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Many Iowans need assistance to meet their health care needs. Sometimes that care must be provided by residential care facilities, nursing or skilled nursing facilities. Care might be provided at an intermediate care facility for persons with mental illness or mental retardation. These facilities provide housing as well as other services. Sometimes a person who requires health-related care and assistance in daily living activities does not need or want to move out of his or her home. This article takes a look at how Medicaid may be able to provide help for persons with disabilities to continue to live at home.

Medicaid Waiver programs - also called Home and Community Based Services (HCBS) Programs - are designed to provide the assistance needed to make living at home possible. The services available under Medicaid Waiver Programs vary from program to program. However, one of the ways most programs can help a person stay in their home is through Consumer Directed Attendant Care (or CDAC) service. Consumer Directed Attendant Care service pays for a personal attendant to provide care to you in your home.

To get help from a Medicaid Waiver Program, the person must qualify for Medicaid in one of its various forms. The Iowa Medicaid Enterprise Medical Services Unit must also assess the person's needs and find that he or she requires a certain level of care such as skilled nursing or care provided by a nursing home.

Home and Community Based Services may be available to the following people:

• Ill and Handicapped - for people under age 65 who are blind or disabled. The person must be certified in need of nursing or skilled nursing facility level of care, or in need of intermediate care facility for the mentally retarded. If over age 21, the person must be ineligible for SSI.
• Elderly - for people who are 65 or older and who are certified in need of a level of care provided by nursing homes. The person must be receiving case management from the long-term care coordination unit designated case management project for the frail elderly.
• AIDS/HIV - for people who are diagnosed with AIDS or HIV, and who are certified in need of the level of care they would otherwise get in a nursing facility, skilled nursing facility, or hospital.
• Mental Retardation - for people who are diagnosed with mental retardation, and who are certified as being in need of long-term care that would otherwise be provided in an intermediate care facility for the mentally retarded. Must receive or start getting case management through Medicaid.
• Brain Injury - for people who have a diagnosis of brain injury and are under age 65. The person must be found in need of intermediate care facility for the mentally retarded, skilled nursing, or nursing facility level of care. He or she must also be assessed as able to live in a home or community-based setting where all medically necessary service needs can be met within the scope of the waiver.
• Physical Disability - for people age 18 through 64 who have a physical disability and are not eligible for the mental retardation waiver. The person must be able to hire, supervise, and fire their service providers, or have a guardian who can take on this responsibility. Must also be found in need of skilled nursing or intermediate care facility level of care.
• Children's Mental Health - for children through age 18 that are diagnosed with a serious emotional disturbance. The child must be found to be in need of hospital level care and still be able to live in a home or community-based setting where services can be provided under the waiver.

For details on these Medicaid Waiver Programs, contact your local Department of Human Services office. If you apply for assistance from one of the programs and are denied, you may be able to get free legal help. Contact Iowa Legal Aid toll-free at 1-800-532-1275.