1915(i) Medicaid Services
Transforming Health Outcomes with Expert Medicaid Assistance
Eligibility Information
Human Service Zones determine Medicaid eligibility AND Determine your eligibility for the 1915(i) services.
Inquiries
Services Overview
Our 1915(i) Medicaid Services are meticulously designed to provide a holistic support system for eligible individuals. Our commitment is to ensure that every participant receives the comprehensive assistance they need to navigate the intricacies of Medicaid. Our mission is to empower individuals to lead a healthy, fulfilling life. With our 1915(i) Medicaid Services, we aim to be the guiding light, ensuring every participant receives the support, care, and resources they deserve.
Eligibility Requirements
Medicaid or Medicaid Expansion Enrolled
Qualifying Household Income
Income must not exceed 150% of the Federal Poverty Line (FPL). Also, includes the §1902(a)(10)(A)(ii)(XXII) eligibility category--see Attachment 2.2-A of the state Medicaid plan.
Residents in compliance with home and community-based settings final rule requirements
Must live in their home or in the community, not in an institution. Care Coordinators complete a site visit and the 1915(i) Initial HCBS Settings Review form.
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Private Residence, i.e., private home or apartment that the individual lives in which is rented or owned by individual or legal guardian.
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Provider Owned or Controlled Residential Setting, i.e., individual living with a caregiver, i.e., sober living, group homes, foster homes, treatment foster homes, transitional living homes.
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Residential Settings presumed to have Qualities of an Institution.
The only exception to residents living in an institution, are those identified with having an institutional discharge date within 90 days; allowing the resident to undergo a “1915(i) pre-eligibility determination conducted by their institutional case manager and provided to the Zone Eligibility Worker with a qualifying diagnosis, WHODAS score, FPL of 150% or below, and a need for 1915(i) services identified. Include a description of the settings where individuals will reside and where individuals will receive HCBS, and how these settings meet the Federal home and community- based settings requirements, at the time of submission and in the future).
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Qualifying Behavioral Health Diagnosis.
Must be verified by a clinician licensed to provide a diagnosis, OR a printout from an Electronic Health Record (EHR) which lists the individual’s diagnoses may be submitted.
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Qualifying WHODAS 2.0 Assessment Score of 25 or higher determined by the Human Service Zone Eligibility Worker at your local county social services office or Human Service Center in your county or by other clinicians identified for your community.
Three type of HCBS Settings Allowable Examples:
Important Note: Following the 1915(i)-eligibility determination, the individual’s Care Coordinator is responsible for verifying initial and ongoing HCBS Settings compliance.
Services Include
Care Coordination services assist participants in gaining access to needed 1915(i) services that include medical, social, educational and other services. A care coordinator is assigned to a client to coordinate and develop a Person-centered Plan of Care and assists clients with gaining access to needed 1915(i) and other services.
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A minimum of one face to face contact between the Care Coordinator and participant per quarter is required. A participant’s need for initial and continued services shall be discussed at each 1915(i) person-centered plan of care meeting, and formally evaluated during the WHODAS 2.0 functional needs assessment as part of the initial and annual reevaluation and service authorization/reauthorization process. Care Coordinators must document a need for the service to support a participant’s identified goals in the Person-Centered POC and document the participant’s progress toward their goals and conduct and oversight assessments process, and complete assessments as needed.
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conducting, developing and monitoring the participant’s crisis plan in collaboration of the participant and PCP care team within the first week of initial contact.
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conducting referrals, collateral contacts and related activities which may include scheduling appointments and connecting them with needed services.
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monitoring and follow up activities
Care Coordinators are responsible for:
Services are delivered to participants age 18 and older by trained and certified individuals in mental health or substance use recovery that promote hope, self-determination, and skills to achieve long-term recovery in the community. Peer Support Specialists have lived experience as a recipient of behavioral health services with a willingness to share personal, practical experience, knowledge, and first-hand insight to benefit service users. Services are provided in a variety of home and community based (HCBS) settings including: the individual’s home, a community mental health center, a peer recovery center and other community settings where an individual and a peer may meet and interact i.e., community center, park, grocery store, etc.
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Engagement, bridging, providing engagement and support to an individual following their transition from an institutional setting (state hospital, inpatient hospital, congregate care, nursing facility, or correctional settings) to their home communities.
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Coaching and enhancing a recovery-oriented attitude
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Promoting wellness through modeling.
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Assisting with understanding the person-centered planning meeting.
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Coaching the individual to articulate recovery goals.
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Providing mutual support, hope, reassurance, and advocacy that include sharing one's own "personal recovery/resiliency story"
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Self-Advocacy, self-efficacy, and empowerment
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Sharing stories of recovery and/or advocacy involvement for the purpose of assisting recovery and self-advocacy;
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Serving as an advocate, mentor, or facilitator for resolution of issues
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Assisting in navigating the service system including:
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Helping develop self-advocacy skills (e.g., assistance with shared decision making, developing mental health advanced directives).
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Assisting the individual with gaining and regaining the ability to make independent choices and assist individuals in playing a proactive role in their own treatment (assisting/mentoring them in discussing questions or concerns about medications, diagnoses or treatment approaches with their treating clinician). The Peer Specialist guides the individual to effectively communicate their individual preferences to providers.
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Assisting with developing skills to advocate for needed services and benefits and seeking to effectively resolve unmet needs.
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Advocacy and coaching on reasonable accommodations as defined by Americans with Disabilities Act (ADA).
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Skill development
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Developing skills for coping with and managing psychiatric symptoms, trauma, and substance use disorders;
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Developing skills for wellness, resiliency and recovery support;
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Developing, implementing and providing health and wellness training to address preventable risk factors for medical conditions.
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Developing skills to independently navigate the service system; promoting the integration of physical and mental health care;
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Developing goal-setting skills;
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Building community living skills.
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Community Connections and Natural Support are provided by peers and completed in partnership with individuals for the specific purpose of achieving increased community inclusion and participation, independence and productivity.
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Connecting individuals to community resources and services.
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Accompanying individuals to appointments and meetings for the purpose of mentoring and support.
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Helping develop a network for information and support, including connecting individuals with cultural/ spiritual activities, locating groups/programs based on an individual’s interest including peer-run programs, and support groups.
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Peer Relief Services are voluntary short-term and offer interventions to support individuals for adverting a psychiatric crisis. The premise behind peer relief is that psychiatric emergency services can be avoided if less intrusive supports are available in the community.
Peer Support services include:
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Family Peer Support Services (FPSS) are delivered to families caring for a 1915(i) participant, under the age of 18, by trained and certified Peer Support Specialists with lived experience as a parent or primary caregiver who has navigated child serving systems on behalf of their child(ren)with social, emotional, developmental, health and/or behavioral healthcare needs. FPSS provide a structured, strength-based relationship between a Family Peer Support provider and the parent/family member/caregiver for the benefit of the child/youth. Services are delivered in a trauma informed, culturally responsive, person-centered, recovery-oriented manner.
Family is defined as the primary care-giving unit and is inclusive of a wide diversity of primary caregiving units with significant attachment to the child, including but not limited to, birth, foster, adoptive, or guardianships, even if the child is living outside of the home.1.
Engagement and Bridging,
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Serving as a bridge between families and service providers, supporting a productive and respectful partnership by assisting the families to express their strengths, needs and goals.
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Based on the strengths and needs of the youth and family, connecting them with appropriate services and supports including accompanying the family when visiting programs.
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Facilitating meetings between families and service providers.
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Assisting the family to gather, organize and prepare documents needed for specific services.
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Addressing any concrete or subjective barriers that may prevent full participation in services, Supporting and assisting families during stages of transition which may be unfamiliar (e.g., placements, in crisis, and between service systems etc.).
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Promoting continuity of engagement and supports as families’ needs and services change.
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Self-Advocacy, Self-Efficacy, and Empowerment
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Coach and model shared decision-making and skills that support collaboration, in addition to providing opportunities for families to self-advocate.
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Supporting families to advocate on behalf of themselves to promote shared decision-making.
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Ensuring that family members inform all planning and decision-making.
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Modeling strengths-based interactions by accentuating the positive.
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Supporting the families in discovering their strengths and concerns.
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Assist families to identify and set goals and short-term objectives.
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Preparing families for meetings and accompany them when needed.
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Empowering families to express their fears, expectations and anxieties to promote positive effective communication.
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Assisting families to frame questions to ask providers.
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Providing opportunities for families to connect to and support one another.
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Supporting and encouraging family participation in community, regional, state, national activities to develop their leadership skills and expand their circles of support.
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Providing leadership opportunities for families who are receiving Family Peer Support Services.
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Empowering families to make informed decisions regarding the nature of supports for themselves and their child through:
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Sharing information about resources, services and supports and exploring what might be appropriate for their child and family
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Exploring the needs and preferences of the family and locating relevant resources.
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Helping families understand eligibility rules Helping families understand the assessment process and identify their child’s strengths, needs and diagnosis.
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Parent Skill Development
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Supporting the efforts of families in caring for and strengthening the health, development and well-being of their children.
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Helping the family learn and practice strategies to support their child’s positive behavior.
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Assisting the family to implement strategies recommended by clinicians.
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Assisting families in talking with clinicians about their comfort with their treatment plans.
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Providing emotional support for the family on their parenting journey to reduce isolation, feelings of stigma, blame and hopelessness.
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Providing individual or group parent skill development related to the needs of the child (i.e., training on special needs parenting skills).
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Supporting families as children transition from out of home placement.
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Assisting families on how to access transportation.
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Supporting the parent in their role as their child’s educational advocate by providing information, modeling, coaching in how to build effective partnerships, and exploring educational options with families and school staff.
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Community Connections and Natural Supports
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Enhancing the quality of life by integration and supports for families in their own communities
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Helping the family to rediscover and reconnect to natural supports already present in their lives.
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Utilizing the families’ knowledge of their community in developing new supportive relationships.
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Helping the family identify and become involved in leisure and recreational activities in their community.
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In partnership with community leaders, encouraging families who express an interest to become more involved in faith or cultural organizations.
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Arranging support and training as needed to facilitate participation in community activities.
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Conducting groups with families to strengthen social skills, decrease isolation, provide emotional support and create opportunities for ongoing natural support.
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Working collaboratively with schools to promote family engagement.
Family Peer Support Services include:
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Non-Medical Transportation (NMT) service is offered in order to enable 1915(i) participants to gain access to 1915(i) and other community services, activities and resources, as specified by the person-centered plan of care.NMT increases the participant’s mobility in the community and supports inclusion and independence. This service is offered in addition to medical transportation and transportation services under the state plan and does not replace them. The service must be provided in the most appropriate, cost-effective mode available. Whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge are utilized.
NMT cannot be used for transporting a client to medical care, e.g., doctor, etc. NMT will be provided to meet the participant’s needs as determined by an assessment. Services are available for participants to access authorized HCBS and destinations that are related to a goal included on the participant’s person-centered plan of care.
Examples where this service may be requested include transportation to 1915(i) services, a job interview, college fair, a wellness seminar, a GED preparatory class, etc. NMT will only be available for non-routine, time-limited services, not for ongoing treatment or services or for routine transportation to and from a job or school. All other options for transportation, such as informal supports, community services, and public transportation must be explored and utilized prior to requesting waiver transportation.
This service is not intended to replace other transportation services but compliment them. NMT is solely for transporting the client to and from his/her home to essential services as allowed within the scope of the service. It does not include the cost of staff transportation to or from the client’s home.
Supported Education Services (SEd) are individualized and promote engagement, sustain
participation and restore an individual’s ability to function in the learning environment. Services must be specified in the person-centered plan of care to enable the individual to integrate more fully into the community and/or educational setting and must ensure the health, welfare and safety of the individual.
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engage and navigate the learning environment
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support and enhance attitude and motivation
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develop skills to improve educational competencies (social skills, social-emotional learning skills, literacy, study skills, time management);
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promote self-advocacy, self-efficacy and empowerment (e.g., disclosure, reasonable accommodations, advancing educational opportunities); and (5) build community connections and natural supports.
The goals of SEd are for individuals to:
Supported Education Services (SEd) are requested by the Care Coordinator as a support to achieve educational goals identified in the person-centered planning process. Services are designed to be delivered in and outside of the classroom setting and may be provided by schools and/or agencies enrolled as Medicaid providers of 1915(i) Supported Education Services, that specialize in providing educational support services. Services must honor the individual’s preferences (scheduling, choice of service provider, direction of work, etc.) and provide consideration for common courtesies such as timeliness and reliability.
Engage, bridge and transition
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Act as a liaison/support in the educational learning environment.
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Facilitate outreach and coordination.
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Familiarize individual and caregiver (if applicable) to school settings, to help navigate the school system and student services.
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Assist with admission applications and registration.
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Assist with transitions and/or withdrawals from programs such as those resulting from behavioral health challenges, medical conditions and other co-occurring disorders.
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Improve access by effectively linking consumers of mental health services to educational programs within the school, college, or university of their choice.
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Assist with developing a transportation plan.
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Act as a liaison and coordinator between the education, mental health, treatment, and rehabilitation providers.
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Assist with advancing education opportunities including applying for work experience, vocational programs, apprenticeships, and colleges.
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Support and enhance attitude and motivation.
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Develop an education/career plan and revise as needed in response to individuals' needs and recovery process.
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Assist in training to enhance interpersonal skills and social-emotional learning skills (effective problem solving, self-discipline, impulse control, increase social engagement, emotion management and coping skills).
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Individualize behavioral supports in all educational environments including but not limited to classroom, lunchroom, recess, and test-taking environments.
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Conduct a need assessment/educational assessment, based on goals to identify education/training requirements, personal strengths and necessary support services.
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Develop skills to improve educational competencies.
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Work with individuals to develop the skills needed to remain in the learning environment (e.g., effective problem solving, self-discipline, impulse control, emotion management, coping skills, literacy, English-learning, study skills, note taking, time and stress management, and social skills).
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Provide training on how to access transportation (e.g., training on how to ride the bus).
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Provide opportunities to explore individual interests related to career development and vocational choice.
Self-Advocacy, self-efficacy and empowerment
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Act as a liaison to assist with attaining alternative outcomes (e.g., completing the process to request an incomplete rather than failing grades if the student needs a medical leave or withdrawal).
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Manage issues of disclosure of disability.
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Provide advocacy support to obtain accommodations (such as requesting extensions for assignments and different test-taking settings if needed for documented disability).
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Advocacy and coaching on reasonable accommodations as defined by Americans with Disabilities Act (ADA) (e.g., note-taking services, additional time to complete work in class and on tests, modifications in the learning environment, test reading, taking breaks during class when needed, changes in document/ assignment format, etc.).
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Provide instruction on self-advocacy skills in relation to independent functioning in the educational environment.
Community connections and natural supports
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Serve as a resource clearinghouse for educational opportunities, tutoring, financial aid and other relevant educational supports and resources.
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Provide access to recovery supports including but not limited to cultural, recreational, and spiritual resources.
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Provide linkages to education-related community resources including supports for learning and cognitive disabilities.
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Identify financial aid resources and assist with applications for Financial Aid.
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Assist in applying for student loan forgiveness on previous loans because of disability status.
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Ongoing supported education service components are conducted after an individual is successfully admitted to an educational program.
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Supported Employment (SEP) services assist individuals to obtain and keep competitive employment at or above the minimum wage. After intensive engagement, ongoing follow-along support is available for an indefinite period as needed by the individual to maintain their paid competitive employment position. SEP services are individualized, person-centered services providing support to individuals who need ongoing support to learn a new job and maintain a job in a competitive employment or self-employment arrangement. Supported Employment services may be furnished to any individual that elects to receive support and demonstrates a need for the service. Services are authorized during the person-centered planning process by the Care Coordinator to assist the individual with achieving goals identified in the person-centered plan of care. Services must be provided in a manner which honors the individual’s preferences (scheduling, choice of provider, direction of work), and consideration for common courtesies such as timeliness and reliability.
vocational/job-related discovery or assessment
negotiation with prospective employers
job carving
training and systematic instruction
job analysis
person-centered employment planning
job coaching
Guidance on income reporting
benefits planning support/referral
job placement
training and planning
rapid job placement
asset development and career advancement services
job development
education and training on reasonable accommodations as defined by ADA
education and training on disability disclosure
support to establish or maintain self-employment (including home-based self-employment)
assistance with securing reasonable accommodations as defined by ADA
other workplace support services including services not specifically related to job skill training that enable the participant to be successful in integrating into the job setting
Supported Employment services are individualized and may include any combination of the following services:
Prior to an individual’s first day of employment, the provider will work with the individual and members of the individual’s team to create a plan for job stabilization. The provider will continue to coordinate team meetings when necessary, follow-up with the participant once they are employed, and provide monthly progress reports to the entire team. are available to an individual once they are employed and are provided periodically to address work-related issues as they arise (e.g., understanding employer eave policies, scheduling, time sheets, tax withholding, etc.).
Ongoing Follow-Along Support may also involve assistance to address issues in the work environment, including accessibility, employee – employer relations. Services are designed to identify any problems or concerns early, to provide the best opportunity for long lasting work opportunities.
Housing Supports help individuals’ access and maintain stable housing in the community. Services are flexible, individually tailored, and involve collaboration between service providers, property managers, and tenants to engage in housing, preserve tenancy and resolve crisis situations that may arise. Housing Support services include Pre-tenancy, Tenancy. A participant’s need for initial and continued services shall be discussed at each 1915(i) person-centered plan of care meeting, and formally evaluated during the WHODAS 2.0 functional needs assessment as part of the initial and annual reevaluation and service authorization/reauthorization process.
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Must be at least 18 years or older OR 17 years old going to be 18 within six months or less.
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Must be experiencing homelessness, at risk of becoming homeless, living in a higher level of care than is required, or is at risk for living in an institution or other segregated setting.
Additional Eligibility Requirement:
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Pre-Tenancy Services provide individuals with the support needed to secure housing. Pre-tenancy services are available only to the individual living in the community and may not be billed when an individual is concurrently receiving Tenancy Support services.
Pre-Tenancy Services Include:
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Support with applying for benefits to afford housing (e.g., housing assistance, SSI, SSDI, TANF, SNAP, LIHEAP, etc.).
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Assisting with the housing search process and identifying and securing housing of their choice.
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Assisting with the housing application process, including securing required documentation (e.g., Social Security card, birth certificate, prior rental history).
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Helping with understanding and negotiate a lease.
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Helping identify resources to cover expenses including the security deposit, moving costs, and other one-time expenses (e.g., furnishings, adaptive aids, environmental modifications).
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Services provided in Pre-tenancy supports may not duplicate the services provided in Community Transition Supports (CTS) or in Care Coordination.
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Tenancy services assist individuals with sustaining tenancy in an integrated setting that supports access to the full and greater community. Tenancy Supports may not be billed when an individual is concurrently receiving Pre-tenancy Support services.
Tenancy services include:
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Assisting with achieving housing support outcomes as identified in the person-centered plan.
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Providing training and education on the role, rights, and responsibilities of the tenant and the landlord.
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Coaching on how to develop and maintain relationships with landlords and property managers.
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Supporting with applying for benefits to afford their housing including securing new/renewing existing benefits.
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Skills training on financial literacy (e.g., developing a monthly budget).
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Assisting with resolving disputes between landlord and/or other tenants to reduce the risk of eviction or other adverse action.
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Assistance with the housing recertification process.
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Skills training on how to maintain a safe and healthy living environment (e.g., training on how to use appliances, how to handle repairs and faulty equipment within the home, how to cook meals, how to do laundry, how to clean in the home). Skills training should be provided onsite in the individual’s home.
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Coordinating and linking individuals to services and service providers in the community that would assist an individual with sustaining housing.
Two Types of Housing Supports:
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