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Eligibility Requirements for Community Care Services Program

 

Who is eligible for Community Care Services?

The eligibility criteria for CCSP include the following:

  • Functional impairment caused by physical limitations

Note:  Alzheimer’s and dementia are physical conditions.

  • Unmet need for care
  • Approval of an intermediate level of care (LOC) certification for nursing home placement
  • Approval of care plan by client’s physician
  • Medicaid eligible or potentially eligible after admission to CCSP
  • Client chooses community-based, rather than institutional services
  • Services fall within the average annual cost of Medicaid reimbursed care provided in a nursing facility.  Health and safety needs can be met by CCSP
  • Participation in one waiver program at a time
  • Medicare home health services or hospice (Medicare or Medicaid) does not meet consumer need for services
  • Home Delivered Meals is not the only service need
  • The home environment is free of illegal behavior and threats of bodily harm to other persons.

A client is not required to be homebound to receive CCSP services.

How does an individual obtain Community Care Services?

Step 1:  The individual contacts the Area Agency on Aging for an assessment.

Step 2:  If the individual is eligible for CCSP, the care coordinator determines which services the applicant needs.

How are services arranged?

Step 1:  The care coordinator arranges for CCSP service agencies to provide the needed services.  Service agencies are approved Medicaid providers who bill the Department of Community Health directly for services rendered to Community Care clients.  Care coordinators also arrange for client services through other service agencies and fund sources.

Step 2:  If the individual is not a Medicaid recipient, she/he applies for Medicaid at the local county office of the Division of Family and Children Services.

Step 3:  The care coordinator maintains regular contact with Community Care clients to assure the services are appropriate and that the individual’s needs are met.  Client/family representative participates in the development of the client care plan.

 What are the financial eligibility requirements?

The following information summarizes the financial eligibility criteria for CCSP.

  • SSI category:  Persons who receive Supplemental Security Income (SSI) and are eligible for medical assistance.  The Social Security Administration takes applications for SSI.
  • Medical Assistance Only (MAO) category:  Persons who do not receive cash benefits under the SSI program may qualify for medical assistance under another Medicaid category.  The county Departments of Family and Children Services take applications for MAO (Medical Assistance Only).  MAO participants may have to pay toward the cost of services.

 

SSI Income Limits*

CCSP Medicaid/MAO Income Limits

SSI & CCSP Medicaid Resource Limits

Individual

Below $733 per month

$2,199 per month

$2,000 or less

Couple

(Both in CCSP)

Below $1,100 per month

$2,199 per month per individual

$3,000 or less

Individual in CCSP,

But Married

Below $1,100 per month

$2,199 per month

$2,000 or less for SSI

$121,220.00 (combined) or less for CCSP Medicaid **

*These limits change when the Social Security Administration increases Social Security and SSI.

** If the CCSP Medicaid applicant has a spouse who is neither in CCSP nor in an institution, the assets of the spouse MUST be considered in the eligibility determination.  The combined total of countable assets of the individual and the spouse must be $121,220.00 or less.  The CCSP client must transfer assets in his/her name in excess of $2,000 to the community spouse within one year from the month Medicaid eligibility begins.

A CCSP Medicaid eligible person may divert up to $2,980.50 per month of income to a legal spouse who is neither in the CCSP nor an institution.  The legal spouse’s income is deducted from the $2,980.50 limit before determining the amount of income to divert.

Rev. Dec. 2014