IMA POLICY MANUAL
PART VII: SPECIAL MA PROCESSING
CHAPTER 3: OTHER HEALTH PROGRAMS AND REFERRALS
Many IMA customers may be ineligible for AR/AX or SR Medicaid but remain in need of health services. This chapter presents the policies and referrals information for special Medicaid expansions and other District programs, including:
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DC HealthCare Alliance
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Elderly and Physically Disabled Home- and Community-Based Services Waiver
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HIV Programs
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Breast and Cervical Cancer Program
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Mental Health Special Rehabilitation Option
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Drug Abuse Program (Addiction Prevention and Recovery)
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Mental Retardation and Developmental Disabilities Waiver
Because each of these programs is administered outside of IMA, it may be necessary to refer customers to the appropriate program agency.
These programs are outside the purview of IMA. In specific instances, the IMA Medicaid Branch “enrolls” customers in these programs by creating an ACEDS record. However, the primary responsibility for enrollment, case maintenance, recertification, and de-enrollment remains with the respective program agency that administers the program.
DC HEALTHCARE ALLIANCE 3.3
Effective June 1, 2006, IMA administers eligibility for the DC HealthCare Alliance. This section has been expanded and moved to Chapter 4: DC HealthCare Alliance in this Part.
Note: Customers in the MC program type in ACEDS with a program code of 370 are actually enrolled in the 50-64 Demonstration; please see Section 1.16: 50-64 Demonstration in Chapter 1 of this Part for additional information.
ELDERLY AND PHYSICALLY DISABLED HOME-AND-COMMUNITY-BASED SERVICES WAIVER 3.4
Frail elderly or disabled customers may be able to receive both Medicaid and home-base care services through this Waiver program, even if their incomes are above the SR Medicaid limit. Waiver services include home nursing and personal care aide services, homemaker and chore services, home modifications, non-medical transportation, etc.
Generally, to be eligible for these services, the individual:
- must have income below 300 percent of the SSI payment level;
- must have assets below the Medicaid categorically needy resource level;
- would be eligible for Medicaid if placed in an institution;
- must require a level of care provided in LTC facilities; and
- could be served in a more cost effective manner with community based services.
The waiver limits the number of individuals who can receive Medicaid funded community based services under this waiver. Customers may apply be calling (202) 535 2178 or (202) 442 5912.
This program is funded and administered by the Medical Assistance Administration within the Department of Health, though the IMA Medicaid Branch establishes ACEDS records under the AZ program type for customers enrolled in the Waiver.
In addition to HIV testing and counseling, the HIV/AIDS Administration offers a variety of programs for HIV-infected District residents. These programs include assistance with COBRA insurance premiums, pharmacy assistance through the AIDS Drugs Assistance Program (ADAP), and several Medicaid expansion programs. Persons with gross incomes less than 400 percent of the Federal Poverty Level may be eligible for one or more of these programs.
To apply, customers should call the HIV/AIDS Administration on (202) 727-2500. Customers may also complete a “Application for Health Services” while at IMA; staff should facilitate the process by faxing documents as required.
These programs are funded and administered by the Department of Health, though the IMA Medicaid Branch establishes ACEDS records for customers enrolled in the Medicaid Demonstrations.
BREAST AND CERVICAL CANCER PROGRAMS 3.6
The Breast and Cervical Cancer Program, also known as “Project Wish”, provides screening and treatment services to District residents with gross incomes below 250 percent of the Federal Poverty Level. Customers must be screened and diagnosed by a Project Wish provider before they can enroll in the program. The program is funded and administered by the Department of Health.
For more information, customers may call Project Wish toll free on 1-888-833-WISH (1-888-833-9474; TYY 1-877-672-7368)
The program is funded and administered by the Department of Health, though the IMA Medicaid Branch establishes ACEDS records under the AZ program type for customers enrolled in the program.
MENTAL HEALTH AND SPECIAL REHABILITATION OPTION 3.7
The Department of Mental Health provides a variety of services to customers to treat and recover from mental illness. These services include diagnostic/assessment services, medication, counseling, intensive day treatment, crisis/emergency services, residential treatment, and specialized services for adults and children. Fees for services are determined on a sliding scale basis. No one will be turned away because of inability to pay for service.
For more information or assistance, customers may call 1-888-7WE-HELP (1-888-793-4357).
DRUG ABUSE PROGRAM (ADDICTION PREVENTION AND RECOVERY) 3.8
The Addiction, Prevention and Recovery Administration (APRA) within the Department of Health provides a variety of services for the prevention of and recovery from addictions. These services include crisis intervention, education, counseling; 24 Hour detoxification services; residential treatment; outpatient and methadone programs; and case management. APRA also offers special services for youth, pregnant and postpartum women.
For more information or assistance, customers may call 1-888-7WE-HELP (1-888-793-4357).
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES HOME-AND-COMMUNITY-BASED SERVICES WAIVER 3.9
The Mental Retardation and Development Disabilities Administration (MRDDA) provides home- and community-based services for adult District residents. These services include home nursing and personal care aide services, adaptive equipment, residential care placements, rehabilitation services, vocation training and placement services.
To apply for MRDDA services on behalf of an individual, customers may contact an intake representative at (202) 673 4554 Monday through Friday from 8:15 am until 4:45 pm. TTY/TDD services 24 hours a day at (202) 673 3580.
These programs are administered and funded by MRDDA, though the IMA Medicaid Branch establishes ACEDS records under the AZ program type for customers enrolled in the Waiver.
