Page 393

• PACE Medicaid Eligibility Community waivers enable elderly, blind, or disabled people to live in community settings rather than in state institutions or nursing homes. They allow Medicaid to pay for services and supports permitting a person to remain in a community setting that normally are not covered by Medicaid. These programs include Family Care, Family Care Partnership, PACE, and IRIS. IM workers are responsible for determining Medicaid eligibility as well as cost share amounts, if applicable. ADRC staff and IRIS consultants are responsible for determining the person’s eligibility for enrollment in the specific community waiver program. If a member disenrolls from the managed LTC program for any reason and does not enroll in IRIS or a managed LTC program, their Medicaid eligibility must be tested under non-HCBW rules. Eligibility for HCBW would end following adverse action logic once the IM worker has been notified by the ADRC that the member has disenrolled from the managed LTC program or IRIS. If an 18-year-old is disenrolled from their managed LTC program during their 12-month continuous coverage period, and they are not eligible for another category of full-benefit health care, they will keep their HCBW Medicaid and can keep getting Medicaid card services for the rest of the 12-month continuous coverage period. However, a voluntary disenrollment will be treated as a voluntary disenrollment from HCBW Medicaid and continuous coverage under HCBW Medicaid will end (see SECTION 1.2 CONTINUOUS COVERAGE FOR QUALIFYING CHILDREN). Managed Long-Term Care of IRIS Enrollment Enrollment in managed LTC or IRIS is completed by the ADRC. The ADRC will submit the following information to IM workers: • ADRC Referral to Income Maintenance for Managed Long-Term Care Services, F-02053, which lists the anticipated program start date for HCBW • Medicaid application, if the ADRC is assisting the applicant with the Medicaid application process or establishing a Medicaid filing date • Functional Screen Eligibility Results page • Medical and Remedial Expenses: checklist For Medicaid Long-Term Care Waiver Programs, F- 00295, or other communication of the total expenses • Housing expenses and any other verification items the ADRC has received from the applicant to support the Medicaid application • Estate Recovery Program (ERP) Disclosure, F-13039, if completed by the ADRC • Declaration Regarding Transfer of Resources Long-Term Care Medicaid Waiver Program and/or Community Options Program, F-20919D, if any potential divestment was reported to the ADRC • Disenrollment from the managed LTC program or IRIS, if applicable 28.1.1 Adult Home and Community Based Waivers Long-Term Care Disability Policy To be eligible for EBD Medicaid or LTC Medicaid, a person must be elderly, blind, or disabled. Adults over age 18 and younger than 65 years old must have a disability determination unless the person is eligible for BadgerCare Plus, WWWMA, Foster Care, or Adoption Assistance. If a person later