Institutional Care Program (ICP)
The institutional Care Program (ICP) helps people in nursing facilities pay for the cost of their care and other medical services. The person is determined to be in need of nursing facility services and appropriate placement as determined by the Department of Elder Affairs (DOEA), Comprehensive Assessment and Review for Long-Term Care Services (CARES) process.
Other important criteria for ICP eligibility include:
Transfer of Assets – assets transferred on or after January 1, 2010, may potentially affect eligibility. The “look-back” period for asset transfers is 60 months prior to the application month.
Spousal Allowance – assets and income are evaluated for married individuals when one spouse is institutionalized, and one spouse continues to live in the community (referred to as the “community spouse”). The community spouse may be eligible to receive a portion of the institutionalized spouse’s income.
Medicaid for Aged and Disabled (MEDS-AD)
Medicaid for low-income individuals who are either aged (65 or older) or disabled. This program does not cover blind individuals, unless they are considered disabled.
The individual must meet the following technical requirements: (1) age or disability, (2) U.S. residency, (3) citizenship, (4) welfare enumeration, (5) third party liability, (6) application for other benefits they may be eligible to receive, (7) not be receiving Medicare, or (8) if receiving Medicare also be receiving institutional, hospice or home and community based services.
Individuals are considered to be receiving home and community based services (HCBS) when they are: (1) enrolled in a HCBS waiver, (2) enrolled in the Program of All-Inclusive Care for the Elderly (PACE), or (3) residing in an assisted living facility, adult family care home or mental health residential treatment facility licensed to provide assistive care services, or (4) identified by the Agency for Health Care Administration as an individual receiving services through the Frail/Elder Program as of December 31, 2005. See DCF Policy Passage 2040.0813.03 Technical Requirements for MEDS-AD.
Individuals residing in an assisted living facility, adult-family care home or mental health residential treatment facility may qualify for the MEDS-AD Program if the facility in which they reside is licensed to provide assistive care services (ACS) and the individual meets all other program criteria. See DCF Policy Passage 1440.1106 Receipt of Assistive Care Services.
The Hospice Program helps maintain care for terminally ill individuals. To receive Hospice services, the individual must enroll in a Hospice program. Additional technical criteria include: a medical prognosis that life expectancy is six months or less (as long as the illness runs its normal course), election of hospice services, and a certification of the individual’s terminal illness by a physician or medical director.
Program of All-Inclusive Care for the Elderly (PACE)
The Program of All-Inclusive Care for the Elderly (PACE) provides home and community-based services for individuals in need of nursing facility care as assessed by DOEA Cares. Once enrolled in PACE, an individual may continue PACE services even if the individual moves to an assisted living facility or nursing home.
An individual enrolled in PACE will have their medical needs managed regardless of their living situation (home, Assisted Living Facility (ALF), or nursing facility). Additional technical criteria include: election of a PACE provider as the sole source of Medicare and/or Medicaid service delivery, at least 55 or older (must meet disability criteria if under age 65), and meet a nursing home level of are as determined by CARES. Note: PACE is not a waiver but follows the same eligibility criteria as HCBS.
Home and Community Based Services (HCBS) Waivers
The HCBS Waivers allow individuals to live in the community in an effort to avoid institutionalization. HCBS Waivers are: Cystic Fibrosis (CF) Waiver, Familial Dysautonomia (FD) Waiver, iBudget Waiver, Model Waiver, Project AIDS Care (PAC) Waiver, Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Waiver, and Traumatic Brain and Spinal Cord Injury Waiver.