1. Ri Home and Community Care Services to the Elderly
The Program consists of two categories of services:
“Waiver” - Medicaid-funded Long Term Services
“Co-pay Program”
CTC Presentation: December 20, 2016

2. Home/Community Services Program
Program Categories
Waiver Services include: Home Care Services
Assisted Living Services Case Management Services Meals on Wheels Personal Emergency Response
Other (Some Home Mod, Self Directed Care, Shared Living)
Persons in Rhody Health Options –
Receive services through Neighbor Health Plan

3. HCC Services Program The Co-pay/CNOM Program services include
home care, adult day services, and case
management.
Co-pay/CNOM services require a client co-payment.
For home care services, there is a 20 hour/week maximum of authorized services; 5 days of ADS

4. HCC Services Program Eligibility: LTC Waiver Services
Medicaid eligible residents of RI who:
Meet Financial guidelines of the RI Medicaid Program as determined by the Dept of Human Services LTC office; and
meet the Clinical guidelines as determined by the Office of Medical Review for the RI Medicaid program; Highest Need – Nursing or HCC eligible High Need – Home/Community Care eligible

5. HCC Services Program Eligibility: DEA Co-pay
To be eligible for the DEA Co-pay/CNOM Program, individuals
must be residents of the State of Rhode Island who:
are aged sixty-five (65) years or older; and
are at risk of needing Long-Term Care services and supports;
are homebound; and
are in need of home and community-based services, including
assistance with ADLs; and
do not qualify for RI Medical Assistance; and
have annual income that does not exceed a percentage (200%) of the Federal Poverty Limits (FPL) as determined by the Division Director.

6. 2016 Guidelines for the Co-pay
HCC Services Program
2016 Guidelines for the Co-pay
July 1, 2016 Income Guidelines Client Cost Share
Level Individual: up to $14, Home Care: $4.50/Hour
(125% FPL) Couple: up to $20, Adult Day Services: $7.00/Day
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Level Individual: up to $23, Home Care: $7.50/Hour
(200%FPL) Couple: up to $32, Adult Day Services: $11.50/Day
* There are no asset limits for the Co-pay/CNOM Program

7. HCC Services Program Access to HCC Programs
There is “no wrong door” to gain information about and access to the DEA HCC Program. Individuals may be referred to DEA by their doctor, by the ADRC/The POINT, by community agencies, by a family member or by contacting DEA on their own behalf.

8. HCC Services Program
If DEA receives a HCC referral, the referral will be assigned to a case management agency (CMA) under contract to DEA, based on where the individual resides
A case manager will be assigned and interviews with the elders (and possibly, a caregiver) in order to complete a comprehensive assessment (social, environmental, financial, medical information and functional (ADL, IADL).

9. HCC Services Program
Information about the elder’s finances will help determine if they may meet the financial guidelines for RI Medicaid or for the Co-pay/CNOM Program.
If elder seems eligible for RI Medicaid, the CM gathers the required financial documentation and submits it to the DHS Long Term Care Office for eligibility determination.
If elder seems to meet the functional criteria for community LTSS, the required medical assessment is submitted to the elder’s physician for completion and submission to the Office of Medical Review in RI Medicaid for the clinical eligibility determination for the Waiver Program.

10. HCC Services Program
If the elder does not qualify for the Medicaid Program, but seems to meet both the income eligibility and the functional requirements for the Co-pay/CNOM program, the case manager will complete all of the necessary documentation and submit it to DEA for final authorization.
DEA will notify the CMA of authorization and the services will be coordinated by the case manager.