Long Term Care (LTC): Waivered Service Programs – ADvantage Waiver Assisted Living Service Option

317:35-17-3(c)(2)

Process for ADvantage Assisted Living Service Option Applications:

  1. When an Assisted Living (AL) application is received:
    • If the application indicates the applicant is currently living in an AL facility, email ADvantageAL@okdhs.org to inform of the AL application.
    • If the application indicates the applicant is currently living at home and requesting AL services, the application will be processed as normal. If the applicant becomes ADvantage certified, the assigned Case Manager will submit an ADvantage AL referral, to the ADvantage AL team, through Harmony.
  1. If the applicant moves into an AL or is found to be living in an AL during the financial application process:
    • The county office should continue to work the application until ADvantage financial eligibility has been determined.
    • DO NOT put the AUSW line in “F” status.
    • Email ADvantageAL@okdhs.org before certification
    • The AL Unit transfer the application to an AL worker. The AL worker will complete AL financial eligibility and request certification.

Please email the ADvantageAL@okdhs.org with any questions

Process for AL Annual Financial Reviews:

Note: annual financial reviews for ADvantage AL Members will remain with the ADvantage AL Team

  • Check the EKL lines and FACS notes.
    • If there is an open ADvantage line, an open AL Provider line, or if FACS notes indicate AL, please email ADvantageAL@okdhs.org to confirm if the case should remain in the county to be reassigned to the prior AL case worker.

Do NOT change the Living Arrangement box under the Household tab.

Remember: Members/Applicants living in an ADvantage AL facility cannot receive SNAP benefits.

If you have additional questions or need clarification, please email ADvantageAL@okdhs.org

ADvantage program members may receive services in a contracted ADvantage Assisted Living Center; an ADvantage Assisted Living Center is the only housing-with-nursing-supervised personal care services option in which a person may appropriately receive ADvantage Services.

The ADvantage Administrative Unit (AAU) in the Aging Services Division (ASD) oversees the ADvantage program and currently is responsible for all ADvantage Waiver Assisted Living case certifications and reviews.

Any questions regarding ADvantage Assisted Living you can contact AAU Worker (405) 522-5050 or email ADvantageAL@okdhs.org

Worker calculates and completes these cases, as well as changes & closures.

Only individuals who are categorically related to ABD may be served through ADvantage Waiver Assisted Living services. If categorical relationship to disability has not already been established, the Level of Care Evaluation Unit (LOCEU) will render a decision on categorical relationship to the disabled using the same definition used by the Social Security Administration.

To receive ADvantage Waiver Assisted Living services, individuals must meet the following criteria:

  • Be age 19 or older if physically disabled and not developmentally disabled, or
  • Developmentally disabled between the ages of 19 and 65 and does not have an intellectually disability or a cognitive impairment related to the developmental disability.

Income

Countable income must be equal to or less than the Categorically Needy Standard found on Appendix C-1, Schedule VIII. B.1. If income is between the Categorically Needy Standard and the Maximum monthly countable income for a Medicaid Income Pension Trust, also found on Schedule VIII B.1, a Medicaid Income Pension Trust (MIPT) must be established and funded prior to applicant/client being determined financially eligible.

Refer to article LTC: Medicaid Income Pension Trust – Establish

If payment of income is made to the individual and another person(s), the income is considered in proportion to the individual’s interest. Otherwise, we look at the income of the applicant only in determining income eligibility.

Resources

The resource standard for an individual is shown on Appendix C-1, Schedule VIII.D. If the individual applying has a spouse, it is necessary to determine the amount of resources for both spouses for the month of the individual’s application for ADvantage Waiver Assisted Living services.

Refer to article LTC: Spousal Impoverishment

The monthly maintenance standard for individuals residing in an ADvantage Assisted Living Facility, which is the amount of money the client may retain for his/her own needs, and is found on OKDHS Appendix C-1, Schedule VIII B.2.

The home property continues to be an exempt resource if one of the following applies:

  • The home property continues to be an exempt resources if one of the following lawfully resides in the home:
    • Spouse
    • Own minor child under 21
    • Own child who is considered blind, disabled per Social Security

Or

  • If individual intends to return home property it may be excluded as a countable resource up to 12 months from date of entry into assisted living.
  • If the client indicates on the 08MA010E (MA-10) and 08MA024E FSS-ML that they do not intend to return to the home or if at any time during the 12 month period, it is determined the individual does not intend to return home, the 08MA025E (FSS-ML-2) must be submitted to have the lien filed.
  • All steps necessary to convert the home into a resource for use in meeting current needs must be made by listing the home for sale. 90 day follow-ups are required to insure efforts to sell remain in progress.

Refer to article Request OHCA to File Lien on Home Property for instructions on filing the lien.

If individual intends to return home property it may be excluded as a countable resource up to 12 months from date of entry into assisted living.

These cases will show county 00C office 55 01, 55-02, or 55-03.

Was this article helpful?

Comments or Suggestions?

We want Quest to be your source for important information that you need to succeed at in your work but we need your help:

Was this article helpful? Was it missing something you needed to get the job done?

Tell us what you think, what you know about this article. What are we doing well, and what we could do better.

All fields are required.