Conducting direct observation of the recipient
Conducting financial and functional eligibility screening, contact or interaction with the recipient's authorized representative
Conducting a comprehensive assessment of the recipient's medical, social, and functional status to include obtainment of level of care determination and financial eligibility documentation
Assisting the recipient with identification and selection of approved and enrolled service providers subject to the recipient's choice
Assisting the recipient with securing necessary physician orders when required for the initiation of any service
Determining and developing the recipient's PCP in collaboration with an interdisciplinary team of professionals and including the recipient or authorized representative, family members, friends, providers of health-related services, recipient's physician, and legal guardian, where appropriate, in establishment of the service plan
Presenting the PCP (including goals, service providers, frequency, and duration of services) to the recipient or representative for acceptance
Submitting the PCP to MAA for review and approval
Assisting the recipient with initiating service provision, confidentiality, and measuring the recipient's progress against the PCP ; and providing telephone reassurance and friendly visiting to recipients as part of the case management program
Conducting a periodic (at least quarterly) review of the recipient's PCP
Assisting the recipient in gaining access to needed Medicaid-financed services and all other needed supports (for example, medical, financial, counseling, housing, adult day care, and personal assistance) that are necessary to maintain the recipient in the community
Providing information about non-Medicaid programs and services for which the recipient might be eligible; referring the recipient to the proper service as necessary; and providing assistance to the recipient in gaining public benefits and linkages to community resources
Coordinating all waiver services for the recipients so that services provided to recipients are delivered in a safe, timely, and cost effective manner; providing supportive counseling to the recipient and family as appropriate; and addressing and resolving identified problems
Coordinating and monitoring necessary and appropriate services in a timely manner (including twenty-four (24) hour crisis coverage) for the waiver recipient as specified in the recipient's PCP
Please reach us at PHS@priorityhealthsystem.com if you cannot find an answer to your question.
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.
This program helps recipients who would otherwise require nursing home to remain living at home. The DC Office of Aging offers a single Medicaid waiver that is relevant to aging District recipients; the Elderly and Persons with Disabilities Waiver, more commonly referred to as the EPD Waiver. This waiver is intended to allow beneficiaries who would otherwise require nursing home care to receive care services outside of that environment and to remain living in their homes or communities.
EPD Waiver qualifications consider both the functional ability and the financial status of the applicant. Candidates must have a medically documented need for nursing home level care and be over 65 years of age or over 18 and be officially disabled.
From a financial perspective, the District considers the applicant's income, financial resources or "countable assets" and past asset transfers dating as far back as 60 months preceding their data of application. Monthly income for an individual applicant is limited to 3 times Supplemental Security Income.
In 2014, this means monthly income cannot exceed $2,163. Countable assets, which exclude the value of the home and primary vehicle, cannot exceed $2,000. It is worth noting that these limits are for a single applicant. Married couples with two applicants have higher limits and married couples with a single applicant are subjected to a different, more complicated rule set. These rules were created in order to enable the "well spouse" (the non-applicant spouse) to continue to live independently. Families in this situation and single applicants who are concerned they do not meet the DC Medicaid limits should consult with a Medicaid planner.
We appreciate your time visiting Priority Health Systems website. You can speak to us anytime during business hours at our office number. Feel free to send your suggestions, questions and comments at our email below or to message us with the form above.
PHS@priorityhealthsystem.com Tel: (202) 545-0195 eFax: (202) 379-9779
Mon | 09:00 am – 05:00 pm | |
Tue | 09:00 am – 05:00 pm | |
Wed | 09:00 am – 05:00 pm | |
Thu | 09:00 am – 05:00 pm | |
Fri | 09:00 am – 05:00 pm | |
Sat | Closed | |
Sun | Closed |
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