If you have a disability or are elderly, you may qualify
for a 1915(c) Home- and Community-Based Services (HCBS) Medicaid waiver. These waivers provide the support you need to live as independently as possible.
The Department for Medicaid Services (DMS) offers six waiver programs:
You may qualify for a 1915(c) HCBS waiver if:
- You wish to live in the community as independently as you can.
- You would be admitted to a nursing facility or intermediate care facility if you did not have 1915(c) HCBS waiver services.
- You meet the nursing facility level of care defined in Kentucky Administrative Regulation 907 KAR 1:022, Section 4.
- You meet the financial conditions for Medicaid. There are special financial conditions for 1915(c) HCBS waivers.
If you are interested in 1915(c) waiver services, you must first obtain financial eligibility for Medicaid. You can apply for Medicaid online using the benefind Self-Service Portal, by calling the Department for Community Based Services (DCBS) at (855) 306-8959, or in-person at a DCBS office. There are some documents that are helpful to have when applying. The Medicaid Waiver Services Fact Sheet lists those documents.
Once you are ready to apply for 1915(c) HCBS waiver services, you can complete your application online using the benefind Self-Service Portal or in-person at an Aging and Disability Resource Center or a Community Mental Health Center.
Please view our Who To Call: Quick Reference Guide for a list of common waiver-related questions or concerns and who to contact for help.
Recent Updates from the 1915(c) HCBS Waiver Programs
MWMA Documentation Requirements: DMS is delaying requirements for direct service providers to use MWMA to enter service notes. All 1915(c) HCBS waiver providers will still be required to use MWMA to report incidents beginning Dec. 1, 2020. DMS outlined these updates in a letter sent to providers on Sept. 11, 2020. Despite the delay of the service note requirement, MWMA access is still expanding to all direct service providers and training is underway. Training information is available on the DMS Training and Webinars page.
Electronic Visit Verification (EVV): DMS is implementing EVV for certain 1915(c) HCBS waiver services by Jan. 1, 2021. Visit the DMS EVV website for more information.
Waiver redesign: DMS issued an update on 1915(c) waiver redesign as of Feb. 13, 2020. Read the Redesign Update Letter for details.
Service authorization: Carewise Health no longer approves services for 1915(c) HCBS waiver participants. Case managers now approve most services, however, DMS will review requests for high-cost and/or high skill services. The following resources are available regarding this policy update.
- Training Materials: Service Authorization Training Webinar Recording, Service Authorization Training Guide, Service Authorization Quiz
- Frequently Asked Questions: Service Authorization Policy FAQ, System and Prior Authorization FAQ
- Service Authorization Standard Operating Procedure
- Service Authorization Crosswalks: ABI/ABI LTC, HCB, Model II, MPW, SCL
- Summary of MWMA Improvements for Providers
- MWMA Quick Reference Guides: LOC Determination, LOC Review, Creating/Modifying PCSPs, Prior Authorizations, Program Closures, and Services Requiring CHFS review
- Instructional Guide: Locating PA Information in MMIS
- Letters: Service Authorization for Participants, Service Authorization for Providers, Additional Service Authorization Guidance Letter
- Examples: Team Meeting Sign-In Sheet
If you have questions about service authorization policy, email DMS
or call (844) 784-5614. If you have technical issues or questions about MWMA, please call (800) 635-2570.