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Waivers 1

Deciding if a waiver is right for you

Getting access to the services and supports you need, to live, work and play where you want, is a key part of living your best life.

For many people with disabilities, Home and Community Based (HCBS) Waivers and the services available through the waiver, help them live in the community, stay in the home of their choosing, find meaningful work, and reach their goals.

The questions and information below will help you decide what next steps to take if you're interested in HCBS waiver services to help you live your best life.

There are many things to think about when considering if a waiver is right for you:

  • Do you have any needs that are not being met?
  • Is your living situation meeting your physical needs and are you safe?
  • Do you have people in your life that help you?
  • Do you want more help than you are currently receiving?

There are also people and advocacy agencies you can talk with and who can help you decide, including:

  • Your family and/or support people
  • Your medical team
  • Your county representative
  • Disability Hub MN
  • Centers for Independent Living

To decide if you'd like the services provided by a waiver, it can be helpful to document your wants and needs. To do this, consider completing:

Waivers 1

Qualifying for a waiver—is it right for you?

To be eligible for a waiver, you must:

1. Be eligible for Medical Assistance (MA)

2. Be certified disabled by the Social Security Administration or the Minnesota State Medical Review Team (SMRT)

3. Complete a MNChoices assessment through your county agency or tribe

NEXT: Answer the questions below to learn more about eligibility, things to think about, and the people, agencies and resources that can help you along the way.

1. Do you have Medical Assistance?

Medical Assistance is health insurance for people with and without disabilities who meet the income and assets rules. It is a heath insurance program that pays for things like hospital care and doctor visits. It can also pay for things that don't tend to be covered by private insurance, like personal care attendant (PCA) services.

If you have Medical Assistance, please continue to Question #2: "Do you have a disability determination?"

If you don't have Medical Assistance, also known as MA, the information below can help you prepare for the application process.

  • Do I want to apply for Medical Assistance?
    You need to apply and be found eligible for Medical Assistance in order to receive HCBS waiver services.
  • Do I want to apply with a paper application or online?
  • Do I need help filling out the application?
  • Do I already have insurance coverage?

You will need the following information for each household member:

  • Monthly income sources (pay stubs, direct deposit proof, taxes), with verification
    Employers' information includes name, address, Employer Identification Number (EIN)
  • Assets (home mortgage, vehicles you own, bank accounts, retirement accounts), with verification
  • Social Security number
  • Contact information
  • Insurance information
  • Immigration status information

You should:

  • Provide correct information on the application and provide updated information if something changes (such as your income, your address, or the number of people in your household)
  • Follow-up with the county when the application is received and processed
  • Check your mail for information and requests for verifications from the county or tribal human services agency
  • Always ask for help if there is something you do not understand

The Disability Hub MN can:

  • Help you find the Medical Assistance application you prefer
  • Help you understand the questions on the application
  • Troubleshoot any issues with processing the application by helping you contact the county or tribal human services agency
  • Connect you to community resources to help with the application

The county/MNSure will:

  • Determine your eligibility for Medical Assistance

The agency determining your eligibility should notify you, by mail, within 45 days of receiving your application. It may take longer if they need to complete a disability determination through the State Medical Review Team (SMRT).  

If you do not receive any requests for more information or a notification within 45 days, contact the county or tribal human services agency you submitted the application to. If you need assistance contacting the human services agency – connect with Disability Hub MN to ask for help, they can call with you! 

If you’re not sure if you have Medical Assistance, contact the Disability Hub MN or your county or tribal human services agency to ask.

2. Do you have a disability determination?

A disability determination is a certification of disability through the Social Security Administration (SSA) or State Medical Review Team (SMRT).

If you have a disability determination from SMRT, please continue to Question 3: "Have you had a MnCHOICES Assessment by your county or tribal human services agency?"

Please continue to Question 3: "Have you had a MnCHOICES Assessment by your county or tribal human services agency?"

If you have a disability determination from Social Security, but you are under the age of 18, you will still need to go through the disability determination process with the Minnesota State Medical Review Team (SMRT) to be approved for a waiver. The SMRT process will determine the level of care you require, which is used to decide which waiver(s) you may be eligible to receive.

If you'd like to move ahead with pursuing an HCBS waiver, start by:

  • Contacting your county or tribal human services eligibility worker to request a SMRT referral.
  • Complete and return the SMRT disability worksheet you receive in the mail.

Here are items to consider:

  • SMRT Hotline
    The SMRT Hotline (651-431-2493 or 1-800-235-7396) can check on the progress of your application.
  • The MNSure Team/County financial worker
    This team can verify your case was referred for a SMRT referral.
  • A medical exam that was completed less than three months ago
  • Contacts for medical records to show proof of disabling condition
  • Work history
  • Activities of daily living
  • Educational history (example: degrees completed)

You should:

  • Fill out the required paperwork and follow-up on any requests for more information
  • Talk with your physician to share why certain documents are required
  • Complete a medical exam (if it’s been longer than three months since your last one)

Disability Hub MN can:

  • Explain the SMRT process
  • Help you think about what supporting documentation may be helpful for the application
  • Find providers in your area
  • Discuss SMRT versus Social Security options with you

The SMRT Team will:

  • Will collect your medical records and make a disability determination

Medical professionals will:

  • Need to provide your medical records to the SMRT Team

The process timeline can vary, from a few months to a year, from the time the county makes the referral to SMRT. It’s important to respond quickly to requests for information, to keep the process moving and get a determination – and to make sure you have had current medical exams. The more work you do to prepare for this process, the quicker it can be completed.

If you don't have a disability determination but would like to be reviewed for one:

  • Contact your county financial worker to request a SMRT referral (you must already have Medical Assistance for this referral to be made).
  • Complete and return the SMRT disability worksheet.
  • Consider applying for a disability determination through the Social Security Administration.

Here are items to consider:

  • Do you need the financial benefit from Social Security?
  • Do you need the determination of disability for Medical Assistance benefits and/or services?
  • Do you need to visit the doctor to establish current medical records?
  • SMRT Hotline
    The SMRT Hotline (651-431-2493 or 1-800-235-7396) can check on the progress of your application.
  • The MNSure Team/County financial worker
    This team can verify your case was referred for a SMRT referral.
  • A medical exam that was completed less than three months ago
  • Contacts for medical records to show proof of disabling condition
  • Work history
  • Activities of daily living
  • Educational history (example: degrees completed)

You should:

  • Fill out the required paperwork and follow-up on any requests for more information
  • Talk with your physician to share why certain documents are required
  • Complete a medical exam (if it’s been longer than three months since your last one)

Disability Hub MN can:

  • Explain the SMRT process
  • Help you think about what supporting documentation may be helpful for the application
  • Find providers in your area
  • Discuss SMRT versus Social Security options with you

The SMRT Team will:

  • Will collect your medical records and make a disability determination

Medical professionals will:

  • Need to provide your medical records to the SMRT Team

The process timeline can vary, from a few months to a year, from the time the county makes the referral to SMRT. It’s important to respond quickly to requests for information, to keep the process moving and get a determination – and to make sure you have had current medical exams. The more work you do to prepare for this process, the quicker it can be completed.

If you're not sure if you have a disability determination, contact the Disability Hub MN.

3. Have you had a MnCHOICES Assessment by your county or tribal human services agency?

A MnCHOICES Assessment is an assessment and planning tool used to gather information and help you make decisions about your long-term services and supports. It assesses your general health, your ability to take care of routine daily tasks and any help you may receive from family and friends. The assessment is free and is typically completed in-person in the place you live, by a certified assessor.

If you've had a MnCHOICES assessment and you've received the results, here are items to consider:

  • Do you agree with the outcome of the assessment?
  • If you are eligible for waiver supports, do you want to use those supports?
  • If you do want waiver services, do you want to have someone else in charge of your services or do you want to be in charge of your services (examples: hiring or firing caregivers, writing your support plan, managing your budget)?
  • Your case manager
  • Special Needs Basic Care (SNBC) Care Coordinator
  • Current support people
  • List of agencies in your area that provide services you're eligible to receive
  • Community resources that help you meet your support needs

If the assessment finds that you are eligible for a waiver:

You should:

  • Decide what is important to you—this will help you select a service provider
  • Notify your Case Manager or MnCHOICES assessor when you select a service provider
  • Ask questions about anything you don't understand

The Disability Hub MN will:

  • Help you understand the services you qualify for
  • Help you understand options for you to direct your own services
  • Find service providers in your area
  • Explain your options if you disagree with your MnCHOICES assessment results

Your assessor/case manager will:

  • Enter in a service agreement with the agency(s) you decide to work with

Within 40 days of the assessment visit, you will receive a written community support plan with details outlining your needs for care and options for services and supports. You will work with your case manager or support planner to create a plan for the services you want to meet your needs. A service agreement or support plan will then be created and approved. The providers you choose will then do an intake to get services set up and started. 

Each year you will complete a renewal of your assessment. 

If you have significant health changes or your support needs change, you can request a reassessment. 

You should receive results within 40 days of the assessment visit. 

If you haven’t received results within 40 days of the assessment visit, you can contact the MnCHOICES assessor to ask for an update, or contact Disability Hub MN to get help contacting the county or tribal office for an update.

If you have requested a MnCHOICES assessment from your county or tribal intake office, it should occur within 20 calendar days of your request. 

If you do not have the assessment scheduled and it has been 20 calendar days since the request, you can contact the county or tribal intake office again to request an update and to make sure it gets scheduled. You can also contact Disability Hub MN to request assistance contacting the county or tribal office. 

Contact the Disability Hub MN for help understanding what a MnCHOICES assessment is or read more in this MnCHOICES assessment brochure.

Is a waiver right for you?

If you want the services provided by a waiver and answered “Yes” to all three questions above – or you would like to start the process so you can answer “Yes” to these questions – than a waiver might be for you. 

If you start the process and change your mind, that’s ok. 

If you get services for a while and then decide you no longer need them, that’s ok.

An HCBS waiver is just one option you have to get help. To learn about other options, review information on Independent Living.

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My needs have changed—how do I get additional services?

If you're approved for a waiver: Contact your Case Manager to request a reassessment. You will need to document your additional needs.

If you're PCA-only approved: Contact your local county or tribal agency's general information line to let them know there was a significant change to your condition that has increased your needs for services. You will need to document your additional needs.