If the claimant leaves the vendor facility and goes to his/her own home or a relative’s home and is receiving Home and Community Based (HCB) waiver services under the Elderly and Disabled waiver, take the following steps:
- Verify that DHSS Division of Senior and Disability Services has authorized the HCB waiver services.
- Complete a budget to determine if the claimant’s income is below the special income limit for the HCB waiver.
- If authorized for the HCB waiver services and under the income limit, send an Advance Notice of Adverse Action (IM-80) advising the claimant that s/he is no longer eligible for vendor payments effective with the date s/he left the vendor facility. S/he continues to be eligible for all other Medicaid services.
- At the end of the advance notice period, update IMU5 to the HCB level of care and reason. Send the claimant a notice that vendor payments have been discontinued and that s/he remains eligible for all other Medicaid services as a non-spend down.
If not authorized for the HCB waiver services or over the income limit, follow the procedures in 0815.070.10 Vendor Facility to Private Home, Not Receiving HCB.