32 Miss. Code. R. 1-10.0
The Independent Living (IL) waiver provides services to clients who, but for the provision of such services, would require the level of care found in a nursing facility. The IL Waiver is a Medicaid home and community-based waiver operated jointly with the Division of Medicaid.
Eligibility is limited to individuals age sixteen (16) or older who have severe orthopedic and/or neurological impairments and possess maximum medical improvement potential. Maximum medical improvement potential, as defined by DOM, has been achieved when all of the following criteria are met:
* Client/applicant is able to communicate effectively with caregiver, Personal Care Attendants (PCA's, Counselors and others);
* Client/applicant is certified as medically stable by their primary physician. Medical stability is defined as the absence of the following:
* an active, life threatening condition (e.g. sepsis, respiratory, or other condition requiring systematic therapeutic measures);
* intravenous drip to control or support blood pressure;
* inter-cranial pressure or arterial monitoring; and
* a diagnosis of dementia, Alzheimer's, mental illness, mental retardation or any related condition of such severity that renders the individual unable to direct his/her own care.
Clinical eligibility for the IL waiver will be determined through the utilization of a comprehensive pre-admission screening tool which encompasses the following areas: activities of daily living, instrumental activities of daily living, sensory deficits, cognitive deficits, client behaviors, medical conditions, and medical services.
Clients/applicants must be Medicaid eligible either as an SSI recipient or meet the 300% of the Supplemental Security Income Federal benefit rate.
Note: All services are provided pursuant to an individualized plan of care approved by the Division of Medicaid and the development of an Independent Living Plan.
Additional Eligibility for Enrollment:
The basic eligibility criteria include:
* age - be 16 years of age or older
Note: Elderly and Disabled Waiver serves individuals 21 years of age and older.
MR/DD Waiver services children under age 21.
* financial eligibility the individual must be eligible for Medicaid as described in the waiver
* medical necessity the individual must meet the level of care criteria for nursing facility (NF) care based on Physician Certification Form.
* waiver specific criteria the individual must meet based on his/her choice of services and service planning. They must:
- have a severe orthopedic and/or neurological impairment
- choose home and community based services in lieu of nursing facility care/informed choice;
- have an on-going need for waiver services;
- need assistance with one or more of the activities of daily living such as dressing, bathing, eating, toileting, transferring;
- be able to communicate effectively with caregivers, Personal Care Attendants, case managers, and others involved in their care, and
- be at risk of nursing facility placement if services were not available
Enrollment in the Independent Living Waiver is limited to:
* the number of individuals approved by the Centers for Medicare and Medicaid Services (CMS) or the availability of state funding
* individuals are enrolled from the Independent Living Waiver Referral List on a "first come, first served" basis
* MDRS suspends enrollment into the waiver program when it is determined that the existing caseloads exceed funds within the current budget year.
32 Miss. Code. R. 1-10.0