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CHAPTER 3 - OTHER HEALTH PROGRAMS AND REFERRALS

INTRODUCTION 3.1

Many IMA customers may be ineligible for AR/AX or SR Medicaid but remain in need of health services. This chapter presents the policies and referrals information for special Medicaid expansions and other District programs, including:

 DC HealthCare Alliance  Elderly and Physically Disabled Home- and Community-Based Services Waiver  HIV Programs  Breast and Cervical Cancer Program  Mental Health Special Rehabilitation Option  Drug Abuse Program (Addiction Prevention and Recovery)  Mental Retardation and Developmental Disabilities Waiver

Because each of these programs is administered outside of ESA, it may be necessary to refer customers to the appropriate program agency.

LEGAL AUTHORITY 3.2

These programs are outside the purview of ESA. In specific instances, the ESA Medicaid Branch “enrolls” customers in these programs by creating an ACEDS record. However, the primary responsibility for enrollment, case maintenance, recertification, and de-enrollment remains with the respective program agency that administers the program.

DC HEALTHCARE ALLIANCE 3.3

Effective June 1, 2006, ESA administers eligibility for the DC HealthCare Alliance. This section has been expanded and moved to Chapter 4: DC HealthCare Alliance in this Part.

Note: Customers in the MC program type in ACEDS with a program code of 370 are actually enrolled in the 50-64 Demonstration; please see Section 1.16: 50-64 Demonstration in Chapter 1 of this Part for additional information.

ELDERLY AND PHYSICALLY DISABLED HOME-AND-COMMUNITY-BASED SERVICES WAIVER 3.4

Frail elderly or disabled customers may be able to receive both Medicaid and home-base care services through this Waiver program, even if their incomes are above the SR Medicaid limit. Waiver services include home nursing and personal care aide services, homemaker and chore services, home modifications, non-medical transportation, etc.

Generally, to be eligible for these services, the individual:

 must have income below 300 percent of the SSI payment level;  must have assets below the Medicaid categorically needy resource level;  would be eligible for Medicaid if placed in an institution;  must require a level of care provided in LTC facilities; and  could be served in a more cost effective manner with community based services.