.

The Family Support Grant provides cash grants to families to offset some of these expenses and gives the families the flexibility to purchase an array of supports and services to meet the child’s needs.  The amount of and number of grants varies by county.  Families wishing to access the program need to complete an application form and provide information to certify the child has been certified disabled, a description of the family’s needs, and other information as needed to determine grant eligibility.

Eligibility:

  • Under 21 years of age; AND
  • Certified disabled;
  • Living in their biological or adoptive family home; OR
  • Residing in a treatment center, ICF/MCR, or other licensed residential service or nursing facility and would return to their family home if the gant were awarded.
  • People who are receiving services through a Home and Community Based Waiver including CAC/CADI/TBI.  People receiving the DD waiver are not eligible for Family Support Grant dollars.

Income Critera: Families with an annual adjusted gross income in 2008 of $88,170 or under are eligible for the Family Support Grant.

Personal Care Assistant (PCA) Services:
Personal Care Assistant Services are provided to assist and support persons with disabilities living independently in the community.  This includes the elderly and others with special health care needs.  PCA services are provided in the recipient’s home or in the community when normal life activities take him/her outside the home. Services may only be provided when:

  • Medically necessary
  • Prior authorized
  • A PCA assessment establishes the need for PCA services
  • A physician has signed the Physician Statement of Need
  • Approved in the recipient’s service plan
  • Documented in the recipient’s PCA care plan
  • Provided by a PCA under the direction of a qualified professional, the recipient, or their responsible party