Community Alternatives for Disabled Individuals (CADI)

Community Alternatives for Disabled Individuals (CADI) is a federally approved home and community-based services program that allows people with disabilities who require the level of care provided in a nursing facility to receive services in community settings rather than in a nursing facility. The individual must be:

l  Eligible for Medical Assistance (MA) payment of long-term care (LTC) services.

l  Certified disabled by the Social Security Administration or State Medical Review Team (SMRT) process.

l  Under age 65 years at the time of acceptance to the waiver.

Note:  People who receive CADI waiver services may choose to either remain on CADI or begin Elderly Waiver (EW) services when they turn 65 years of age.

l  Assessed through a Long-Term Care Consultation (LTCC) A program to help people make decisions about long-term care and prevent inappropriate nursing home or boarding care placement. LTCC was formerly known as the Pre-Admission Screening Program (PAS). and found to need the level of care provided in a nursing facility.

More information about the disability waivers can be found in the Disability Services Program Manual.

Eligibility factors and links to standard program guidelines are provided below.

Application Process.

Eligibility Begin Date.

Renewals.

Verifications.

Social Security Number.

Citizenship/Immigration Status.

Residency.

Insurance and Benefit Recovery.

Household Composition.

Eligibility Method.

Asset Guidelines.

Income Guidelines.

Deductions/Disregards.

Spenddowns.

Covered Services.

Service Delivery.

Other Requirements.

End of Eligibility Basis.

Relationship to Other Groups/Bases.

Top of Page

Application Process  (standard guidelines)

Follow standard MA guidelines.

Note:  Refer all applicants or their authorized representatives to the appropriate area of the county agency to obtain an LTCC screening if they have not already done so at the time they apply for MA.

Eligibility Begin Date  (standard guidelines)

Eligibility for waiver services cannot begin before an LTCC is completed, a care plan is developed, and eligibility for MA payment of LTC services has been determined.

Top of Page

Renewals  (standard guidelines)

Follow standard MA guidelines.

Verifications  (standard guidelines)

Disability must be verified by the State Medical Review Team (SMRT) A unit at DHS that determines disability in consultation with medical professionals appointed by the commissioner. or the Social Security Administration (SSA) A federal agency which administers the SSI, RSDI and Medicare programs. through a disability certification. Do not refer CADI applicants/enrollees who are certified disabled by SSA to SMRT.

The lead agency case manager The health plan, county or tribal agency staff person who provides case coordination or case management services. will verify the following information on the Lead Agency Case Manager/Worker Communication Form (DHS-5181):

l  Waiver program conversion or diversion status.

l  LTCC date.

l  Anticipated start date of waiver services.

Top of Page

Social Security Number  (standard guidelines)

Follow standard MA guidelines.

Citizenship/Immigration Status  (standard guidelines)

Follow standard MA guidelines.

Top of Page

Residency  (standard guidelines)

Follow standard MA guidelines.

Insurance and Benefit Recovery  (standard guidelines)

Follow standard MA guidelines.

CADI enrollees who are not eligible for the Medicare Savings Programs may be eligible for payment of Medicare premiums as cost effective insurance.

Exception:  CADI enrollees who are also enrolled in MA-EPD must have income at or below 200% FPG to qualify for reimbursement of Medicare Part B premiums. Part B premiums must be reimbursed for any month(s) the enrollee’s income was at or below 200% FPG back to the date of MA-EPD eligibility, regardless of the amount of the premium. No cost effective determination is needed.

Top of Page

Household Composition  (standard guidelines)

Use a household size of one for all months in which the applicant or enrollee receives CADI services.

l  If the person is requesting retroactive MA for months before CADI services will begin, follow standard MA household size and deeming guidelines.

l  For Medicare Savings Program eligibility, follow the household size and deeming guidelines of the Medicare Savings Program.

l  For MA-EPD eligibility, follow the household size and deeming guidelines of the MA-EPD program.

Eligibility Method  (standard guidelines)

Use Method B for assets and income.

Top of Page

Asset Guidelines  (standard guidelines)

l  Asset limit:

Only count the applicant or enrollee's assets toward the asset limit in any month the person receives CADI services. Do not deem the assets of a spouse in any month the applicant or enrollee receives CADI services.

The asset limit is $3,000 (household size of one) with the following exceptions:

n  There is no asset limit for children under 21.

n  Follow the MA-EPD asset guidelines for adults who are concurrently eligible for CADI and MA-EPD.

l  Transfers:

CADI applicants and enrollees may transfer assets to their spouses without penalty. Asset transfers by applicants, enrollees or their spouses to others may be uncompensated, resulting in a transfer penalty period during which the client is ineligible for MA payment of LTC services, including LTC services received through the CADI waiver. See Transfers for more information on transfers.

l  Home Equity Limit:

CADI applicants and enrollees are subject to a Home Equity Limit.

l  Annuities:

CADI applicants and enrollees are subject to certain rules regarding annuity interests. See Annuities for more information.

Income Guidelines  (standard guidelines)

Income standard is 100% FPG.

Only count the income of the applicant or enrollee in any month he or she receives CADI services.  

l  Do not deem the income of a parent or spouse in any month the applicant or enrollee receives CADI services.

l  Exclude child support and RSDI payments received by or on behalf of children under age 18.

Example:

Simon is a disabled adult who is applying for MA under the CADI waiver. He is also eligible for Medicare. His income meets the income standard for CADI and QMB. However, when his wife’s income is deemed to him, their combined income is over the standard.

Action:

Because his wife’s income must be deemed to him under QMB program guidelines, deny QMB for Simon. However, because only his income is used to determine his MA eligibility under the CADI waiver, he is under the income standard for that program. Approve CADI for Simon.

Parents of children who are eligible for CADI may have to pay a parental fee. See Parental Fees for information about when to refer the case to DHS for a parental fee determination.

Exception:  Follow MA-EPD income guidelines for adults who are concurrently eligible for MA-EPD.

Top of Page

Deductions/Disregards  (standard guidelines)

Follow standard MA guidelines.

Spenddowns  (standard guidelines)

If income is greater than 100% FPG, the person must spend down to 75% FPG. Use a monthly spenddown. Treat the projected amount of CADI services for the month as a medical bill incurred on the first day of the month. The CADI enrollee is responsible for payment of the spenddown amount.

Exception:  If the person is concurrently eligible for MA-EPD, follow MA-EPD rules to determine the premium amount.

Top of Page

Covered Services  (Prepaid MHCP Manual)

CADI funds the following services in addition to the standard MA services:

l  Adult day care.

l  Respite care.

l  Homemaker services.

l  Adaptations to the person's home or vehicle and other adaptive equipment.

l  Extended home health services, including LPN, RN, respiratory therapy, speech therapy, physical therapy, occupational therapy, and supplies and equipment. These services are available through CADI only after regular MA coverage is exhausted.

l  Extended personal care attendant services after regular MA coverage is exhausted.

l  Case management.

l  Independent living skills.

l  Family counseling and training.

l  Assisted living.

l  Adult foster care.

l  Residential care services.

CADI services are not available during periods of hospitalization.

Top of Page

Service Delivery  (Prepaid MHCP Manual)

People who are not enrolled in a managed care A health care delivery system under which enrollees receive most medical services through a health plan or network of providers which coordinates the services provided. DHS pays a fixed rate in advance for each enrollee. plan receive services through fee-for-service A method of payment for health services. The medical provider bills the insurer and is paid for specific individual services. (FFS).

People under age 65 who are eligible for MA due to blindness as determined by the Social Security Administration (SSA) or the State Medical Review Team (SMRT) are excluded from mandatory managed care enrollment. However, people may voluntarily enroll in Special Needs BasicCare (SNBC) if they are:

l  ages 18-64 and are eligible for MA with or without Medicare Parts A and B, and

l  certified disabled by SSA or SMRT.

Note:  Long-term care services, such as personal care attendant (PCA), private duty nursing (PDN), ICF/DD, county case management, and home and community-based waiver services provided under CAC continue to be paid through fee-for-service (FFS).

Top of Page

Other Requirements

Not applicable.

End of Eligibility Basis

Follow standard MA guidelines.

Relationship to Other Groups/Bases  (standard guidelines)

CADI enrollees who apply for Medicare Savings Programs must meet all requirements for those programs.

Children who do not require the additional services provided by the CADI waiver may be eligible under TEFRA.

Top of Page