Minnesota Medicaid pays for in-home personal care and related services through 3 programs, including the Elderly Waiver (EW) and the Community Access for Disability Inclusion (CADI) Waiver. DHS oversees the waivers and counties administer them; Minnesota also runs CAC and BI disability waivers and the state Alternative Care program. A common service menu across the four disability waivers began January 2021, and consolidation into two disability waivers is set to phase in from January 1, 2027. Respite rates are set in Minn. Stat. 256B.4914 subd. 9a; confirm EVV requirements with DHS.
Yes. Community First Services and Supports (CFSS, Minn. Stat. 256B.85) is a state plan option that replaces the personal care assistance (PCA) program; it covers help with ADLs, IADLs, and health-related tasks through an agency-provider model or a budget model for people dependent in at least one ADL or Level 1 behavior.
Which Minnesota waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Elderly Waiver (EW)
Population
Medical Assistance enrollees 65 and older assessed under Minn. Stat. 256B.0911 as needing nursing facility level of care.
Services covered
homemaker
chore
companion
respite (in-home and out-of-home)
individual community living supports
adult day services
home-delivered meals
consumer-directed community supports
customized living
Billing format
Members enrolled in a managed care organization get EW services and case management through the MCO; others get county or tribal fee-for-service case management (Minn. Stat. 256S.05, 256S.07).
Community Access for Disability Inclusion (CADI) Waiver
Population
People with a disability who require the level of care provided in a nursing home.
Services covered
individualized home supports
respite
night supervision
adult day services
integrated community supports
positive support services
employment services
transportation
Billing format
Counties administer the waiver and write individualized service plans; services are paid under the disability waiver rate system (Minn. Stat. 256B.4914).
People with developmental disabilities or a related condition who need ICF/DD level of care.
Services covered
individualized home supports
respite
night supervision
day support services
community residential services
family residential services
positive support services
employment services
Billing format
Counties administer the waiver and write individualized service plans; services are paid under the disability waiver rate system (Minn. Stat. 256B.4914).
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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