Federally approved BI, CAC, CADI, DD and EW plans, Minn. Stat. §256B.0913, Minn. Stat. Ch. 256S, Minn. Stat. §256B.0922

Institutional settings: For the purposes of this page, an institutional setting is a:

This page applies to the following programs:

Anyone may apply for waiver, AC or ECS programs. The lead agency can receive referrals from a variety of sources (e.g., the person, discharge planners, schools, health care providers, other lead agencies). For more information, refer to the initial assessment section on CBSM – Assessment applicability and timelines.

During the assessment and reassessment process, the assessor works with the person to determine eligibility for waiver programs and services. Then, the assessor completes the MnCHOICES assessment summary. For more information, refer to:

The assessment process also includes support planning. After the assessment, the case manager/care coordinator creates a support plan in partnership with the person and/or their legal representative.

The support plan documents the person's informed choices about the program, provider(s) and services. For more information, refer to:

BI, CAC, CADI and DD

For people who use BI, CAC, CADI and DD, the case manager:

The lead agency enters service authorizations into the Medicaid Management Information System (MMIS). The county of financial responsibility approves the service authorization. Once approved, MMIS produces a service agreement, which allows providers to bill for approved services.

AC, ECS and EW

For people who use AC, ECS and EW, the case manager/care coordinator:

For service authorization instructions, refer to the applicable document:

Once a service agreement is authorized, providers are able to bill for approved services.

All programs

Limitations

The case manager/care coordinator cannot authorize waiver, AC or ECS services that do not meet the service requirements. For more information, refer to CBSM – Waiver/AC programs overview – Services.

A person cannot receive waiver, AC or ECS services in an institutional setting (as described in the definition section), unless specified in a service description. If a person enters an institutional setting, follow the process on CBSM – Temporary waiver exits and restarts: MMIS actions.

Paying relatives and legally responsible individuals

Under certain circumstances, relatives and legally responsible individuals may be paid to provide waiver, AC or ECS services to a person. For more information, refer to CBSM – Paying relatives and legally responsible individuals.

To transition from one waiver program to another, a person must meet the level of care and eligibility criteria required for the requested waiver. This information is determined through a reassessment .

For more information, refer to:

BI, CAC and CADI

A person age 65 or older at the time of the initial waiver application is not eligible to enroll in the BI, CAC or CADI waivers.

65th birthday assessment

When a person who receives BI, CAC or CADI waiver services turns 65 years old, the person may choose to stay on BI, CAC or CADI.

The county/tribal nation must conduct in-person reassessments for all people on the BI, CAC and CADI waivers when they turn 65 years old.

At the 65th birthday reassessment, a person may choose to either:

For more information, refer to CBSM – Assessment applicability and timelines – 65th birthday assessment.

Returning to a disability waiver after age 65

There is no maximum age for people age 65 and older to return to BI, CAC and CADI waivers when certain criteria are met.

A person who was previously enrolled in BI, CAC or CADI before age 65 may reopen to BI, CAC or CADI after age 65 in either of the following scenarios:

1. The person exited the waiver for institutional care and is returning to BI, CAC or CADI within 180 days from the date of exiting. This scenario includes people opened to EW and returning to BI, CAC or CADI within 180 days from exiting for institutional care.

In this scenario, the county/tribal nation can reopen the person to BI, CAC or CADI without submitting a request to DHS if the person continues to meet all the eligibility criteria for that waiver.

2. The person meets all of the following criteria:

In this scenario, the county/tribal nation must submit a request using Reopening someone who is 65 years or older to a disability waiver, DHS-7759D.

Managed care organizations (MCOs) should contact the county/tribal nation if they identify a person who requests to return to BI, CAC or CADI.

For information about the assessment process, refer to CBSM – Assessment applicability and timelines – Initial assessment.

Changing disability waivers after age 65

A person on the BI, CAC or CADI waiver may change to another disability waiver after age 65 without DHS approval if the person meets all eligibility requirements for the other waiver.

DD Waiver

There is not a 65th birthday assessment requirement for people on the DD Waiver. People of any age can access the DD Waiver if they meet eligibility requirements (refer to CBSM – DD Waiver).

Changing disability waivers after age 65

A person on the DD Waiver may change to another disability waiver after age 65 if all of the following criteria are met:

To submit a request, contact the applicable RRS (refer to CBSM – RRSs).

BI, CAC, CADI and DD

Some waiver services only can be provided to people living in their own homes. For information about how to determine if a setting is considered a person's own home, refer to CBSM – Requirements for a person's own home (BI, CAC, CADI and DD).

The lead agency only may authorize waiver or AC services outside of Minnesota under certain conditions when the person is either temporarily traveling out of state or if the person is attending an out-of-state post-secondary school.

Temporary travel

A person on AC, BI, CAC, CADI, DD or EW can travel temporarily outside of Minnesota, within the United States, and continue to receive certain waiver services.

The person must maintain:

Services are limited to direct-care-staff services (defined below) authorized in the person’s support plan.

Waiver plan requirements continue to apply to services provided outside of Minnesota and include:

Non-covered expenses

The waiver does not pay for travel expenses for the person on the waiver and the person’s companions. Companions include paid and non-paid caregivers.

Time limit

For people on AC and EW, temporary travel is defined as a maximum of 60 days per calendar year, with the exception of emergencies. In situations in which temporary travel may exceed 60 days due to an emergency (e.g., canceled flights by airlines, family emergencies, etc.), the case manager must be notified as soon as possible and before the 60th day. The case manager determines whether the situation constitutes an emergency and whether to authorize additional waiver services.

This time limit does not apply to BI, CAC, CADI and DD.

People attending post-secondary school

A person attending an out-of-state post-secondary school within the United States can continue to receive direct-care-staff services (defined below) when:

Waiver plan requirements continue to apply to services provided outside of Minnesota and include:

Direct-care-staff services

Direct-care-staff services are:

Out-of-state travel without services

When a person temporarily travels out of state or attends an out-of-state post-secondary school and does not receive direct-care-staff services, refer to CBSM – Waiver, AC and ECS case management – Service requirements and exceptions.

A person who resides in Minnesota may have a need to use a provider who is in a bordering state. In these instances, the lead agency may authorize waiver services when:

Lead agencies must terminate a waiver, AC or ECS program or services for a person when:

When the lead agency terminates a waiver, AC or ECS program or services for a person, the lead agency:

For additional information, refer to CBSM – Temporary waiver exits and restarts: MMIS actions.