Along with the medical, behavioral, vision, dental and pharmacy services Molina Healthcare covers, Molina Healthcare also manages certain Long Term Services and Supports (LTSS), or waiver services, for the state of Michigan.
What are waiver services>
The Michigan Duals Demonstration Project through MI Health Link offers Long Term Services and Supports (LTSS) and home and community-based waivers . Waiver services allow our members and your patients to remain in their own home or live in a community setting. Each waiver is designed for individuals with similar needs and offers a different set of services. You can read more about them here.
Home and community-based long term services and supports is managed by Molina Healthcare for adults who are elderly and/or disabled and meet nursing facility level of care.
Managed Specialty Services and Supports Program (MSS&SP) is operated by Prepaid Inpatient Health Plans (PIHPs)* for individuals with a need for services related to serious and persistent mental illness, developmental disability, and/or substance use disorder.
Habilitation Supports Waiver is operated by PIHPs* and includes home and community based services designed to offer an alternative to institutionalization that provides intensive habilitation and support services to assist individuals with intellectual/developmental disabilities to live independently in the community.
*Pre-paid Inpatient Health Plan (PIHP) - PIHPs manage the Medicaid specialty services under the 1915(b)(c) Waiver Program, covering mental health and substance use services for people eligible for Medicaid who have a need for behavioral health, intellectual/developmental disabilities services and supports, or substance use services.
Eligibility for waiver services
In order to qualify, the member must meet certain eligibility requirements. Molina Healthcare does not determine eligibility into the waiver or nursing home programs.
The Michigan Department of Community Health makes this determination by reviewing a Nursing Facility Level of Care Determination, to see if a member is eligible for Long Term Care or to receive waiver services. If a member qualifies for waiver services, the member will be notified.