Elderly Waiver (EW) and Alternative Care (AC) Program
Provider Type Links |
Overview
Elderly Waiver (EW) and Alternative Care (AC) programs fund home and community-based services (HCBS) for people 65 years old and older who require the level of care provided in a nursing home, but choose to live in the community. These programs provide services and supports for people to live in their homes or a community setting and may delay or prevent nursing facility (NF) care. The purpose of these programs is to promote community living and independence with services and supports designed to address each person’s individual needs and choices. In the case of EW, the additional services go beyond what is otherwise available through Medical Assistance (MA).
Assessments
Anyone may request an assessment for themselves or another person by contacting the local lead agency (described in more detail in the following Lead Agency section). The lead agency will determine program eligibility. EW and AC have different application processes, financial eligibility requirements and covered services.
Eligible Members
All applicants must meet the service eligibility criteria for the specific HCBS program in which they anticipate receiving services. Refer to the MHCP Provider Manual, Programs and Services for more information about MA and eligibility.
Roles
Lead Agency
Lead agency or human services eligibility workers determine financial eligibility for payment of Elderly Waiver services. Lead agency staff will also conduct asset assessments as needed for determination of AC and EW financial eligibility.
For EW, the lead agencies can be counties, Tribes or MCOs (also known as health plans). For AC, lead agencies can be counties or Tribes. A lead agency can be the local public health agency, human service agency or social service agency. Lead agencies are responsible for the following:
Long-Term Care Consultation
The lead agency provides long-term care consultation (LTCC) services, including the following:
Case Management
A person approved for EW or AC will receive case management or care coordination from a public health nurse, registered nurse or social worker. The case manager or care coordinator assists with access to and navigation of social, health, educational, and other community and natural supports and services based on the person’s values, strengths, goals and needs. The professional is responsible to provide the information necessary for the person to make informed choices. See the Community-Based Services Manual (CBSM) for a complete description.
Program Access and Administration
Lead agencies are responsible for providing program access and administration, which includes the following:
Notice of Action
By law, the lead agency or state must notify the MHCP member before they deny, terminate, reduce, or suspend services. The lead agency or state must send a notice in writing at least 10 days before they take action. Lead agencies (counties and Tribal nations) must use the Notice of Action (Assessments and Reassessments) (DHS-2828A) (PDF) and Notice of Action (Service Plan) (DHS-2828B) (PDF) to notify the person of impending changes to the waiver services. MCO’s use their own forms and processes.
Informed Choice
The lead agency will do the following:
Lead Agency Case Managers
Lead agency case managers determine financial eligibility for payment of Alternative Care services.
Eligible Providers
Providers who wish to offer and receive MHCP payment for EW and AC waiver services must enroll with MHCP and meet specific standards. To enroll in MHCP to provide waiver or AC program services, follow the instructions in the Home and Community-Based Services (HCBS) Programs Provider Enrollment section.
Providers must also determine which program services they are qualified to provide. Providers can find specific provider qualifications in this manual within each service description. The HCBS Programs Service Request Form (DHS-6638) (PDF) also lists qualifications.
Some waiver services require one or more of the following:
For more information, refer to one or more of the following:
Covered Services
Select the link in the following Service able to view the Community-Based Services Manual (CBSM) policy page for each service that includes the legal reference, service description, covered and noncovered services when applicable and provider standards and qualifications. If a service does not link to the CBSM, see service descriptions, billing codes, and provider standards in the sections following the table.
Service | EW | AC |
X | X | |
X | X | |
X | X | |
X | ||
X | X | |
X | ||
X | X | |
X | X | |
X | X | |
X | ||
X | X | |
X | ||
Extended Personal Care Assistance/Community First Services and Supports (PCA/CFSS) | X | |
X | X | |
X | X | |
X | ||
X | X | |
X | ||
X | X | |
X | X | |
X | ||
X | ||
X | X | |
X | X | |
X | X | |
X | X |
These services and requirements are the minimum guidelines. Lead agencies may refer to the Community-Based Services Manual (CBSM) for more information.
Extended Home Care Services – EW Program Only
Service and HCPCS | EW |
Home Health Aide Extended | X |
LPN Regular Extended | X |
LPN Complex Extended | X |
PCA – Extended | X |
RN, Regular, Extended | X |
RN Complex, Extended | X |
Additional information to extended home care services:
Refer to the extended home care services for more information.
Home Health Services – AC Program Only
Service and HCPCS | AC |
Home Health Aide | X |
Home Health Aide Visit | X |
LPN Regular | X |
LPN Complex | X |
PCA | X |
RN Regular | X |
RN Complex | X |
Skilled Nurse Visit | X |
Tele- Homecare | X |
Service Authorization
AC and EW services require a lead agency case manager/care coordinator to complete a service authorization (SA).
County and Tribal nations initiate the fee-for-service (FFS) service authorization in MMIS. If the rate, procedure code(s), or begin and end dates on the SA are incorrect, providers must contact the case manager. The case manager is ultimately responsible to ensure that the SA is accurate. If an SA line item is changed and approved, the case manager generates a revised service authorization letter (SAL) to the provider overnight and sends it the following day to the provider’s MN–ITS mailbox.
MCOs have their own service authorization systems. Contact the MCOs for instructions when obtaining authorizations and billing for EW services.
The SA allows the provider to provide services and then bill DHS to receive payment. MHCP will pay only services on the SA; however, an approved SA is not a guarantee of payment. For claim payment:
Each line item on the SA lists the following:
The EW and AC service authorization displays units, duration and rates. All authorized services need to stay within the published case mix budget caps (maximum monthly rate limit) and published state rate limits for services. For current long-term services and supports rate limits, please see Long-Term Services and Supports Rate Limits (DHS-3945) (PDF).
Providers must verify program eligibility for each member each month through the MHCP phone-based eligibility verification system (EVS) or online via MN–ITS.
Provider Quick Reference
Service Authorization Letters
Providers registered with MN–ITS receive their service authorization letters in their electronic mailboxes. Letters may be viewed, printed or saved to a disc or computer hard drive and are automatically purged after 30 days.
The Service Authorization Letters (SAL) file contains:
Prior Authorization Letters (PAL) file contains:
Service Authorization Changes
The case manager is responsible for any changes made to the SA of any member.
Changes in the Status of a Member
Change in a Member’s Need
Providers need to contact the lead agency when a member’s needs change. The case manager/care coordinator is responsible for reassessing the member and amending the community support plan.
Changes may include:
Transitioning from MA Home Care to Waiver Services OR Waiver Services to MA Home Care Services
Refer to the Home Care Services section for more information.
Home Care Nursing Payment for Spouses
Refer to the Home Care Services section for more information.
People Enrolled in Waiver Services Who Elect Hospice
Refer to the Hospice Services section for more information regarding covered services.
Billing
There are many advantages for both providers and lead agencies to coordinate efforts to ensure that an MHCP member receives necessary services, and that providers receive timely payments for services rendered. If a provider has a contract with an MCO to provide services, the provider should receive instructions from the MCO on how to ensure payment.
To bill for FFS elderly waiver and alternative care services, refer to the Billing for Waiver and Alternative Care (AC) Program section.
For extended home care services approved on the waiver authorization, submit claims using the 837I Institutional Outpatient transaction (via MN–ITS), following home care billing guidelines.
MCOs have their own service authorization systems. Contact the MCOs for particular instructions when obtaining authorizations and billing for EW services.
Authorized Services vs. Non-Authorized Services
Do not bill for services that require an SA on the same claim as services that do not require an SA.
For example, for people eligible for MA, home care therapy services (physical, occupational, respiratory and speech therapy) do not require an SA and cannot be billed on the same claim as a waiver service, such as adult day services.
Payment Rates
Lead agencies authorize service and provider payment rates. DHS establishes rate limits for AC and EW services and publishes the limits in Long-Term Services and Supports Service Rate Limits (DHS-3945-ENG) (PDF). Service rates authorized and claimed may not exceed these limits.
Most AC and EW services are authorized and paid a state-established rate. The dollar value for state-established rates is the rate limit for the service published in Long-Term Services and Supports Service Rate Limits (DHS-3945-ENG) (PDF). Some services are authorized and paid a market rate, up to the state-established limit, based on the typical price charged for the service in the community market. EW residential services, which include customized living and adult foster care, are authorized and paid a daily rate determined by the Residential Services Tool (RS Tool) completed by lead agencies.
More information about payment rates is available on the Rate methodologies for AC, ECS and EW service authorization web page in the CBSM. Review the long-term services and supports rates changes web page for the most up-to-date information about changes to rate limits.
Elderly Waiver Customized Living Services Rate Adjustment
The 2025 Minnesota Legislature approved changes to the rate floor adjustment (or minimum daily rate) for customized living services providers that are designated as disproportionate share facilities.
Eligible facilities
To be eligible to apply for customized living services minimum daily rate adjustment payments in 2026, the facility must meet all the following requirements as of Sept. 1, 2025:
Effective Oct. 1, 2023, the commissioner must not process any new initial applications for disproportionate share facilities. Only facilities that were determined eligible to be a disproportionate share facility through the Sept. 2023 application period can apply.
New requirements
The Legislature added the following requirements:
Providers must acknowledge they understand these requirements when they apply.
Adjustment amount
The Legislature-approved minimum daily rate adjustment is $141 for calendar year 2026. Qualified facilities will get adjustments up to the minimum daily rate on claims for people who use EW and receive 24-hour customized living services from Jan. 1, 2026, to Dec. 31, 2026. The payment does not apply to claims for residents who use Brain Injury (BI) and Community Access for Disability Inclusion (CADI) waivers.
Individual disproportionate share facilities began receiving minimum daily rate payments in calendar year 2022, when the rate adjustment first took effect. DHS adjusts the value of the minimum daily rate annually on January 1 as directed by law. The minimum daily rate amounts are reported in the following table.
Effective dates | Minimum Rate |
July 1, 2022, to December 31, 2022 | $119 |
January 1, 2023, to December 31, 2023 | $131 |
January 1, 2024, to December 31, 2024 | $190 |
January 1, 2025, to December 31, 2025 | $141 |
January 1, 2026, to December 31, 2026 | $141 |
How to apply
Currently approved eligible facilities can apply using Disproportionate Share Facility Application (DHS-8157) (PDF). Submit your application Sept. 1 to Sept. 30, 2025. Review the Billing section for more information.
Facilities must submit one application for each licensed assisted living facility. A facility that holds a single license for a setting that meets the definition of an assisted living facility campus under Minnesota Statutes,144G.08, subd. 4a must submit one application for the licensed campus. Providers who are exempt from assisted living licensure must submit one application for each building that has a unique street address. As a part of reviewing completed application forms, DHS will request applicants submit a census list of members on a waiver program in a secure and encrypted format to verify the resident numbers submitted on the application form.
DHS will designate eligible facilities by Oct. 15, and qualified facilities receive the minimum daily rate adjustment from Jan. 1 through Dec. 31, in the year immediately following the application period.
Lead agency information
For lead agency information, see the Customized living (including 24-hour customized living) section of the Community-Based Services Manual (CBSM) or contact dhs.aasd.hcbs@state.mn.us.
Elderly Waiver Obligation and MA Spenddown
Eligibility for EW is based on two income limits:
The waiver obligation is:
An MA spenddown may be met with any combination of MA services, including HCBS services. MA spenddowns must be met each month.
The lead agency financial worker enters the waiver obligation or MA spenddown into MMIS. DHS will report the amount the provider can bill the member on their remittance advice. Claims that are reduced due to the EW obligation or spenddown will show claim adjustment reason code PR 142 on the remittance advice. MCOs also receive reports on their enrollees who have waiver obligations and spenddowns. Each MCO has a process for informing providers on amounts of waiver obligations and spenddowns. See the Special Income Standards (SIS), in Appendix F, of the MHCP Eligibility Policy Manual.
A person enrolled in MHCP can designate a provider to whom they will pay the obligation. The member must notify the financial worker if he or she wishes to choose this option. Members who receive waiver services through an MCO cannot use the designated provider option that is available through the financial worker request.
Home Care Services Provided for an MA-eligible Member Receiving EW Services
All people receiving EW services must first access MA home care services to the highest extent before adding EW services to the community support plan.
MA covers the following home care services:
Home Care and EW Waiver
Home Care and AC
The lead agency case manager determines and authorizes the amount of home care services that are counted towards the member’s case mix budget. AC does not have an MA benefit.
Legal References
Minnesota Statutes, 245A (Human Services Licensing)
Minnesota Statutes, 245A.143 (Family Adult Day Services)
Minnesota Rules, 9555.9600 – 9555.9730 (Adult Day Services Center Licensure)
Minnesota Rules, 9555.5050 – 9555.6265 (Adult Foster Care Services and Licensure)
Minnesota Statutes, 245A.03 (Who Must Be Licensed)
Minnesota Statutes, 148.171 – 148.285 (Public Health Occupations)
Minnesota Rules, 9575.0010 – 9575.1580 (Merit System)
Minnesota Statutes, 256.012 (Minnesota Merit System)
Minnesota Statutes, 256B.02, subdivision 7 (Definitions – Vendor of Medical Care)
Minnesota Statutes, 256B.0913 (Alternative Care Program)
Minnesota Statutes, 256S (Medical Assistance Elderly Waiver)
Minnesota Statutes, 144D.025 (Optional Registration)
Minnesota Rules, 9555.5105 – 9555.6265 (Social Services for Adults)
Minnesota Rules, 9555.6205, subparts 1 – 3, 9555.6215, subparts 1 and 3, and 9555.6225, subparts 1, 2, 6 and 10 (Social Services for Adults)
Minnesota Rules, 4668 (Home Care Licensure)
Minnesota Rules, 4669 (Home Care Licensure Fees)
Minnesota Statutes, 144D (Housing with Services Establishment)
Minnesota Statutes, 256B.0653 (Home Health Agency Services)
Minnesota Statutes, 326B.802, subdivision 11 (Definitions – Residential Building Contractor)
Minnesota Rules, 4626 (Food Code; Food Managers)
Minnesota Statutes, 245C (Human Services Background Studies)
Minnesota Statutes, 245D (Home and Community-Based Services Standards)
Minnesota Statutes, 245A.03, subdivision 2, (a)(1) – (2) (Exclusion from licensure)
Minnesota Statutes, 144A (Nursing Homes and Home Care)
Minnesota Statutes, 144A.43 – 144A.45 (Nursing Homes and Home Care)
Minnesota Statutes, 148.621 (Definitions)
Minnesota Rules, 3250 (Licensure and Practice)
Minnesota Statutes, 148.623 (Duties of the Board)
Minnesota Statutes, 157.17 (Additional Registration Required for Boarding and Lodging Establishments or Lodging Establishments)
Minnesota Statutes, 144.696, subdivision 3 Definitions -– Minnesota Statutes, 144.50 (Hospitals, Licenses; Definitions) Minnesota Statutes, 144.058 (Interpreter Services Quality Initiative)
Minnesota Statutes, 256B.0659 (Personal Care Assistance Program)
Minnesota Rules, 9505.0335 (Personal Care Services)
Minnesota Rules, 9505.0290, subpart 3B (Home Health Agency Services)
Minnesota Rules. 9505.0175, subpart 23 (Definitions – Long-term Care Facility)
Minnesota Rules, 9505.0310 (Medical Equipment and Supplies)
Minnesota Rules, 9505.0195 (Provider Participation)
Minnesota Statutes, 65B (Automobile Insurance)
Minnesota Statutes, 174.30 (Operating Standards for Special Transportation Service)
Minnesota Statutes, 174.29 – 174.30 (Department of Transportation)
Code of Federal Regulations, title 42, part 441, subpart G, 441.310(a)(2)(ii) (Limits on Federal Financial Participation [FFP])
Laws of Minnesota, 2022 Regular Session, Chapter 98, Article 7, Section 31 or 2022 Minnesota Statutes, 256S.205 (Customized Living Services; Disproportionate Share Rate Adjustments)
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