Assistive Care Services and Assisted Living for the Elderly Waiver

Assistive Care Services and Assisted Living for the Elderly Wavier Services
Coverage and Limitations Handbook
Requirements to Receive Services, continued
Medicaid
Application
Responsibilities
Individuals who have not applied for and been determined eligible for
Medicaid at the time they need ALE services must complete or have a
designated representative complete and submit a Request For Assistance
(RFA) to the local Department of Children and Families (DCF), Office of
Economic Self-Sufficiency.
Prior to determining eligibility, DCF will require verification that the individual
is a resident of an enrolled ALF, is receiving case management, has a level of
care, and has been determined to need ALE services in order to remain in the
ALF or in order to move into an ALF.
Who Can Receive
Services
To receive ALE waiver services, recipients in this waiver must be 60 years of
age or older and meet the following requirements:
• Medicaid eligible;
• Determined disabled according to Social Security standards if under 65
years of age;
• Deemed appropriate for ALF placement by the facility administrator;
• Moving out of a nursing facility or other institutional program, be an ALF
resident needing additional services in order to remain in the ALF, or be
living at home and determined at risk of nursing facility placement and
desiring to move into an ALF;
• Have a case manager employed by a waiver enrolled case management
agency; and
• Meet one or more functional criteria.
Functional Criteria
Functional criteria include limitations in activities of daily living (ADLs).
ADLs are defined as bathing, dressing, grooming, ambulating, eating, toileting,
and transferring. To qualify for ALE waiver assistance, the recipient must
need an average of more than one hour of direct services per day and meet at
least one of the following criteria:
• Require assistance with four or more ADLs or three ADLs plus
supervision or administration of medication;
• Require total help with one or more ADLs;
July 2001 5-2