DC Department of Health Care Finance Office of Chronic and Long-Term Care 

STEPS IN THE WAIVER ADMISSION PROCESS

INDIVIDUALS ARE ENROLLED IN THE WAIVER ON A FIRST-COME, FIRST SERVED BASIS. WHENEVER THE ANNUAL CEILING IS ACHIEVED, INDIVIDUALS WILL BE PLACED ON A WAITING LIST.

WAIVERS ARE CHOICE PROGRAMS; THUS THE INDIVIDUAL OR REPRESENTATIVE MUST SELECT THE PROVIDER(S) OR SERVICE(S).

To obtain information on how to access the waiver program, please call any one of the following DC Medicaid representatives:

A RECIPIENT MUST COMPLETE STEPS 1 THROUGH 9 IN ORDER TO BE ADMITTED INTO THE ELDERLY AND PHYSICAL DISABILITIES WAIVER PROGRAM. STEPS 6 AND 7 APPLY TO THOSE INDIVIDUALS WHO ARE APPLYING FOR MEDICAID ELIGIBILITY AT 300% OF SSI.

STEP 1: Select and contact the case management provider of your choice from the Provider Directory.

STEP 2: The designated case manager will make an appointment to perform an assessment of your needs and preferences, and will complete the necessary waiver documents:

a. 30-AW

b. Risk Assessment

c. Bill of Rights

d. Beneficiary Freedom of Choice

e. Referral for Medicaid Level of Care (this form must be signed by the physician anD submitted to Delmarva Foundation for Medical Care. Delmarva will make a determination regarding the level care or functional limitations which places the recipient at risk for institutional care)

f. Health History

g. Individual Service Plan

h. Medicaid application (if receiving financial eligibility at 300% SSI)

STEP 3: Case Manager develops and reviews the ISP with the recipient/representative and obtains input from the recipient/representative regarding the services and providers of  their choice based on the identified needs. The case manager will also review the agreed upon plan with the recipient/representative.

STEP 4: The case manager submits the completed waiver application package to the DC Department of Health Care Finance (DHCF) for review and approval. If the client is applying for Medicaid at 300% SSI, the Medicaid application and supporting documents must accompany the waiver application.

STEP 5: Designated DHCF Office of Chronic & Long-Term Care (CLTC) staff review the waiver application and approve services, as necessary. If additional information is needed, designated DHCF/CLTC staff will contact the case manager to obtain the information. Approval is provided once the requested information is received.

STEP 6: If the recipient is applying for Medicaid at 300% SSI, the designated DHCF/CLTC staff will submit the waiver documents to the Income Maintenance Administration for review for Medicaid financial eligibility.

STEP 7: If the recipient is approved by the Income Maintenance Administration (IMA) for Medicaid financial eligibility, IMA will notify the designated DHCF/CLTC staff of the approval and the effective date of the Medicaid eligibility.

STEP 8: The designated DHCF/CLTC staff will then generate prior-authorizations for each selected provider of service. The prior-authorizations will be faxed and mailed to each provider of service. A letter that delineates the providers, services, frequency and duration of services, and the certification dates will also be sent to the recipient.

STEP 9: The designated provider of service will contact you to initiate services.