28.2 Home and Community-Based Waivers Long-Term Care Application

To be eligible for LTC waiver services, applicants must be both Medicaid-eligible and functionally eligible. All waiver applicants must complete a Medicaid application unless they are already open for another program of assistance.

Adult waiver applicants receive level of care assessment, long-term care options, and enrollment counseling services from the ADRC . Once the level of care assessment is complete and the applicant is determined functionally eligible, the ADRC will submit the waiver program start (enrollment) date to the IM agency along with the waiver functional eligibility determination.

If an applicant is not functionally eligible, the ADRC will send the appropriate correspondence to the applicant regarding their functional eligibility results, which may include the Notice of Denial of Functional Eligibility, Notice of Non-Nursing Home Level of Care, and Appeal Rights.

28.2.1 Spousal Impoverishment

Spousal impoverishment policy applies to waiver participants with a community spouse , with the exception of MAPP waiver participants (see Section 18.2.3 Institutionalized and Section 26.3.7 Spousal Impoverishment).

28.2.2 Tentative Approval

Persons who apply for waivers may receive tentative waiver approval while their Medicaid eligibility is being determined.

The tentative approval process begins when the care manager refers the waiver applicant to the IM agency with accompanying information about the type of waiver, waiver begin date, and medical/remedial expenses.

This page last updated in Release Number: 18-01

Release Date: 04/13/2018

Effective Date: 04/13/2018

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030