0815.000.00 Vendor Eligibility

0815.070.15 Vendor Facility to Private Home, receiving HCB

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:

  1. Verify that DHSS Division of Senior and Disability Services has authorized the HCB waiver services.
  2. Complete a budget to determine if the claimant’s income is below the special income limit for the HCB waiver.
  3. 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.
  4. 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.