Section 144-332-13-1 - DEFINITIONSIndividuals can get Medicaid coverage and special services if they meet the medical and financial requirements of one of the following coverage groups:
I.Home and Community Benefits for the Elderly and for Adults with Disabilities Waiver:This is for individuals (age 18 or older) who meet nursing facility level-of-care requirements and choose to remain at home. Some of the services include: care coordination, personal support services, home health services, adult day health services, transportation, emergency response system, environmental modifications and respite services. The program rules are in Section 19 of the MaineCare Benefits Manual, (10-144 CMR Chapter 101)II.Support Services for Members with Intellectual Disability or Autistic Disorders: This benefit provides support services to members who most commonly live on their own or with families; there are occasionally individuals living in group homes who are also eligible. The major support services are community support and work support. This waiver does not provide any residential services. The program rules are in the MaineCare Benefits Manual, Section 29. III.Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Waiver:This waiver offers a comprehensive mix of services to members age 18 or older. The major services offered are: home support-including support to live alone or in settings with others (i.e. group homes), community support, and work support. The program rules are in the MaineCare Benefits Manual, Section 21. These individuals are residing in the community, and have been classified as needing nursing facility level-of-care requirements or meeting the ICF-IID level of care.
IV.Home and Community Based Waiver Benefit for Children with Intellectual Disabilities and/or Pervasive Developmental Disorders (ID and/or PDD): This waiver provides an alternative to institutional care to children aged five through twenty with ID and /or PDD who would otherwise require services in an ICF-IID or a psychiatric hospital. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 32. V.Home and Community Based Waiver Benefit for Adults with Other Related Conditions Aged 21 and Over: This waiver provides an alternative to institutional care to adults aged 21 and older with a "related condition," as defined at 42 C.F.R. § 435.1010. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 20. VI.Home and Community Based Waiver Benefit for Adults with Brain Injury: This waiver provides an alternative to institutional care to adults aged 18 and older with brain injury. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 18. An individual eligible for waiver may live with family members eligible for community MaineCare. The waivered individual's income and assets are used in the eligibility determination for the remaining family members.
Example
Mr. Clooney lives with his wife, Wendy. They meet SSI - Related criteria as a married couple. Mr. Clooney's eligibility for community MaineCare will be based on the combined income and resources of the couple, with an income limit for a household of two. Wendy's eligibility for waiver services is based on income and resources owned solely by her.
Eligibility for the Medicare buy-in is determined using community rules for a couple. Eligibility for waiver does not affect how the Medicare Buy-In is determined.
10- 144 C.M.R. ch. 332, § 13-1