How does an individual apply for Adult Day Care?
The application process for Adult Day Care starts at the adult day facility.
The individual will need to visit one of the state approved facilities in person. At the facility they will complete an application packet for 4-month temporary coverage (packet is processed by Community Living, Aging and Protective Services (CAP). The facility will also submit a Harmony referral at the same time for ADvantage Waiver or the Developmental Disabilities Services (DDS) Home and Community-Based Services (HCBS) Waiver, as appropriate.
**The State Funded Adult Day applications must start with the provider, because the Health Department requires providers to come up with a plan of care and the provider also must get medical approval from the applicant’s physician.
** State Funded adult day is a limited funded program, so all available funding is already contracted out to our current providers. ADvantage has Federal funding in addition to the State dollars they receive, so they are able to contract with more providers than the State Funded ADH program.
Who approves the 4-month temporary coverage?
Once the provider has received their entire admission packet from the client, the provider will then send a State Funded application to Community Living, Aging and Protective Services (CAP) with proof of income and a portal reference number for ADvantage as proof they have submitted an ADvantage request. Once CAP certifies the State Funded services, the temporary 4-month coverage period begins.
Who processes the Harmony Application?
Applications submitted through Harmony and will be processed by the LTC unit as an ADvantage Waiver application.
What happens if the individual is approved for ADvantage?
Should they be approved for ADvantage, both financially and medically, then the Adult Day Care service is built into their Care Plan. (All individuals receiving Nursing Home, Assisted Living, ADvantage, DDS HCBS waivered services, VA or respite vouchers are not eligible for ‘State Funded’ services, due to their needs being met through those programs.)
What happens if the individual is denied for ADvantage?
If the client is denied ADvantage medically or due to resources exceeding agency standards, the client is then on permanent coverage with “State Funded” services until the provider discharges the client. Those permanent coverage cases are then kept on the CAP adult day caseload.
For a list of contracted facilities refer to oklahoma.gov | Adult Day Health Services Contacts.
For further information on how the CAP State Funded Adult Day Health Services operates, please go to the Microsoft Stream channel and select State Funded Adult Day to watch the video.
ADvantage Application Process
- Application starts at the state approved facility. (Client must call or go to facility in person in order for the facility to begin the process).
- The Facility will complete an application packet and submit a harmony application.
- The facility will complete an application packet and submit to Community Living. Aging and Protective Services (CAP). (State Funding).
- The facility will also submit a harmony application for Advantage to be processed by Long Term Care Unit. (Mostly federal funding).
- CAP Unit processing and LTC Unit Advantage Approval
- CAP Unit – Once packet is certified, Client is placed on temporary 4-month coverage while ADvantage application is being processed.
- LTC Unit Denied – If denied for ADvantage (medically or due to resources) then coverage determination goes back to CAP. Client is then placed on permanent coverage with “State Funded” services until the provider discharges the client. Those permanent coverage cases are then kept on the CAP caseload.
- LTC Unit Approved – if approved for ADvantage (both financially and medically) the Adult Day Care service is built into their Care.
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