The Medicaid Waiver Program is one
of two funding sources for UPCAP’s Care Management Program.
Enrollment into the Medicaid Waiver Program is based on the need
for long-term care, eligibility for nursing home level of care
as defined by the State, and financial eligibility criteria. The
financial eligibility criteria used for the Medicaid Waiver
Program is the same as is used for financial support from
Medicaid for actual nursing home placement.
Under the Medicaid Waiver Component of UPCAP’s Care
Management Program, a person who meets the Medicaid eligibility
guidelines may have access to a significant source of funding
for needed services. Actual service provision is based on the
plan of care developed by UPCAP’s Care Managers as a direct
result of the needs assessment. As part of the assessment
process, UPCAP’s Care Managers will complete a Medicaid
Application and submit it to the local Family Independence
Agency for an eligibility determination.
UPCAP’s Care Managers are well versed in the financial
eligibility requirements for Medicaid and will assist those
individuals seeking assistance through Care Management with the
necessary paper work. They will also work with the FIA office to
obtain necessary verification of finances. The eligibility
criteria established for the Medicaid Waiver Component are
different from those of normal community based Medicaid and
restrictions do apply. Only UPCAP’s Care Managers can
establish Waiver eligibility, and such eligibility can only be
established after the completion of the assessment process.
Once an individual is deemed financially eligible, UPCAP is
able to assist that person in purchasing a wide variety of
in-home and supportive services. These services are purchased by
UPCAP directly from over fifty U.P. home care agencies. Despite
the wide variety of services available through the Waiver
Program, not all needed services are covered under Medicaid
guidelines. Here again UPCAP’s Care Managers play an important
role as they are extremely knowledgeable in what is covered,
what is not, and how to access those needed services which are
not covered. Payment for non-covered services may come from
other entitlement programs such as Medicare, the Older Americans’
Act, State or Community resources, private insurances, and as
always, private pay resources.
