Eligibility Guidelines

To qualify for a MA-Waiver program, the services must:

• Be necessary to protect your health and safety
• Help develop or maintain skills you need in your daily life
• Best meet your desires, interests, and needs (after considering all available options)
• Help you avoid institutionalization or help you function with greater independence in the community
• Not be paid for by any other source, including private health coverage, Medicare, standard Medical Assistance (MA), education services, or Vocational Rehabilitation. If you can access the same service offered by a MA-Waiver program elsewhere, you have to access it elsewhere

Who Can Enroll?

The number of people who can enroll in a MA-Waiver program depends upon legislative action and how much funding is available. In some years, there are plenty of slots available for all people who need MA-Waiver services; in some years there are not enough available slots.

Check with your county or tribal human services office for information on program availability in your area.

In addition to the criteria above, each MA-Waiver program has its own specific eligibility requirements which are discussed on the ensuing pages in this section.

Application

The application process for each of the four MA-Waiver programs described in this section is the same.

• Start by reviewing the eligibility criteria for each waiver program to see which one you might qualify for.
• If you are already on disability-based Medical Assistance (MA) or on Medical Assistance for Employed Persons with Disabilities (MA-EPD), you can apply for a MA-Waiver program at your county or tribal human services office. You will need to fill out the appropriate paperwork and schedule a MnCHOICES assessment. Eligibility for all MA-Waiver programs is ultimately determined during the assessment process
• If you are not already on disability-based MA or MA-EPD, you can also apply for any waiver program at your county or tribal human services office. You will need to schedule an assessment/screening and fill out the MHCP Long-Term Care and Waiver Services Application and any other necessary paperwork.

Remember that there may be waiting lists for the waiver program you’re interested in. Be sure to apply as soon as you think you meet the eligibility criteria. The length of waiting lists may vary from program to program and county to county.

If you have questions about applying for a MA-Waiver program, contact your county or tribal human services office or Chat with a Hub expert.

Maintaining Eligibility

The most important thing to remember about maintaining eligibility for MA-Waiver programs is this: You must remain eligible for disability-based Medical Assistance (MA) or for Medical Assistance for Employed Persons with Disabilities (MA-EPD) to maintain eligibility for your MA-Waiver program. If you lose disability-based eligibility for MA or MA-EPD, you'll no longer qualify for your waiver program either.

You must remain eligible for disability-based Medical Assistance (MA) or for Medical Assistance for Employed Persons with Disabilities (MA-EPD) to maintain eligibility for your MA-Waiver program.

Asset Limits

Disability-based MA has a limit on how many assets you’re allowed to own. Disability-based MA has an asset limit of $3,000 for individuals and $6,000 for a couple. You must approve the use of the Account Validation Service (AVS) so that MA can make sure your assets are below the limit.

Your home, the car you drive to work, and a number of other items do not count towards that total. Click here for a listing of all assets that are exempt under standard MA.

Tip: If you’re on MA-EPD, there is no asset limit.

Note: If you are getting disability-based MA and are under 21, you do not have an asset limit. If you are on MA via SSI's 1619b provision, the asset limit is $2,000 for individuals ($3,000 for a couple).

Income Limits

You have to meet the income limits for disability-based MA in order to remain eligible for MA-Waiver programs. The Income limits for MA vary depending upon which type of MA you're using. This list does not include income-based MA, because having that type of MA does not let you get the benefits provided by MA-Waiver programs.

• Disability-Based Medical Assistance (100% FPG): One way you can qualify for MA is to have a disability and have total countable income below 100% of the Federal Poverty Guidelines (FPG). That’s $1,255 per month for individuals and $1,704 for a family of two.
• Medical Assistance with a spenddown: If your countable monthly income is above 100% of FPG, you can pay a monthly spenddown to maintain your disability-based MA coverage. A spenddown is the amount of money you have to pay for health care expenses each month before MA starts to pay for the rest of your health care bills.
• SSI 1619(b): If you’re on MA through Social Security’s 1619(b) provision, you will keep your MA coverage as long as your annual earned income is below $79,483.
• Medical Assistance for Employed Persons with Disabilities (MA-EPD): MA-EPD has no upper income limit though you must be earning more than $65 per month to qualify for the program. Your MA-EPD premium will rise as your income rises, but you’re not at risk of losing MA-EPD eligibility if your income increases.

If you have questions about working and maintaining access to MA, MA-EPD, or MA-Waiver services, Chat with a Hub expert. You can also read the DB101 articles about disability-based MA and MA-EPD.

Other Tips on Maintaining Eligibility

Maintaining your disability-based MA or MA-EPD coverage is essential to maintaining your eligibility for your waiver program.

Here are a few other things you should do to be sure you keep your MA-Waiver services:

• Complete and return all renewal forms and verifications
• Participate in any medical and other assessments, as needed
• Understand how changes in your income or benefits, including Social Security benefits, will affect your eligibility for MA or MA-EPD

Appeals

You may appeal any decision that is made regarding a Minnesota public health care program, including MA-Waiver services, by contacting your county or tribal human services office or writing to the Minnesota Department of Human Services at:

Minnesota Department of Human Services
Appeals and Regulations
P.O. Box 64941
St. Paul, MN 55164-0941

If you have questions about filing an appeal, Chat with a Hub expert.

Community Alternative Care (CAC) Waiver

The CAC Waiver provides funding for MA-Waiver services for adults and children with disabilities. The goal of the program is to make it possible for people with disabilities to live safely in their community rather than in a hospital.

The CAC Waiver is one of Minnesota's smallest MA-Waiver programs, serving 200 – 300 people annually. CAC Waiver services vary depending upon your needs, and can include services such as home nursing, nutritional therapy, and modifications to a home or vehicle.

Eligibility

To qualify for the CAC Waiver, you must meet the eligibility criteria outlined here.

Additionally, your primary care physician and a MnCHOICES assessment must determine that you need a level of care that is typically provided in a hospital. This means that:

• You need skilled intervention several times a day to maintain your health
• You have predictable health needs
• There is some risk of your health status changing quickly and if it were to change, it could lead to a life-threatening situation
• You require a 24-hour plan of care that includes a back-up plan to assure your health and safety, and
• You would require frequent or continuous care in a hospital without CAC Waiver services

Services

To qualify for the CAC Waiver, you must also be enrolled in Medical Assistance (MA), so everyone on the CAC Waiver has access to all services covered under MA. In addition, there are a number of other services that the CAC Waiver covers that MA does not. These services include:

• Case management services
• Consumer-directed community supports (CDCS)
• Employment services, including work Exploration, Development, and Support
• Extended home health aide and nursing services
• Extended home health therapies
• Extended Personal Care Assistant (PCA) services
• Extended transportation services
• Family counseling and training
• Foster care services
• Homemaker services
• Modifications to the home or vehicle
• Nutritional therapy
• Respite care
• Specialized supplies and equipment
• Transitional services

If you have any questions about the CAC Waiver program, Chat with a Hub expert.

The CADI Waiver program provides funding for MA-Waiver services so that adults and children with disabilities can live in the community rather than in a nursing facility.

The CADI Waiver serves about 10,000 people annually and provides a wide range of services including adult day care, homemaker services, independent living services, and home delivered meals.

Eligibility

To qualify for the CADI Waiver, you must meet the eligibility criteria outlined here.

Additionally, a MnCHOICES assessment must determine that you need the level of care typically provided in a nursing facility. This means that you need additional assistance for at least one of the following:

• Complex care management
• A functional limitation
• Complicating conditions
• A cognitive or behavioral condition
• Unstable health, frailty, or vulnerability, or
• Rehabilitation or some other special treatment

Services

As with other MA-Waiver programs, all CADI Waiver enrollees are also enrolled in Medical Assistance (MA) and have access to all services covered under MA. In addition, there are a number of other services available to people on the CADI Waiver.

If you have questions about the CADI Waiver program, Chat with a Hub expert.

The DD Waiver program provides services to people with a documented developmental disability or related condition.

The DD Waiver enables adults and children with developmental disabilities to live in the community rather in an Intermediate care facility for persons with developmental disabilities (ICF/DD). The DD Waiver serves about 14,000 people per year.

To qualify, you must meet the eligibility criteria outlined here. Additionally, a MnCHOICES assessment must determine that you need the level of care typically provided in an ICF/DD and you must have documented diagnosis of a developmental disability.

For more information on MnCHOICES, contact your county or tribal human services office or Chat with a Hub expert.

Services

DD Waiver enrollees have access to all services covered under Medical Assistance (MA), as well as a number of additional services that help the live in the community.

If you have questions about the DD Waiver program, Chat with a Hub expert.

The BI Waiver program provides services to people with a brain injury.

As with all other MA-Waiver programs, you must meet the eligibility outlined here to qualify for the BI Waiver program. In addition:

• You must have a diagnosed brain injury or related condition that results in significant cognitive and behavioral impairment
• You must need a higher level of service than is available through any other MA-Waiver program
• You must be able to function well enough to participate in rehabilitation activities, and
• A MnCHOICES assessment must determine that you need the level of care normally provided in a nursing facility or neurobehavioral hospital

Services

More than 1,000 people receive BI Waiver services each year. BI Waiver enrollees have access to all services covered under Medical Assistance (MA), as well as numerous additional services.

If you have any questions about the BI Waiver program, Chat with a Hub expert.

Working and MA-Waiver Programs

One of the keys to keeping access to MA-Waiver services is to stay eligible for disability-based Medical Assistance (MA) or Medical Assistance for Employed Persons with Disabilities (MA-EPD). If you work and your countable monthly income rises above 100% of the Federal Poverty Guidelines ($1,255 per month for an individual, $1,704 for a family of two), there's a chance you could lose your disability-based MA coverage (and your MA-Waiver services as a result).

MA-Waiver Services and Other Disability Benefit Programs

Many people with disabilities are on more than one disability benefit program at the same time. For example, many people who get Supplemental Security Income (SSI) are also on Medical Assistance (MA). Many people who get Social Security Disability Insurance (SSDI) benefits are also on Medicare.

There are no laws that prevent you from getting services from a MA-Waiver program and other disability benefit programs at the same time. Changes in your Medicare, Minnesota Supplemental Aid (MSA), or Supplemental Nutrition Assistance Program (SNAP) benefits, for example, will not affect your eligibility for a MA-Waiver program unless those changes affect your eligibility for MA or MA-EPD. If you lose your disability-based MA or MA-EPD, you will lose your MA-Waiver services.

As soon as something impacts your eligibility for disability-based MA or MA-EPD though, it can affect your eligibility for MA-Waiver services. If you lose your disability-based MA or MA-EPD coverage, you will also lose your MA-Waiver services.

Bearing that in mind, here are some things that could affect your eligibility for MA and MA-EPD:

• Losing your SSI or MSA: If you’re on SSI or MSA, you will qualify for disability-based MA if you apply for it. If you lose your SSI or MSA though, you may lose your MA coverage as well (and your MA-Waiver services, by extension)
• An Increase in Assets: If your assets suddenly go up, you may lose your disability-based MA and MA-Waiver coverage
• Medical Redetermination: If Social Security or the State Medical Review Team (SMRT) determines that you are no longer disabled, you would lose your disability-based MA and MA-Waiver coverage. This is known as medical redetermination.

If you have any questions about how to keep your MA-Waiver coverage, Chat with a Hub expert.

Eric's Story

Eric has multiple sclerosis. He’s been living on his own for most of his adult life and has always valued his independence. In recent months, Eric’s health has worsened. He has a hard time cooking for himself and the nursing services he receives under his Medical Assistance (MA) plan are not extensive enough to meet his needs. He’s also having a hard time with daily tasks like bathing and cleaning his apartment.

Several friends have recommended he consider moving into a nursing facility, but Eric does not want to do that. He starts searching the Internet to see if he can come up with an alternative. That’s when he read about Minnesota’s MA-Waiver programs. MA-Waiver programs are available to certain MA and Medical Assistance for Employed Persons with Disabilities (MA-EPD) enrollees, and are designed to help people live in the community rather than in an institution.

“This is good,” Eric thinks to himself. “I may be on to something here.”

Eric's Options

The CADI Waiver provides services for people who want to live in the community who would otherwise have to live in a nursing facility.

Eric reads up on several different MA-Waiver programs. There’s one that serves people with traumatic brain injuries (the BI Waiver) and another that serves people with developmental disabilities (the DD Waiver). Those aren’t for him. Then he starts reading about the Community Access for Disability Inclusion (CADI) Waiver. It provides services for people who want to live in the community who would otherwise have to live in a nursing facility. And it provides all the services he needs including extended nursing services, homemaker services, home delivered meals, and assisted living services.

The Application Process

Eric goes down to his county or tribal human services office the next morning to get more information on MA-Waiver programs and to apply. In addition to filling out an application, he schedules a MnCHOICES assessment for two weeks later, where he'll be screened for MA-Waiver programs.

When Eric returns for his screening, he meets with John, a social worker, and Kimberly, a public health nurse. Together, the two handle the assessment. John and Kimberly ask Eric a series of questions to help assess whether he can live safely in the community, with the support of MA-Waiver services, rather than in a nursing facility. They also ask him questions to determine what types of MA-Waiver services he’d need.

Ultimately, Eric is approved for the CADI program. He is ecstatic. He and a social worker draft an individual plan of care that outlines the CADI Waiver services Eric will need. Then they review the things Eric will need to do to retain his MA-Waiver services.

First and foremost, he must retain his disability-based eligibility for MA. Without MA, he can’t receive MA-Waiver services. This means Eric needs to keep his assets below the disability-based MA asset limit ($3,000). Further, he needs to keep his countable monthly income below 100% of the Federal Poverty Guidelines ($1,255). There are actually ways he could earn more money and keep his MA, but the social worker doesn’t want to get into that with Eric at the moment. If his income increases, Eric will Chat with a Hub expert about how he can keep his MA coverage.

Eric also needs to be sure and stay of top of things. This means filling out renewal forms on time, participating in any assessments that are requested, and following any guidelines laid out in his individual plan of care.

Eric is thrilled. He’s going to be able to stay in his community and continue to live independently with the supports he needs. The CADI Waiver program is an ideal fit for Eric.