The Commonwealth Coordinated Care Plus (CCC Plus) program is a Virginia Medicaid waiver designed to provide comprehensive care to specific populations, enabling them to receive necessary services in their homes and communities rather than in institutions. This program is crucial for both adults over 65 with medical or nursing needs and individuals under 65 with disabilities and similar healthcare requirements. A significant advantage of the CCC Plus Waiver is that there is no waiting list, ensuring timely access to care for those who qualify.
This waiver operates through two service delivery models, offering flexibility in how care is managed and provided:
- Agency-Directed Model: Traditional model where services are managed and delivered by a home health agency or other provider organization.
- Consumer-Directed Model: Empowers individuals and their families to have more control over their care, allowing them to hire and manage their own caregivers.
For a detailed understanding of the services available under this waiver, you can refer to the CCC Plus Waiver Services Descriptions. It’s also important to note that when determining eligibility for the Medicaid Waiver, family income is never considered, focusing solely on the individual’s needs and financial status.
Applying for the CCC Plus Waiver: Connecting with Local Resources
To initiate the application process for CCC Plus Waiver services, the first step is to reach out to your local Department of Social Services or Department of Health. These local departments serve as the primary points of contact for individuals seeking to access the CCC Plus program.
- Department of Social Services: Find your local department here.
- Department of Health: Locate your local health department.
When you contact these departments, you may be asked to explain why you or the individual you are representing needs the CCC Plus Waiver. It’s beneficial to be prepared to identify the specific services that are needed. Remember, you cannot be denied a screening for the CCC Plus Waiver. If you are denied a screening, it’s crucial to request a letter of denial, which can be important for further steps or appeals. Importantly, you are not required to have Medicaid already or to file a Medicaid application to undergo the initial screening process for the waiver. Eligibility for the Medicaid Waiver screening is separate from Medicaid enrollment itself. However, if you are found eligible for the waiver based on the screening, applying for Medicaid is a necessary step to actually utilize the waiver services.
The Screening Process: Uniform Assessment Instrument (UAI) Explained
Representatives from both the local Department of Health and the Department of Social Services collaborate to conduct screenings for individuals interested in the CCC Plus Waiver. These screenings are designed to assess whether an individual meets the specific qualifications to receive waiver services. An appointment will be scheduled for a formal screening. This screening is conducted by a team consisting of a Health Department nurse and a Social Services representative. The team utilizes a standardized tool called the Uniform Assessment Instrument (UAI). The UAI is designed to evaluate several key factors to determine eligibility:
- Functional Dependencies: Assesses the individual’s ability to perform daily activities and their level of dependence on others for assistance.
- Medical/Nursing Needs: Evaluates the complexity and intensity of the individual’s medical and nursing care requirements.
- Risk of Nursing Home Placement: Determines the likelihood of the individual needing nursing home care if waiver services are not provided.
Screenings can also be arranged for individuals who are currently hospitalized. If you or someone you know is in the hospital and might benefit from the CCC Plus Waiver, you should ask the hospital staff to arrange a screening. For those interested in the specific screening criteria used for children, detailed information is available in the UAI Children’s Screening Criteria document, starting on page 2.
Alt text: Apply for Medicaid online, phone, or in person at your local Department of Social Services – Link to CoverVA application portal.
Medicaid Application and Financial Eligibility for CCC Plus Waiver
While a Medicaid application is not required for the initial CCC Plus Waiver screening, it becomes a necessary step once an individual is deemed eligible for waiver services through the screening process. To formally access and utilize the CCC Plus Waiver, submitting a Medicaid application and meeting specific financial requirements are essential.
You can apply for Medicaid through various methods:
- Online: Through the Cover Virginia website: Apply for Medicaid Online.
- Phone: Apply by phone.
- In-Person: Visit your local Department of Social Services and apply in person or request an application. Find your local department.
It’s crucial to understand the financial considerations for Medicaid eligibility in the context of the CCC Plus Waiver. For adults (18 years and older) applying for the waiver, financial eligibility is based solely on the individual’s income, not the family’s income. This is a significant aspect that can benefit many individuals who might not qualify for regular Medicaid based on family income.
In 2024, the specific financial limits for adults receiving the CCC Plus Waiver are:
- Monthly Individual Income Limit: $2,829
- Resource Limit: $2,000.00
These figures are subject to change, so it’s always advisable to verify the most current limits with the Department of Medical Assistance Services (DMAS) or your local Department of Social Services.
Post-Approval: Navigating the CCC Plus Health Plan Program
Upon approval for the CCC Plus Waiver, individuals will typically be enrolled in the CCC Plus Health Plan Program. This program is designed to manage and coordinate the healthcare services for waiver recipients. However, there is an exception: individuals already enrolled in the Health Insurance Premium Program (HIPP) are excluded from the CCC Plus Health Plan.
To gain a deeper understanding of the CCC Plus Health Plan Program, you can visit the official CCC Plus website. This website provides comprehensive information about the health plan, covered services, provider networks, and member resources.
Regulations, Manuals, and Essential Documents for the CCC Plus Waiver
For those seeking detailed information about the policies and guidelines governing the CCC Plus Waiver, several key documents are available for review:
- CCC Plus Waiver Regulations: Provides the official regulatory framework for the waiver. View Regulations
- CCC Plus Waiver Manual: A comprehensive manual detailing the operational procedures and guidelines for the waiver program. Access Manual
- CCC Plus CMS (Federal) Waiver Application: The formal application submitted to the federal Centers for Medicare & Medicaid Services (CMS) for waiver approval. View Application
- Reimbursement Rates CCC Plus Waiver: Information on the reimbursement rates for services provided under the waiver. View Reimbursement Rates
These resources are invaluable for both individuals seeking to understand the intricacies of the CCC Plus Waiver and for professionals involved in healthcare and social services.
Understanding Your Appeal Rights Under Medicaid
It’s important to be aware that you have the right to appeal decisions or actions related to your Medicaid benefits, including those concerning the CCC Plus Waiver. If you disagree with a decision or action taken regarding your Medicaid case, you have the right to challenge it. To initiate an appeal, you must request it within 30 days of the date of the decision or action you are disputing. For detailed information about the Medicaid appeal process, you can refer to the Medicaid Appeal information.
The CCC Plus Waiver is ultimately administered by the Virginia Department of Medical Assistance Services (DMAS). Visit the DMAS website for more information about Medicaid programs and services in Virginia.
In conclusion, the Commonwealth Coordinated Care Plus Program offers a vital pathway for eligible Virginia residents to receive necessary care and support within their communities. By understanding the eligibility criteria, application process, and available resources, individuals can effectively navigate the system and access the benefits of this important Medicaid waiver.
