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COMBINED MANUAL

ISSUE DATE 09/2016

SPECIAL MEDICAL CRITERIA

0011.36

MFIP: This section describes special medical criteria outlined below 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).

To qualify for the special medical criteria, the child or an adult in the household only needs to meet the criteria; he/she does not need to be receiving services.

In a 2-parent household with a child or an adult who meets the special medical criteria, only 1 parent is presumed to be prevented from obtaining or maintaining employment. If the family provides documentation from their health care provider that a 2nd parent is also needed in the home to care for the child or adult who meets the special medical criteria, the 2nd parent may be eligible for a hardship extension under the category for participants whose presence is needed in the home because of the illness or incapacity of another member of the assistance unit.

Participants must be evaluated for extension on or before the 60th month. The special medical criteria extension applies only when the caregiver has a child or an adult in the household who meet the criteria. When the caregiver receives similar services or has a serious and persistent mental illness, he/she may be extended in another category, such as the ill/incapacitated (lasting 30 days or more) category or the hard to employ/MI category.

SPECIAL MEDICAL CRITERIA CATEGORIES

Participants are considered to have a child or adult in the unit 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 criteria for home care services. For the purpose of this determination, home care services means a medically necessary health service that is ordered by a physician and documented in a service plan that is reviewed by the physician at least once every 60 days for the provision of home health services, or private duty nursing, or at least once every 365 days for personal care. Participants may also request services directly from a Home Care Agency, which can contact the physician for the necessary documentation. Home care services are provided at the recipient’s residence that is a place other than a hospital or long term care facility.

● 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. These are services not normally covered by MA which are covered under a waiver, including case management, homemaker services, adult day health treatment, habilitation, respite care, and day treatment for individuals with chronic mental illness. The provisions of this criterion apply to the following home and community-based waiver services programs:

Alternative Care Grant Program (ACG) A state-funded program that targets people age 65 or older who are at risk of nursing facility level of care and whose personal financial resources would allow no more than a 6-month stay in a nursing facility. The service menu is the same as that available for people receiving services under the Elderly Waiver

Community Access for Disability Inclusion (CADI) Targets people at risk of nursing facility level of care. They must meet ALL of the following:

- Be under 65 at the time of assessment.

- Be certified disabled by the Social Security Administration or the State Medical Review Team (SMRT).

- Be eligible for Medical Assistance.

- Be assessed by a Public Health Nurse or Social Worker as needing the level of medical services provided in a nursing facility.