This Medicaid Waiver provides services to individuals ages 65 or older and individuals with physical disabilities ages 18-64 years who meet a nursing facility level of care.
Overview of the CT ABI Waiver II
The Connecticut Acquired Brain Injury (CT ABI) Waiver II is a Medicaid home and community-based services (HCBS) waiver program designed to serve individuals 65 and over and individuals with physical disabilities aged 18 through 64. This program focuses on enabling these individuals to live in home and community-based settings, including assisted living facilities, as an alternative to nursing facilities.
The primary goal of the CT ABI Waiver II is to provide in-home supports to its participants, which includes both elders and individuals with physical disabilities. These supports are tailored to help participants with their daily activities while allowing them to maintain independence and stay within their communities.
The objectives of the CT ABI Waiver II include ensuring that the target populations:
- Remain in home and community-based settings that adhere to the HCBS regulation standards.
- Have access to participant-directed supports.
- Experience enhanced quality of life through preserved independence and maintained relationships with family and friends.
- Benefit from various long-term services and supports, including conflict-free case management and person-centered planning.
The Department of Health Care Finance (DHCF) administers the program, oversees contracted entities and providers, and manages the waiver's processes.
Eligibility Requirements
The eligibility criteria for the CT ABI Waiver II include the following requirements:
- Medicaid Eligibility: The individual must be eligible for Medicaid with a maximum monthly income of three hundred percent (300%) of Supplemental Security Income (SSI).
- Level of Care Requirement: The individual requires the level of care provided in a nursing facility under Medicaid.
- Age and Disability Criteria: The individual must be aged 65 or older or between 18 and 64 with one or more physical disabilities.
- Residential Status: The individual must not be an inpatient of a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities.
Additionally, there are specifically reserved capacities for specific groups within the program: 60 beneficiaries are allocated for individuals transitioning from institutional care to the community (under the Money Follows the Person program), and 15 beneficiaries are reserved for individuals aging out of HSCSN enrollment or those eligible for the EPD waiver. Once these reserved capacities are established, there are no additional preferences and participation in the waiver is allocated on a first-come, first-served basis.
Services and Supports
The CT ABI Waiver II program offers various services to support eligible participants. The services covered under this waiver include:
- Adult Day Health: Non-residential medical supports and supervised therapeutic activities in a community setting to foster community inclusion and prevent more costly facility-based care.
- Case Management: Conflict-free case management services to support individuals in accessing and coordinating long-term care services and supports.
- Homemaker: Assistance with household tasks and activities to support individuals in maintaining a clean and safe living environment.
- Personal Care Aide: Assistance with personal care activities such as bathing, dressing, and grooming.
- Respite: Temporary relief services for caregivers, allowing them time away while ensuring the individual's needs are met.
- Assisted Living: Services provided in an assisted living setting help individuals live as independently as possible.
- Chore Aide: Assistance with heavy household chores to maintain a healthy living environment.
- Community Transition Services: Support for individuals transitioning from an institutional setting to a community-based setting.
- DSNP/Managed Care Capitated Waiver Services: Services provided under a managed care model.
- Environment Accessibility and Adaptation Services: Modifying the home environment to improve accessibility and safety.
- Individual Directed Goods and Services: Services or items not otherwise provided through the waiver or Medicaid State Plan, which address an identified need in the service plan.
- Participant-Directed Community Support Services: Services directed by the participant that assist them in living independently in the community.
Compensation for Caregivers
CT ABI Waiver II participants can self-direct certain services, such as participant-directed community support (PDCS). This option allows participants to control how these services are provided and by whom. A district-wide IRS-approved Vendor Fiscal/Employer Agent FMS-Support Broker entity offers financial management services and assistance to support this. This setup implies that caregivers chosen by participants can access compensation through this structured support system.
Limitations and Challenges
A limitation of the CT ABI Waiver II, like many Medicaid waivers, could be its strict eligibility criteria and potential limitations in service coverage, which might not encompass every individual's needs. Additionally, navigating the participant-direction opportunities and administrative processes might be challenging for some participants and their families.
A Note from Givers
We encourage you to fill out our free assessment to learn more about the CT ABI Waiver II and determine if you or your loved one qualifies for caregiver compensation. Our team is ready to assist you in navigating this beneficial program.
