An overview of Medicaid Long-Term Care [Jan. 2012]

An Overview of Medicaid Long-Term Care

Overview
Medicaid Long-Term Care programs enable eligible Georgians to live in the setting that is most appropriate for their needs -- nursing facilities, their own home or a caregiver's home. To be eligible for long-term care assistance, applicants must meet both income and resource limits, which may be higher than the limits for other Medicaid programs. Other criteria considered are functional status, age (in the Independent Care Waiver program {ICWP} only), citizenship and Georgia residency. Waiver recipients must also qualify for the level of care provided in a nursing facility or other qualified institution.
Georgia Medicaid Long-Term Care Programs
The Community Care Services Program (CCSP) The Community Care Services Program waiver provides homeand community-based services to elderly and/or functionally impaired or disabled people. The program includes care management, adult day health care, alternative living services, personal care, home-delivered meals, extended home health, respite care and emergency response systems.
Independent Care Waiver Program (ICWP) ICWP offers services to a limited number of adult Medicaid members with physical disabilities, including persons with traumatic brain injuries (TBI). This program is available for eligible Medicaid members between the ages of 21 and 64 who are severely physically disabled when they apply. ICWP services include personal support, home health, emergency response systems, specialized medical equipment and supplies, counseling and home modifications.

Programs
Community Care Services Independent Care Waiver New Options Waiver Nursing Facility Service Options Using Resources in a Community Environment (SOURCE) Home Health Services Hospice Community Mental Health

New Options Waiver Program/Comprehensive Supports Waiver Program (NOW/COMP) NOW and COMP offer home- or community-based services for people with developmental disabilities or intellectual disabilities. Six regional offices under the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) determine eligibility and coordinate service delivery for these programs. The programs cover supported employment, residential services,
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Georgia Department of Community Health | 2 Peachtree Street NW, Atlanta, GA 30303 | www.dch.georgia.gov | 404-656-4507

January 2012

An Overview of Medicaid Long-Term Care

personal care and respite services, specialized medical equipment and supplies, vehicle adaptations, home modifications and behavioral support services.
Nursing Facility Nursing Facility services include skilled nursing care, rehabilitation services and health-related care in an institutional setting. Persons in nursing facilities need around-the-clock nursing oversight. These services also include Intermediate Care Facility/Mental Retardation and swing bed services.
Service Options Using Resources in a Community Environment (SOURCE) SOURCE serves frail elderly and disabled Georgians who are eligible for Supplemental Security Income/Medicaid. The SOURCE program is based on a case management model that uses primary care physicians on the case management team. In addition to core services of monitoring and assistance with functional tasks, SOURCE individuals can have Assisted Living Services, extended home health, personal care, home-delivered meals, adult day health care, emergency response services, and 24-hour medical access to a case manager and primary care physician.
Home Health Services Home Health Services include skilled nursing, home health aide, and physical, speech and occupational therapy services. Services are provided in the member's home and require physician orders. Because they are meant to be short term in nature, there is an annual limit on the number of home health visits that can be reimbursed.

Hospice Hospice includes palliative medical care and services for terminally ill persons and their families. Hospice offers nursing care, medical social services, counseling, medications, medical appliances and supplies, and hospice-aide. Care may be provided in the member's home or in an in-patient facility, including nursing facilities.
Community Mental Health Services Community Mental Health Services are provided to persons of all ages who have mental illness or issues with substance abuse. Services are provided in the community, in out-patient facilities, clinics or short-term, in-patient facilities. Community Mental Health Services include:
Diagnostic assessments
Crisis intervention
Psychiatric treatment
Nursing assessment and care
Individual, group and family outpatient therapies
Medication administration
Behavioral health rehabilitation services
Substance abuse and detoxification services
Short-term, in-patient care for severely, emotionally disturbed youth