HOME CARE SERVICES
There is a child or an adult in the household who meets the disability or medical necessity criteria for home care services. For the purpose of this determination, home care services means a medically necessary health service that is ordered and documented in a service plan that is reviewed by the physician or other qualified ordering entity at least once every 60 days for the provision of home health services or home care nursing. Medical necessity for Personal Care Assistant Services (PCA) is determined by an annual lead agency (county, tribal nation or Managed Care Organization (MCO)) eligibility assessment of the child or adult. For additional information, see the Home Care CBSM pages.

HOME AND COMMUNITY-BASED WAIVER SERVICES
There is a child or an adult in the household who meets the disability or medical criteria for a home and community-based waiver services program. Also see the Minnesota Health Care Programs Eligibility Policy Manual for additional information. Services available are those not normally covered by Medical Assistance (MA) such as case management, homemaker services, adult day services, and respite care. Each of the waivers serves both people moving from an institutional setting to the community and people who are determined to be "at risk of" the level of care provided in the respective institutional setting. The provisions of this criterion apply to the following home and community-based waiver services programs:

Alternative Care (AC)
A state-funded program with federal grant match for people age 65 or older who require the level of care provided in a nursing home but choose to stay in the community, and whose personal financial resources would allow a nursing facility stay of no more than 135 days. AC participants are also not yet eligible for Medical Assistance. For specifics regarding AC eligibility requirements and services, see the Alternative Care CBSM page.

Community Access for Disability Inclusion (CADI)
A program that provides home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding CADI waiver eligibility and services, see CBSM - Community Access for Disability Inclusion (CADI) Waiver.

Community Alternative Care (CAC)
A program that provides home and community-based services to children and adults who are chronically ill or medically fragile and require the level of care provided in a hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding CAC waiver eligibility and services, see CBSM - Community Alternative Care (CAC) Waiver.

Brain Injury Waiver (BI)
A program that provides home and community-based services to children and adults with a diagnosis of brain injury who require the level of care provided in a specialized nursing facility or neurobehavioral hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. People must be younger than 65 years old at the time of opening to the program for the first time, and may remain on the waiver after age 65 if warranted by their needs and service plan. For specifics regarding BI waiver eligibility and services, see CBSM - Brain Injury (BI) Waiver.

Developmental Disabilities (DD) Waiver
A program that provides home and community-based services to children and adults of any age with a diagnosis of a developmental disability or a related condition who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD). These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety and community integration. For specifics regarding DD waiver eligibility and services, see CBSM - Developmental Disabilities (DD) Waiver.

Elderly Waiver (EW)
A program that funds home and community-based services for people age 65 and older who require the level of care provided in a nursing home and choose to live in the community. EW promotes community living and independence with services and supports that address each person's individual needs and choices. EW offers services that go beyond what is available through Medical Assistance. For specifics regarding EW eligibility requirements and services, see CBSM - Elderly Waiver.

SEVERE EMOTIONAL DISTURBANCE (SED)
There is a child or children in the household who meet the following definition of “severe emotional disturbance” as determined by a qualified professional such that he/she:

- Has been admitted within the last 3 years or is at risk of being admitted to inpatient or residential treatment for an emotional disturbance.

OR

- Is a Minnesota resident receiving inpatient treatment or residential treatment for the emotional disturbance through the interstate compact.

OR

- Has been determined by a mental health professional to have psychosis or clinical depression, to be at risk of harming self or others as a result of emotional disturbance, or to have psychopathological symptoms that resulted from physical or sexual abuse or psychic trauma within the past year.

OR

- Has significantly impaired home, school, or community functioning for at least 1 year or for a period that a mental health professional documents as presenting substantial risk of lasting at least a year.

SERIOUS AND PERSISTENT MENTAL ILLNESS (SPMI)
There is an adult or adults who meet the definition of “serious and persistent mental illness” as determined by a qualified professional such that he/she:

- Has undergone 2 or more episodes of inpatient care for a mental illness within the preceding 24 months.

  OR

- Continuously experienced a psychiatric hospitalization or residential treatment exceeding 6 months' duration within the preceding 12 months.

  OR

- Has been treated by a crisis team 2 or more times within the preceding 24 months.

  OR

- Has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline personality disorder which indicates a significant impairment in functioning and a mental health professional documents that he/she is reasonably likely to have future episodes requiring inpatient or residential treatment unless ongoing case management or community support services is provided.

  OR

- Has been court-committed as a mentally ill person in the past 3 years or has had the commitment stayed or continued.

  OR

- Meets any of the criteria above but the specified time period has expired.

  OR

- Was diagnosed with severe emotional disturbance as a child and who a mental health professional has documented in the past 3 years is reasonably likely to have future episodes requiring inpatient or residential treatment unless ongoing case management or community support services is provided.

Presumed unable to work and do not need to verify their inability to work.

Eligible for Family Stabilization Services (FSS). See 0011.34 (Family Stabilization Services).

Eligible for a hardship extension beyond 60 months if they still meet the special medical criteria.

Eligible for 1 additional banked month to be used beyond 60 months for each month during their 1st 60 months that they qualify for special medical criteria.

Only 1 parent can qualify for the special medical criteria in a 2-parent household with a child or an adult who meets the disability or medical criteria for home care services. If the family provides documentation from their health care provider that a 2nd parent is also needed in the home to care for the child or adult who meets the special medical criteria, the 2nd parent may be eligible for FSS under the category for participants whose presence is needed in the home because of the illness or incapacity of another member of the assistance unit.

If the special medical criteria no longer applies, they must use the banked months before they can be extended under an extension category. Participants are subject to regular Employment Services requirements and Pre 60 month sanction policies while using banked months. If the participant is in a 2-parent unit in which 1 parent is extended under the hard to employ or employed/employed with limited hours extension category, then post-60 month sanction policies apply. If there is information known to the county or employment services provider that the participant may meet 1 of the other Family Stabilization Services (FSS) eligibility criteria, then FSS sanction provisions must be followed prior to imposing a sanction. See 0028.30.04.03 (Post-60 Month Sanctions: 2-Parent Provisions), Employment Services Manual 17.61 (Sanctions).

If the special medical criteria still applies, extend them on the special medical criteria category and DO NOT use banked months. When the caregiver is no longer eligible for the special medical criteria extension category, they must use the banked months before being re-assessed for a different extension category. After the banked months have been exhausted, evaluate the caregiver to see if there is eligibility for an extension under another extension category. See TEMP Manual TE13.041 (Special Medical Criteria – MAXIS Coding Tips).