Document Library

2015 Financial Eligibility Guidelines

This Program Instruction (PI) transmits the Financial Eligibility Guidelines that take effect on February 10, 2015 for the Home Care Program, and sets out the voluntary co-payment, cost sharing, and Respite Care co-payment schedules. Please click the link below for the actual guide and schedule.

Download Cost Share Table for the Home Care program 2015

Financial Worksheet

Below is a link to a Microsoft Word document of the consumer Financial Worksheet that should be used for determining program eligability.

Download Financial Worksheet 4-2014

Applicant Consent and Disclosure Form

The link below is for a Microsoft Word document to be used by ASAPs to aquire the appropriate level of consumer information consent and disclosure.

Download EOEA Applicant Consent and Disclosure Form (2)

Notification of Non-Participation

The link below is a Microsoft Word document that contains the appropriate text for a notice of non-participation in the Home and Community-Based Services Waiver Program.

Download Notification of Non-Participation revised 12-10-13

Recipient Choice Letter

The link below is a Microsoft Word document that contains the appropriate language to be included in a Recipient Choice Letter.

Download Recipient Choice Form

Medicaid Intent to Refer Letter

The link below is a Microsoft Word document with the text to be included in a letter of referral to Medicaid.

Download Intent to Refer Revised 12 11 2013

Program Instruction - 2013 Home Care Program Cost Sharing Tables

Document Abstract: This Program Instruction (PI) transmits the Financial Eligibility Guidelines that took effect February 1, 2013, for the Home Care Program and sets out the voluntary co-payment, cost sharing, and the Respite Care co-payment schedules.

Revised Co-payment and Cost Sharing Schedule:  Elder Affairs implemented co-payment and cost share increases effective February 1, 2013. This job aid gives users the step-by-step procedures necessary to track Long Term Options Counseling (LTOC) services and outcomes in SAMS.   

Author: Mary DeRoo

Sources Executive Office of Elder Affairs

Keywords 126, financial eligibility

File: Download PI-13-02 Revised Cost Share Table for the HC Progrm  

Formerly Categorized As: Document Library Announcements, Home Care

Revised Cost Share Table for the Home Care Program

This Program Instruction (PI) transmits the Financial Eligability Guidelines that take effect on Februry 1, 2014 for the Home Care Program, and sets out the voluntary co-payment, cost sharing, and Respite Care co-payment schedules. Please click the link below for the actual guide and schedule.

Download PI-14-02 Revised Cost Share Table for the Home Care Program

Clinical Assessment and Eligibility Program: Best Practices Guide and Appendix

The information contained within the guide is the be used by professionals working within the ASAP and is to serve as a guide and reference only. The information contained within the guide is only current as of November 2014. The most current regulations, program instructions, and information memorandums should be adhered to at all times Click the links below for the full Guide and Appendix respectively.

Download CAE Guide Version 1.02 11.4.14 FULL VERSION

Download CAE Guide Appendix 9.10.14

Requirements for Comprehensive Screening and Service Model Activities (CSSM)

The purpose of this Program Instruction is to issue requirements for Aging Services Access Points (ASAPs) in the performance of Comprhensive Screening and Services Model (CSSM) program related activities. This Program Instruction requires all ASAPs to adopt a specified management and staffing model and protocols to perform CSSM-related activities.