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DDA Home and Community Based (HCB) waivers
January 2, 2014
Purpose: Determining Medicaid eligibility and client responsibility for cost of care for clients functionally eligible for a Developmental Disabilities Administration (DDA) Waiver program.
- Follow procedures in General eligibility for Long-Term Care to establish financial eligibility.
- This section from the main long-term care index links to the following eligibility requirements for DDA Waivers:
- Transfer of assets
- Available resources
- How annuities affect eligibility
- Aged-Blind-Disabled requirements
- Gross income cannot exceed the Special Income Level (SIL) which is 300% of the FPL.
- Available Income
- Excluded Income
- Overview - Long Term Services and Supports chart for responsibilities and program administration (Who does what program).
- AREP Screens for long-term care cases Required for some DDA programs).
- Consider a client who is approved for DDA Waivers by DDA as having attained Institutional status.
- 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.
- Eligibility for the L21 or L22 DDA Waiver is a 2 prong eligibility program. The individual must meet both the financial and functional eligibility for the program. If DDA waiver services are closed by DDA, DDA must inform the financial worker via the DSHS 15-345 in barcode. Financial would then need to consider eligibility for other medical programs.
- The L21/L22 program code is used for the DDA Waivers. There are exceptions:
- Eligibility for Health Care for Workers with Disabilities (HWD), use the S08/HWD program. Refer to the HWD specialist.
- DDA Foster Care Program
- Because of systems issues such as a SSI deemed eligible client with gross income over the SIL. Use a S02 program.
- For a DDA client with earnings, see Working clients on long-term services and supports This link includes information on the Health Care for Workers with Disability program.
- 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). See Allowable Medical Expenses.
- Court ordered guardianship fees used as a deduction in long term care are described in the Guardianship section.
- Information on DDA community based waivers are in WAC 388-845
- Follow necessary supplemental accommodation services (NSA). The DDA case manager will inform the DDA financial worker of any additional NSA services indicated in the CARE plan with a accommodation to access or maintaining services.