Revision 12-4; Effective December 1, 2012

 

HHSC also determines Medicaid eligibility for MEPD for a person who meets the criteria for one of the following services.

 

A-4100 Community Attendant Services (CAS)

Revision 11-4; Effective December 1, 2011

 

Those who may be eligible for CAS services are persons who are not eligible under a Medicaid program and have a functional need for Medicaid Primary Home Care (PHC) services. The intent of the program is to delay or prevent the need for institutional care; therefore, countable income must be equal to or less than HHSC's special income limit. Eligible persons do not receive regular Medicaid benefits; they receive only PHC services. The program has its statutory basis in §1929(b) of the Social Security Act. This program historically was called Waiver Five and later 1929(b).

Automated System Program Identifier
TIERS – ME-Community Attendant and CC-CCAD-Community Attendant

 

A-4200 Program of All-Inclusive Care for the Elderly (PACE)

Revision 11-4; Effective December 1, 2011

 

The PACE program serves the frail elderly and features a comprehensive service delivery system and integrated Medicare and Medicaid financing. Those who may be eligible for PACE services are persons age 55 and older with chronic medical problems and functional impairments who meet criteria for MN (only required for program entry) and are eligible for Medicaid (see §1905(a)(26) of the Social Security Act (enacted in Section 4802 of the Balanced Budget Act of 1997)).

More information concerning this program is available through the DADS Case Manager Community Care for Aged and Disabled (CM-CCAD) Handbook, Appendix XXXIV, Waiver Program Descriptions.

Automated System Program Identifier
TIERS – ME-Waivers and CC-PACE

 

A-4300 Retroactive Coverage

Revision 09-4; Effective December 1, 2009

 

 

A-4310 General

Revision 12-4; Effective December 1, 2012

 

In addition to the creation of the SSI program, Public Law 92-603 extended Medicaid benefits to cover the three-month time period before the month an application is filed with the Social Security Administration for SSI, if unpaid or reimbursable medical bills are incurred during the prior months.

Medicaid coverage also is extended to cover the three-month time period before the month an application is filed with MEPD for an ongoing MEPD program. For example, if an individual applies for ME – Nursing Facility, the eligibility specialist explores three months prior coverage.

People are potentially eligible for coverage in the prior months, regardless of their eligibility for the month of application and ongoing is approved or denied.

Note: This provision does not provide prior coverage for an application for which no MEPD program is available.

For specific program coverage, see Section G-7100, Prior Coverage for SSI Applicants, Section G-7200, Prior Coverage for Medical Assistance Only (MAO) Applicants, Section G-7210, Prior Coverage for Deceased Applicants, and Section G-7300, Prior Coverage for Aliens.

 

A-4320 Two Months Prior

Revision 11-4; Effective December 1, 2011

 

Public Law 104-193, Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Section 3502.4, changed policy for retroactive Medicaid coverage for persons found eligible for SSI. Effective July 1997, HHSC automatically adds Medicaid coverage for the month prior to the first month of SSI cash payment due (20 CFR §416.501). The person may apply with HHSC for coverage for the two preceding months if there are unpaid or reimbursable medical bills and the person meets all Medicaid eligibility requirements in those months.

Automated System Program Identifier
TIERS – ME-SSI Prior

 

A-4330 Deceased Individuals

Revision 12-4; Effective December 1, 2012

 

Medicaid coverage is extended to a deceased person, if a bona fide agent files an application with MEPD on behalf of a deceased person. The three-month time period is the three months prior to the month the application is received by MEPD.