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Mental Retardation HCBS Waiver - Iowa

The mental retardation (MR) services waiver pays for services to persons with a primary diagnosis of mental retardation who would otherwise require care in a medical institution.

To be eligible for the mental retardation waiver, the person must meet all of the following requirements:

·           Have a primary diagnosis of mental retardation, as verified by the service worker or case manager. The Iowa Foundation for Medical Care (IFMC) uses the required assessment tool and support documentation to determine level of care.

·           Be certified by IFMC to need long-term care that but for the waiver, would otherwise be provided in an intermediate care facility for the mentally retarded. This includes:

·                        Residential care facilities (RCFs)

·                        County care facilities

·                        Community supervised apartment living arrangements

·           Be receiving Medicaid case management services or be identified to receive case management services immediately following waiver enrollment.

·           Have service needs that can be met by the waiver program. Adults must receive at least one unit of supported community living service or supported employment or respite per month. Children must receive at least one unit of respite care or supported community living service per month.

·           Have an individual comprehensive plan completed annually. "Individual comprehensive plan (ICP)" means a written consumer-centered outcome-based plan of services developed using an interdisciplinary process that addresses all relevant services and supports being provided or proposed to be provided. The ICP is also known as a case permanency plan or individualized program plan.

·           Be eligible for Medicaid in one of the following coverage groups:

·                        SSI or SSI-related, with the exception of Medically Needy. The waiver applicant must meet all of the standard SSI eligibility requirements, including disability.

·                        FMAP-related, with the exception of Medically Needy. The waiver applicant must meet all of the standard FIP eligibility requirements.

·                        Foster care. Determine Medicaid eligibility under the MR waiver coverage group for applicants who are currently eligible because of foster care.

·                        300 percent coverage group or eligible for SSI but for living in a medical institution.

Waiver Slots:

The number of people served under the mental retardation services waiver is subject to a limit based on the number of payment slots. The county of legal settlement (for nursing facility care for the mentally retarded level of care for adults) and the state (for all other) designate the number of people to be served under each waiver. The payment slots are on a county basis for adults with legal settlement. Services will be denied and the applicant will be placed on the waiting list if the limit on the number of payment slots has been reached. As slots become available, people are selected in order from the waiting list to keep the number of approved people on the program.

See Also:

·           HCBS Waivers Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter N, pages 44-53

Regulation citations: 441 IAC Chapter 83, Division IV; 83.61(3) and (4)"a"; 83.61(4)

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