Workforce Challenges & DDS Waiver Services Analysis
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Understanding Level of Care
In order to receive waiver services, eligible individuals must demonstrate the need for a Level of Care (LOC)
that would meet the state's eligibility requirements for services in an institutional setting.
。 Waivers target a population of people in need of LTSS (for example: people with intellectual and
developmental disabilities; people with autism; people with physical disabilities; seniors) and use
functional eligibility criteria (LOC)
。 Eligibility for Medicaid HCBS waivers is directly linked to institutional level of care, because waivers are
an alternative to institutionalization in facilities like Intermediate Care Facilities for Individuals with
Intellectual Disabilities and Nursing Facilities
o Level of Care is determined initially at admission and then recertified annually.
The overall goal of Level of Care determinations is to ensure that the right people are getting the right
amount of care, in the right environment.
。 People most in need have access to Long Term Services & Supports (LTSS)
o Limited state resources are used to provide LTSS for that population of people
o Those people have the opportunity to receive LTSS in the least restrictive environment that meets their
needs
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ALVAREZ & MARSAL
LEADERSHIP ACTION. RESULTS.View entire presentation