Alternative Care (AC)
Page posted: 10/1/03 | Page reviewed: 9/27/24 | Page updated: 5/20/25 | |
Legal authority | Federally approved AC 1115 demonstration, Minn. Stat. §256B.0913 | ||
Definition | Alternative Care (AC): Program that provides home and community-based services (HCBS) for people age 65 and older who require the level of care provided in a nursing facility, choose to live in the community and are not yet financially eligible for Medical Assistance (MA). | ||
Purpose | The AC program promotes community living and independence with services and supports designed to address each person’s individual needs and choices. | ||
Eligibility | To be eligible for the AC program, a person must choose to receive community services and meet all the following criteria: A person cannot be on AC if they: Temporary ACThe AC program can temporarily serve a person who is financially ineligible for AC for up to 60 days if they: There are no service differences between temporary AC and regular AC, other than the restricted amount of time a person can be active on the program. Choosing between AC and MAA person can choose between AC and MA when they: | ||
Covered services | The following services are covered under the AC program. For a service-specific policy page, select a service from the list: | ||
Non-covered services | The AC program does not cover: Note: Older Americans Act [OAA] funding is not considered “another funding source” for this purpose because people on AC are not legally entitled to receive OAA-funded services. DHS does not require that OAA programs fund benefits that are available to a person through AC. The lead agency should authorize the service or amount of service the person needs within the limits of AC. If a person age 60 or older needs additional services beyond what can be authorized under AC, OAA programs may be an option for the person. For more information, refer to ACL – OAA payer of last resort. Monthly conversion budget limits are not available under AC. For more information, refer to the case mix budget exceptions section of CBSM – AC and EW budgets and case mix caps. | ||
Secondary information | The AC program covers many of the same services covered under EW. AC also covers the following services that are not covered by EW: The AC program is not provided through managed care organizations (MCOs). The AC program has the same transfer penalty period policy as MA. A person cannot access AC or MA during their transfer penalty period. | ||
Estate recovery | The AC program has the same estate claim policy as MA. Lead agencies should share AC Program Recovery Information, DHS-5186 (PDF) with people on the AC program. When a person on AC dies, their case manager must submit a completed Referral for An AC Estate Claim, DHS-4801 (PDF) to the probate department of the person’s county of financial responsibility. | ||
Citizenship and immigration | All MA citizenship verification requirements apply to the AC program. In the limited circumstance that a person applying for AC who is a U.S. citizen or national does not qualify for Medicare and does not meet an exemption, the county or tribal nation must electronically verify citizenship and immigration status. The county or tribal nation must request a SAVE query to electronically verify the person’s immigration status before requesting paper proof. The county or tribal nation works with their county or tribal eligibility workers to request a SAVE query for people who are noncitizens. | ||
AC allocations | As of July 1, 2015, all AC program funds are held in a single, statewide account. DHS no longer allocates funds to individual lead agencies. Since Nov. 1, 2013, DHS receives a federal match for the AC program due to approval of an 1115 waiver with the Centers for Medicare & Medicaid Services (CMS). DHS continues to receive an appropriation from the Minnesota Legislature for the AC program. Lead agencies can continue to track spending and individual and average costs, but they do not submit an AC plan and budget to DHS. For assistance with tracking and monitoring AC activity, lead agencies can use MMIS InfoPac reports. The reports include data such as the total amount of local AC services authorized, number of units used and number of people who receive AC services. Lead agencies can continue to apply for discretionary funds. For instructions, refer to CBSM – AC discretionary services. For additional financial information, refer to CBSM – Rate methodologies for AC, ECS and EW service authorization. | ||
Tools | Refer to the following forms for the AC program: | ||
Additional resources | CBSM – AC discretionary services | ||
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