In order to determine medical eligibility, the member and Case Manager must provide to DHHS the following:Ī. The estimated annual cost of the member's services under the waiver is equal to or less than two hundred percent (200%) of the state-wide average annual cost of care for an individual in an ICF/IID, as determined by the DHHS.
Meets all MaineCare eligibility requirements as set forth in the MaineCare Eligibility Manual andį. Does not receive services under any other federally approved MaineCare home and community based waiver program andĮ.
Meets the medical eligibility criteria for admission to an ICF/IID as set forth under the MaineCare Benefits Manual, Chapter II, Section 50 andĭ.
Has an Intellectual Disability as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association) (DSM) or Autism Spectrum Disorder as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders,(American Psychiatric Association) or Rett Syndrome as defined by the DSM andĬ. Is age eighteen (18) or older (members who were younger than age 18 and were already receiving services under this Section as of Decemmay continue to receive benefits under this Section) andī. The number reserved for members in out of state residential placements is based on the number of current out of state residential placements funded by MaineCare or State funds.Ĭonsistent with Subsection 21.03-1, a person is eligible for services under this Section if the person:Ī. The number reserved for ICF/IID, long term nursing home placement, state psychiatric hospital or hospital residents is based on currently known referrals.
The number reserved associated with Section 21.03-2 above is an average based on the DHHS's data for those in need of adult protective services in recent years.