Beginning April 1, 2024, all In Home and CDS participants must meet new eligibility requirements to continue to receive services. The Department of Health and Senior Services has implemented a change in the points needed to meet eligibility of services. The goal of this change is The Missouri Department of Health and Senior Services’ (DHSS) Division of Senior and Disability Services (DSDS) recently completed a review of the Medicaid-funded home and community based services (HCBS) program to ensure the right services are provided for the at the right time. 

The nursing facility level of care eligibility for HCBS will change from from 24 points to 18 points. Although the point grade will decrease, under the new transformation point system, many will no longer be eligible for services.

 

This requirement will be implemented by the state during each annual reassessment review as your care plan ends. The state department will send notifications to you if and when the change as they occur. Although the point grade will decrease, under the new transformation point system, many will no longer be eligible for services. 

Over the next few weeks, we will be reviewing assessments to ensure that the data provided by you to the assessor at your start of care has remained the same or if your condition has changed. Points are determined by your need for human assistance to complete tasks.

These decreases will occur within the next few months. The state department will send notifications to your client in regards to the change as they occur.

People who apply for Medicaid waiver programs or institutional care must meet “level of care” criteria to be eligible. A level of care determination is a decision made about an individual’s physical, mental, social, and/or emotional status. 

New Level of Care (LOC) model that ensures the right services are provided to the right individuals at the right time. 

Would this individual require nursing facility placement if they did not receive HCBS services?

An individual must meet the nursing facility LOC as a condition of eligibility for authorization of Home and Community Based Services (HCBS) that fit the need for hands-on assistance and not just monitoring.

Services are denied on the basis that you do not meet the level of care criteria, or you are losing services because your level of care has changed, you have the right to appeal the decision. 

When completing an assessment, please be truthful with your needs. If you say you can do everything yourself, then you will receive services. 

These are sad times for some seniors and disabled adults who will lose some if not all of their care. These statewide budget changes not only affect the Medicaid clients but also the workers schedules who provide exceptional much needed care.

On a positive note, At Home Care will continue to be your advocate and community resource advocate. We pride ourselves in displaying Christ like love and providing the utmost compassionate customer service.