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COMBINED MANUAL

ISSUE DATE 04/2022

SPECIAL MEDICAL CRITERIA

0011.36

MFIP: This section describes special medical criteria (SMC) that provide for banking months during the 1st 60 months, and extension after reaching the 60-month time limit. See 0011.30 (60-Month Lifetime Limit), 0011.33 (MFIP Hardship Extensions), 0011.33.09 (MFIP Ill/Incapacitated Extension Category), 0011.39 (Qualified Professionals), 0028.18 (Good Cause for Non-Compliance -- MFIP/DWP).

The special medical criteria applies only when the caregiver has a child or an adult in the household who meets the criteria listed below. A child or an adult in the household only needs to meet the criteria; they do not need to be receiving services. When the caregiver receives similar services or has a serious and persistent mental illness, they may be extended in another Family Stabilization Services (FSS) category but will not accrue banked months.

SPECIAL MEDICAL CRITERIA CATEGORIES

Participants are considered to have a child or adult in the household who meets special medical criteria in any of the following categories: ● HOME CARE SERVICES There is a child or an adult in the household who meets the disability or medical necessity criteria for home care services. For the purpose of this determination, home care services means a medically necessary health service that is ordered and documented in a service plan that is reviewed by the physician or other qualified ordering entity at least once every 60 days for the provision of home health services or home care nursing. Medical necessity for Personal Care Assistant Services (PCA) is determined by an annual lead agency (county, tribal nation or Managed Care Organization (MCO)) eligibility assessment of the child or adult. For additional information, see the Home Care CBSM pages.

● HOME AND COMMUNITY-BASED WAIVER SERVICES There is a child or an adult in the household who meets the disability or medical criteria for a home and community-based waiver services program. Also see the Minnesota Health Care Programs Eligibility Policy Manual for additional information. Services available are those not normally covered by Medical Assistance (MA) such as case management, homemaker services, adult day services, and respite care. Each of the waivers serves both people moving from an institutional setting to the community and people who are determined to be "at risk of" the level of care provided in the respective institutional setting. The provisions of this criterion apply to the following home and community-based waiver services programs:

Alternative Care (AC) A state-funded program with federal grant match for people age 65 or older who require the level of care provided in a nursing home but choose to stay in the community, and whose personal financial resources would allow a nursing facility stay of no more than 135 days. AC participants are also not yet eligible for Medical Assistance. For specifics regarding AC eligibility requirements and services, see the Alternative Care CBSM page.

Community Access for Disability Inclusion (CADI) A program that provides home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding CADI waiver eligibility and services, see CBSM - Community Access for Disability Inclusion (CADI) Waiver.

Community Alternative Care (CAC) A program that provides home and community-based services to children and adults who are chronically ill or medically fragile and require the level of care provided in a hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding CAC waiver eligibility and services, see CBSM - Community Alternative Care (CAC) Waiver.

Brain Injury Waiver (BI) A program that provides home and community-based services to children and adults with a diagnosis of brain injury who require the level of care provided in a specialized nursing facility or neurobehavioral hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote