Within the Community Choices Waiver there are four options for services:
Community Choices Waiver • Assisted Living Facility Waiver
Long Term Care Waiver • Program of All-Inclusive Care for the Elderly
WHAT IS CCW?
The Community Choices Home and Community Based Services Waiver, CCW, is also called the Assisted Living Facility and Long Term Care Waiver. This is a Medicaid program and provides long-term care services for individuals who require a nursing home level of care, but choose to remain living in the community (their home, the home of a family member, or an assisted living residence) rather than in a nursing home.
WHAT IS THE ASSISTED LIVING FACILITY (ALF) WAIVER?
The Assisted Living Facility Waiver, ALF, provides for personal care services in an Assisted Living Facility.
WHAT IS THE LONG TERM CARE (LTC) WAIVER?
The Long Term Care Waiver, LTC, provides personal care services in the home.
WHAT IS THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)?
The Program for All-Inclusive Care for the Elderly, PACE, provides services to participants in their home and at the PACE Center. Currently available for those ages 55 and older.
WHAT IS MEDICAID?
Medicaid is the state and federal partnership that provides health coverage for selected categories of individuals with low income and limited resources.
What is the cost of in-home services under the waiver?
None. The recipient is not responsible to contribute towards the cost of services provided under the LTC waiver.
What is the cost of ALF Services under the waiver?
A recipient is responsible to pay the room and board cost.
What is the cost of LTC Services under the waiver?
A recipient is not responsible for paying toward the cost of services provided under the LTC Waiver, however, co-payments may apply.
What is the cost of PACE Services under the waiver?
A recipient is not required to contribute toward the cost of approved services, as long as the PACE participant has been determined Medicaid eligible and continues to receive PACE services in their home or at the PACE center. (In the event the PACE participant requires a nursing home stay there may be a Patient Contribution, assessed for the time in the nursing home. The participant will be required to pay directly to the PACE Center.)
BENEFITS OF EACH PROGRAM:
- Allows eligible participants to serve as the employer of their care provider
- You can choose who will be their paid caregiver
- Family members, such as an adult child, can be hired as the direct service worker. (Note, spouses, legal guardians, power of attorneys for health care, power of attorneys, and health care directive designees cannot be hired to provide care.)
- Direct Service workers earn approximately $10 – $12/hour and cannot work in excess of 40 hours/week.
Individuals using the In-Home Participant Directed Option must have the ability to, direct their own care. For those unable to manage these activities, a family member with power of attorney for health care may be able to do so on their behalf. Including:
- All aspects of being an employer
- Case Management
- Medication Management
- Personal Care
- Supervision, safety, and security
- 24-hour on-site response staff
(Note: the amount of services provided is based on the LT-101 score.
LTC Services: (note, personal care can be self-directed)
- Adult daycare
- Case management
- Home delivered meals
- Non-medical transportation
- Personal care
- Personal emergency response system
- Respite care
- Skilled nursing services
- Adult daycare
- Home Care
- Hospital and emergency care
- Lab tests and diagnostic procedures
- Meals and nutritional counseling
- Medical specialty services
- Nursing and social work
- On-site physician access with personalized care tailored to your needs
- Personal care
- Physical, occupational and speech therapy
- Prescription drug coverage and management
- Primary and specialty medical care including dental, audiology, optometry and podiatry
- Recreational Therapy
- Transportation services (accessible)
The gross monthly income limit is $2205. (Note: Individuals with income above this may qualify by establishing an Income trust)
Income is defined as anything received in cash or in-kind, that can be used to meet and individual’s needs.
Income is counted:
- When it is received
- When it is credited to an individual’s account
- When it is set aside for an individual’s use
The applicant must:
- Meet U.S. Citizenship/Immigration status
- Be a resident of Wyoming or intend to reside in Wyoming
- Be age 19 or older (for ALF or LTC Waiver)
- Be age 55 or older (for PACE program)
- Be age 65 or older, blind or disabled
- Meet the level of care requirements for entry into a nursing home (LT-101)
- Have approved plan of care
- Meet financial eligibility
Resources include real and personal property that an individual owns. Some resources are not counted in the limit, such as but not limited to:
- One home may be excluded if the value is less than $560,000 and it is the individual’s primary place of residence.
- One vehicle may be excluded.
- Individual – $2,000
- Couple – $3,000, when both are applying
- Couple – $120,900 when one is applying
Medicaid law prohibits the transfer of resources for less than market value by and institutionalized Medicaid applicant/recipient or anyone acting on their behalf. Certain transfers are allowable, such as the transfer of a home to a spouse or disabled child. A 60-month lookback period applies to resources transferred on or after February 8, 2006.
IF YOU QUALIFY:
1. You will receive a letter from the Medicaid Long Term Care Financial Eligibility Unit telling you that your Medicaid eligibility is pending.
2. Your case manager will contact you to prepare your Plan of Care. Waiver services can begin after the Plan of Care is approved by HCSU staff.
3. You will begin receiving waiver-funded services and you will be Medicaid eligible. You will also receive a Medicaid card for us to access Medicaid-covered services.
4. Your case manager will visit you each month to see how your waiver services are going and if any changes need to be made.
The Community Choices Waiver is not an entitlement program, meaning there are limited slots available for enrollment. Just because one is eligible for the program does not guarantee that they will be accepted into the program. CCW is administered by the Wyoming Department of Health’s Division of Healthcare Financing (DHCF).
You can learn more about this program and others by visiting the Wyoming Department of Health’s website!