DEPARTMENT
OF SOCIAL SERVICES
Effective January 1, 2010
Service Level |
Description |
Functional Need |
Financial Eligibility |
Care Plan Limits |
Funding Source |
Category
1 |
Limited home care for moderately frail elders |
At
risk of hospitalization or short term nursing home placement |
Individual
Income Assets: |
<25%
NH Cost but (15%
copay may apply eff. |
STATE |
Category 2A |
Intermediate home care for very frail elders with some assets above the Medicaid limits |
In need of short or long term nursing home care |
Individual
Income Assets: |
<50%
NH cost but (15%
copay may apply eff. |
STATE |
Category 2B |
Same as 2A |
Same as 2A |
Same as 2A |
<80%
NH cost but (15%
copay may apply eff. |
STATE |
Category 3 |
Extensive home care for very frail elders who would otherwise be in a nursing home on Medicaid |
In need of long term nursing home care (deficits in 3 critical need areas or ADLs) |
Individual
Income Assets: |
100%
NH Cost (Social Services cap = $3,978) |
MEDICAID (state/federal) |
Notes:
1. Clients with incomes of $1,806.00 and above are required to contribute to
the cost of their care; eff.
2. There is no income limit for the State-Funded levels. The Medicaid
Waiver income limit equals 300% of SSI.
In some circumstances a "pooled trust" account may be used to
exclude excess income.
3. Services in all categories include the full range of home health and
community-based services.
4. Care plan limits in all categories are based on the total cost of all
state-administered services.
5. Some individuals may be functionally eligible for either category 1 or 2
services and financially eligible for Medicaid. In such cases, home
health services will be covered by Medicaid and other community-based services
covered through state funds.
6. Married couples who are over the $23,512 asset limit for category 3 may
still be eligible based on spousal asset protection rules (maximum $109,560;
sometimes more if needed to meet community spouse minimum monthly needs..
7. Functional need is a clinical determination by the Department concerning the
applicant's critical need for assistance in the following areas: bathing,
dressing, toileting, transferring, eating/feeding,
meal preparation and medication administration.
8. Care plan cost limits are for CHCPE fee-for-service only.