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Effective: December 1, 2006 |
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03.40.10ar1 - Community Alternatives for Disabled Individuals (CADI) (Archive) |
Archived: July 1, 2008 |
Community Alternatives for Disabled Individuals (CADI) is a federally approved waiver program for people living in the community who are eligible for Medical Assistance (MA) and:
l Have a disabled basis of eligibility for MA.
l Are screened by the Long-Term Care Consultation (LTCC) team.
l Have a determination from the LTCC team that one of the following conditions is met:
n If not for the provision of waiver services, the person would reside in a nursing facility.
n The person requires the level of care provided in a nursing facility.
l Are under age 65 at the time of screening.
Note: People who turn age 65 after the CADI screening may remain on CADI if the case manager determines their needs cannot be met through other programs (such as Elderly Waiver).
l Require the level of care provided in a nursing facility.
l Have anticipated costs to MA for community-based services that do not exceed the cost of services that are or would be provided in a health care facility.
l Choose home and community-based services.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Follow standard MA guidelines.
The date of the LTCC screening and approval is the earliest possible date of CADI eligibility. Coordinate the MA/CADI determination with the LTCC team and case manager.
Renewals (standard guidelines)
Follow standard MA guidelines.
Disability must be certified by the State Medical Review Team (SMRT) or the Social Security Administration (SSA) . Do not refer CADI applicants/enrollees who are certified disabled by SSA to SMRT.
Verify that the county case manager has determined the person to be CADI-eligible through developing a county service plan that ensures the person's health and safety, and completed a cost determination.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Residency (standard guidelines)
Follow standard MA guidelines.
CADI enrollees who are not eligible for the Medicare Savings Programs are not eligible for payment or reimbursement of Medicare premiums unless they also receive MA for Employed Persons with Disabilities (MA-EPD).
Note: MA-EPD enrollees must have income under 200% FPG to qualify for payment or reimbursement of Medicare premiums.
Household Composition (standard guidelines)
MA eligibility is determined using only the person's own income and assets (household size of one) for all months in which the applicant/enrollee receives CADI services.
l If the person is requesting retroactive MA for months before CADI services 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.
Example:
Harold applies for MA for his wife, Delores, on January 28. Delores has been hospitalized several times since November. Harold is requesting MA retroactive to November. Delores was screened by the LTCC team on January 15 and found eligible for CADI services. She receives RSDI based on her disability. Her assets are under $3000 and she will be able to meet a monthly spenddown with the projected cost of CADI services.
Action:
Check with the LTCC team and case manager to determine whether CADI can begin in January or February. Deem Harold’s income and assets for the months in the retroactive period before CADI begins.
Use Method B for assets and income.
Asset Guidelines (standard guidelines)
Asset limit is $3000 (household size of one), except for:
l Children under 21, who have no asset limit.
l Adults who are concurrently eligible for MA-EPD; then follow the MA-EPD asset guidelines.
Note: When eligibility for a Medicare Savings Programs is also being determined, follow that program’s asset guidelines for the Medicare Savings Program eligibility.
CADI applicants and enrollees may transfer assets to their spouses without penalty. Asset transfers to others may be improper, and result in a period during which the client is still eligible for MA, but ineligible for CADI waiver services.
Income standard is 100% FPG.
Exception: If concurrently eligible for MA-EPD, there is no separate income limit. Follow MA-EPD income guidelines.
Exclude child support and RSDI payments received by or on behalf of children under age 18.
Deductions/Disregards (standard guidelines)
Follow standard MA 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 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.
Covered Services (standard guidelines)
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.
Service Delivery (standard guidelines)
CADI enrollees age 65 or older must enroll in managed care if they live in managed care counties.
Refer CADI enrollees under age 18 to DHS to determine and collect parental fees.
Note: If the child receives adoption assistance, either note that on the referral form or notify the DHS Parental Fee unit by other means. Parents of children who receive adoption assistance are not liable for parental fees
A person is eligible for the CADI waiver through the month of the person's 65th birthday. If the person’s needs cannot be met by other programs, the person may continue on CADI after age 65, as long as the cost of services in the community does not exceed the cost of LTC care to MA.
CADI enrollees who apply for Medicare Savings Programs must meet all requirements for those programs.
Not applicable.