The Commonwealth Coordinated Care Plus (CCC Plus) program is a Virginia Medicaid waiver program designed to provide comprehensive care for specific populations, allowing them to receive necessary services in their homes or communities rather than institutions. This program is crucial for individuals who require a level of care typically provided in nursing facilities but prefer to live more independently.
Who is Eligible for the CCC Plus Waiver?
Eligibility for the CCC Plus Medicaid Waiver is defined by specific criteria focusing on age and medical needs. You may be eligible if you are:
- Adults 65 years of age or older who have medical or nursing needs requiring a certain level of care.
- Individuals under 65 years of age who have a disability and also have medical or nursing needs.
A significant benefit of the CCC Plus waiver is that there is no waiting list. This ensures that eligible individuals can access services promptly upon approval. The program is structured to deliver services through both agency-directed and consumer-directed models, offering flexibility in how care is managed and delivered.
Applying for the CCC Plus Waiver Services
To initiate the process of receiving CCC Plus Waiver services, you should contact either your local Department of Social Services or your local Department of Health. These departments serve as the primary points of contact for individuals seeking to access the program.
When you reach out, be prepared to explain why you or the individual you are representing needs the CCC Plus Waiver. It is helpful to identify the specific services that are needed. It is important to know that you cannot be denied a screening to determine potential eligibility. If, for any reason, you are denied a screening, ensure you request a letter of denial, as this may be necessary for further steps or appeals.
Crucially, you do not need to have Medicaid already in place to be screened, nor are you required to file a Medicaid application at this stage. The screening process is designed to assess functional dependencies and medical/nursing needs to determine if an individual meets the waiver’s requirements.
Representatives from the Department of Health and Department of Social Services will conduct the screening to ascertain if you meet the necessary qualifications. An appointment will be scheduled for this screening. The screening team, typically consisting of a Health Department nurse and a Social Services representative, utilizes a tool called the Uniform Assessment Instrument (UAI). This UAI helps determine if individuals exhibit the required functional dependencies, medical or nursing needs, and if they are at risk of needing nursing home placement. Screenings can also occur while an individual is hospitalized. In such cases, you can request hospital staff to arrange a screening.
For those interested in the specific screening criteria for children under the UAI, detailed information is available here.
Medicaid Application and Financial Eligibility for CCC Plus
While you don’t need to apply for Medicaid before the screening, if you are found eligible for the CCC Plus Waiver based on the screening, you must apply for Medicaid to utilize the waiver services.
To formally apply for Medicaid, you can submit an application via phone, online through the CoverVA website, or in person at your local Department of Social Services.
It’s important to understand the financial considerations for Medicaid eligibility in the context of the CCC Plus Waiver. For adults (18 years and older) receiving the Waiver, financial eligibility is based solely on the individual’s income, not the family’s income. For 2024, the monthly individual income limit is $2,829, and the resource limit is $2,000.00. These financial guidelines are crucial for determining Medicaid eligibility for the CCC Plus program.
What Happens After CCC Plus Waiver Approval?
Upon approval for the CCC Plus Waiver, individuals will typically be enrolled in the CCC Plus Health Plan Program. This program integrates healthcare services to provide coordinated care. However, individuals already enrolled in the Health Insurance Premium Program (HIPP) are excluded from the CCC Plus Health Plan. More detailed information about the CCC Plus Health Plan Program can be found on the CCC Plus website.
Regulations, Manuals, and Important Documents
For those seeking in-depth information and official documentation, several key resources are available online:
- CCC Plus Waiver Regulations: Provides the legal framework and rules governing the program. View Regulations
- CCC Plus Waiver Manual: A comprehensive guide detailing the operational procedures and guidelines of the waiver. View Manual
- CCC Plus CMS (federal) Waiver Application: The official application submitted to the federal Centers for Medicare & Medicaid Services. View Application
- Reimbursement Rates CCC Plus Waiver: Information on the payment structures for services under the waiver. View Reimbursement Rates
Appeal Rights for Medicaid Decisions
It is important to be aware that you have the right to appeal decisions made regarding Medicaid and the CCC Plus Waiver. If you disagree with a decision or action, you must request an appeal within 30 days. Information regarding Medicaid Appeal information is readily available to guide you through this process.
The CCC Plus Waiver is administered by the Virginia Department of Medical Assistance Services (DMAS). For further inquiries or more detailed information, you can visit the VA Dept. of Medical Assistance Services website.
This program serves as a vital resource in Virginia, ensuring that individuals who require significant medical support can receive care in the most appropriate and least restrictive setting possible, often within their own homes and communities.
