STEP 1 – What is the disability for eligibility?
STEP 2 – Check ALL barriers in client’s Home
__ Garage Access
__ Front Door Access
__ Back Door Access
__ Other ______________________________________
STEP 3 – Check waiver that would best fit the client’s disability
__ Brain Injury (BI)
__ Community Mental Health Supports Waiver (CMHS)
__ Developmental Disabilities Waiver (DD)
__ Elderly, Blind and Disabled Waiver (EBD)
__ Spinal Cord Injury Waiver (SCI)
__ Support Living Services Waiver (SLS)
_ Children’s Extensive Support Waiver (CES)
_ Children’s Home and Community Based Services Waiver (CHCBS)
_ Children’s Habilitation Residential Program Waiver (CHRP)
_ Children with Life-Limiting Illness Waiver (CLLI)
STEP 4 – What is my Waiver benefit amount?
Generally, (NOT always) children’s waivers are for $10,000 every 5 years until the child turns 18 years of age at which point the child will then be transferred over to an Adult waiver. Adult Waivers have a $14,000 one-time lifetime cap.
STEP 5 – What home modifications qualify?
Wheelchair or Vertical Platform Lifts
Incline Platform Lifts
Barrier-Free Showers and Bathroom Modifications
Automatic Door Openers
STEP 6 – Which county do I live & Corresponding case management agency?
STEP 7 – What is the Process and How long does it take?
|Check Off||Where am I at in the process?|
|1||Family member contacts the appropriate Medicaid Agency and submits an application for approval or denial to go through the home modification process.|
|2||IF the family is approved, a Case Manager (CM) from the Medicaid Agency will be assigned.|
|3||Most of the Medicaid agencies will contact a certified home modification Occupational Therapist (OT) that is required to provide a home evaluation of the disability eligibility and will recommend specific home modifications that will be covered under the Medicaid Home Modification Waivers.|
|4||The OT submits their Survey to the CM with a recommendation summary. The CM either provides the family with a list of approved contractors OR the CM will reach out to the list of contractors on behalf of the family.|
|5||The Medicaid Home Modification Process is a “competitive bid process”, the family is required to have 2 or 3 different contractors provide estimates for the same project. These estimates are sent to the CM.|
|6||NOTE: As of February of 2016, the family is allowed to select the contractor of their choice, whether the bid is more expensive or not.|
|7||The Medicaid Home Modification Process is a “competitive bid process”, the client is required to have 2 or 3 different contractors provide estimates for the same project. These estimates are then sent to the case manager|
|NOTE: As of February of 2016, the client is allowed to select the contractor of their choice, whether the bid is more expensive or not.|
|8||The chosen contractors estimate will then be sent to the state for approval for the amount specified on the contractors estimate.|
|9||The state provides the chosen contractor a Prior Authorization Request (PAR) serving as the green light for the contractor to begin the project.|
|NOTE: This process can take up to 6-9 months on average and can take up to a year, BEFORE the project actually begins with the client.|
NOTE: This guide does not guarantee that the client will receive the funds mentioned above, but it will connect the OT or family to the correct Medicaid agency that will help to start the Medicaid Home Modification Application Process.