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Steps in the Elderly & Physically Disabled (EPD) Waiver Admission Process

Individuals are enrolled in the waiver on a first-come, first-served basis. Whenever the annual ceiling is achieved, individuals will be placed on a waiting list.

Waivers are choice programs; thus the individual or representative must select the provider(s) of service(s).

To obtain information on how to access the waiver program, please call any one of the following DC Medicaid representatives:

A recipient must complete steps 1 through 9 in order to be admitted into the elderly and physical disabilities waiver program. Steps 6 and 7 apply to those individuals who are applying for Medicaid eligibility at 300% of SSI.

Step 1: Select and contact the case management provider of your choice from the Provider Directory.

Step 2: The designated case manager will make an appointment to perform an assessment of your needs and preferences, and will complete the necessary waiver documents:

    1. Beneficiary Freedom of Choice
    2. Level of Care
    3. Health History
    4. Individual Service Plan (ISP)
    5. Medicaid application (if receiving financial eligibility at 300% SSI)

Step 3: Case Manager develops and reviews the ISP with the recipient/representative and obtains input from the recipient/representative regarding the services and providers of their choice based on the identified needs. The case manager will also review the agreed upon plan with the recipient/representative.

Step 4: The case manager submits the completed waiver application package to the Medical Assistance Administration for review and approval.

Step 5: Designated MAA staff review the waiver application and approve services, as necessary. If additional information is needed, designated MAA staff will contact the case manager to obtain the information. Approval is provided once the requested information is received.

Step 6: If the recipient is applying for Medicaid at 300% SSI, the designated MAA staff will complete the forms required for submitting the waiver documents to the Income Maintenance Administration for review for Medicaid financial eligibility.

Step 7: If the recipient is approved by the Income Maintenance Administration (IMA) for Medicaid financial eligibility, IMA will notify the designated MAA staff of the approval and the effective date of the Medicaid eligibility.

Step 8: The designated MAA staff will then generate prior-authorizations for each selected provider of service. The prior-authorizations will be faxed and mailed to each provider of service. A letter that delineates the providers, services, frequency and duration of services, and the certification dates will also be sent to the recipient.

Step 9: The designated provider of service will contact you to initiate services.

NOTE: DIRECT Action is providing this information from the DC department of Health. DIRECT Action expresses no view about the quality or accuracy of the information provided by this agency of the DC government.

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