Medicaid ADvantage Waiver Program

Purpose

The ADvantage Program of the Home- and Community-Based Waiver Services provides Medicaid services to help people stay at home instead of going to a nursing home. The program assists frail elders and adults who have physical disabilities.

A person must first qualify for Medicaid, a low-income service, prior to receiving ADvantage. ADvantage cannot be provided for children or those individuals with an intellectual disability or a cognitive impairment.

Contact(s)

Mailing Address:
P.O. Box 35900
Tulsa, OK 74153
(918) 933-4900
(800) 435-4711

Eligibility

  • Be a resident of Oklahoma;
  • meet Medicaid financial eligibility requirements, which currently limit monthly countable income to $2,199 and a resource limit of $2,000. These figures are subject to change;
  • be 65 years of age or older;
  • be age 21 or older with a physical disability;
  • if age 21 or older with a clinically documented, progressive degenerative disease process that responds to treatment and previously has required hospital or nursing facility (NF) level of care services for treatment related to the condition and requires ADvantage services to maintain the treatment regimen to prevent health deterioration;
  • if developmentally disabled, and between the ages of 21 and 65, but does not have an intellectual disability or a cognitive impairment related to the developmental disability; and
  • nursing home level-of-care needs.

AT Services Provided/Covered

  • Assessments & Evaluations
  • Case Management
  • Training for Member & Family
  • Information & Referral
  • Locating Alternate Funding

AT Devices Provided/Covered

  • Aids for Daily Living
  • Speech Communication
  • Environmental Adaptation
  • Mobility/Seating & Positioning

How to Get the AT

  • Call the statewide referral number (800) 435-4711 or go to the local OK Department of Human Services (DHS) county office to apply.
  • The staff will refer appropriate applicants to their local DHS office for a functional assessment.
  • When applying for ADvantage call the contact line or go to the local county OKDHS office, where an “assessment” will be arranged. A nurse will come to the home to complete the assessment. At that time, the nurse will determine medical eligibility for ADvantage. During the same time period, an OKDHS social worker will decide financial eligibility for ADvantage. If both financial and medical eligibility is determined, a case manager will help decide what services are needed and will develop an individualized treatment plan. The case manager will also help to arrange the services.
  • Home modifications can be provided if needed in the treatment plan.
  • ADvantage Program Case Managers can assist members with acquiring specialized equipment. However, these items are not generally purchased directly with ADvantage funds.

Pieces of the Puzzle

  • 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.
  • Consumer Directed Personal Assistance Services and Supports (CD-PASS) offers ADvantage members the opportunity to direct decisions regarding personal care services. CD-PASS enables members with personal assistance needs to recruit, hire, train, supervise, and when necessary, fire their personal service assistant. ADvantage members are not required to utilize the CD-PASS option.
  • A redetermination for both financial and medical eligibility is conducted annually.
  • The number of individuals who may receive ADvantage services is limited. If the OKDHS/Aging Services determines all ADvantage waiver slots are filled, the individual cannot be certified on the OKDHS computer system as eligible for ADvantage services; the individual’s name is placed on a waiting list for entry as an open slot becomes available.
  • All durable medical equipment (DME) purchased with Oklahoma Medicaid funds become the property of the Oklahoma Health Care Authority (OHCA) to be used by the recipient until no longer needed.
  • When the ADvantage member no longer needs the valuable DME they may contact the Oklahoma Durable Medical Equipment Reuse Program (OKDMERP) so it can be refurbished, repaired if needed, and reassigned to another Oklahoman at no cost. Priority is given to SoonerCare members for the first 60 days. Call OKDMERP staff at 833-431-9706 or go to okabletech.org for more details.

Dispute Resolution Process

  1. The 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 applicants/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 allow 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”.