MEDICAID - ADVANTAGE WAIVER PROGRAM

ADvantage Administration Unit, Aging Services Division

Department of Human Services (DHS)

PURPOSE

The ADvantage Waiver Program is a long-term care program providing Medicaid funded home & community-based services to frail elders and adults with physical disabilities stay at home instead of going to a nursing facility. ADvantage is a program of the Oklahoma Department of Human Services (DHS) through its Aging Services Division. ADvantage services support families n caregiving; they do not replace a family’s effort. The ADvantage program has added adults with developmental disabilities age 21 and over who do not have mental retardation or a cognitive impairment.

CONTACT

ADvantage Administration Unit

Tom Dunning

Programs Administrator

2401 NW 23rd St., Ste 40

Oklahoma City, OK 73107

(405) 521-4165

www.okdhs.org/programsandservices/aging/adw/

See Appendix B for Department of Human Services County Offices.

FINANCIAL CRITERIA

• See “ELIGIBILITY”

ELIGIBILITY

• Be a resident of Oklahoma

• 65 years of age or older and in frail health; age 21 and older with a physical disability or developmental disabilities who do not have mental retardation or a cognitive impairment; or 21 and older if physically disabled and has a progressive degenerative disease process that responds to treatment

• Nursing home level-of-care need

• Meet Medicaid financial criteria established by the Oklahoma Health Care Authority

• Monthly income limit of $2022.00, with a resource limit of $2000 - this figure is subject to change

AT SERVICES PROVIDED/COVERED

• Assessments & Evaluations

• Maintenance & Repairs

• Case Management

• Training for Consumer & Family

• Information & Referral

• Locating Alternate Funding

• Advocacy/Other

AT DEVICES PROVIDED/COVERED

Aids for Daily Living
Home Modifications

Aids for Hearing Impaired
Hospital Beds

Aids for Vision Impaired |
Medical Supplies

Augmentative Communication
Prosthetics & Orthotics

Environmental Controls
Wheelchair & Mobility Aids

Seating/Positioning Equipment

APPLICATION PROCESS

• Call the statewide referral number (800) 435-4711. The staff will conduct a telephone interview with the potential applicant or family member.

• The staff will refer appropriate applicants to their local DHS office for a functional assessment.

• Case management services for ADvantage are through contracted providers accessed through the county DHS office.

APPEALS PROCESS

1. Oklahoma Department of Human Services (OKDHS) and the ADvantage Program provides an opportunity to request a Fair Hearing to individuals who are not given the choice of home and community-based services as an alternative when eligible for nursing home care, are denied services of their choice or the provider of their choice or, whose services are denied, suspended, reduced or terminated. Fair Hearings are held primarily to safeguard the rights and interests of applicant/members, afford protection to the applicant/member against infractions on the part of OKDHS and help identify the need for clarification or revision of policy or practice.

2. The Service Plan form and Service Plan addendum allows a recipient to disagree with the Service

Plan as it is written, by selecting “No” to the following statement. “I have been informed of my right to request a fair hearing if I disagree with any action taken regarding my Medicaid services. A fair hearing is intended to safeguard my rights and interests by affording me due process. I understand I have the right to appeal any action of the Oklahoma Department of Human Services, which I consider improper by reporting my complaint verbally or in writing to a local county office”.

3. Please note that the appeal process may not be initiated until: 1) the ADvantage Administration Unit (AAU) receives completed copies of the current versions of the Adv6e and Adv6e1 and, 2) the 6g showing a reduction of services is authorized and sent to the Case Management agency.

PIECES OF THE PUZZLE

• Referrals may be made by any source in the community (provider, advocate, family member, consumer, etc).

• When calling the statewide referral number, you may have to leave a message. Normally calls are returned within 24 hours of receiving them.

• The ADvantage Waiver is a Medicaid Program. The program recognizes that many individuals at risk of institutionalization can be cared for in their homes and communities, preserving their independence and ties to family and friends, at a cost no higher than that of institutional care. See “PIECES OF THE PUZZLE” for Medicaid in the Public Agencies Section for more details.

• Questions about Medicaid coverage of specific items should be directed to the Oklahoma Health Care Authority, Customer Service at (800) 522-0114.

• All DME purchased with Oklahoma Medicaid funds become the property of the OHCA to be used by the recipient until no longer needed.

• DME may include home modification, which is a one time exemption to the care plan.

• The ADvantage Administration Unit oversees the day to day operation of the ADvantage Services.