MLTSS Waiver Programs
The goal of the Managed Long Term Service and Supports (MLTSS) Program is to help you improve your well-being, avoid re-admissions, return to and/or remain living in the residence of your choice (including your home and community) and increase the quality of your life.
You will always have access to a live person, and you can customize your plan of care with your CCC to improve your health outcomes. We have a robust array of service and support options to fit your needs. Get more information about the program by exploring the links below.
Your Community Care Coordinator (CCC) can help you:
- Get the services and support you need to achieve your goals
- Empower you to take control of your health issues
- Understand your health plan benefits with MeridianHealth
- Address any questions or concerns you have
MeridianHealth’s Care Coordination program works as a team. Each team is made up of a CCC, a Nurse or Social Worker Team Lead, and consultants from other specialties like Nutrition, Behavioral Health, and Pharmacy. These teams meet daily to review your needs. A MeridianHealth Medical Director oversees each team to make sure you get the most out of your health care and a Community Health Outreach Worker can help you connect with the resources you need to achieve your goals.
Call your CCC with any questions. If you don’t know who your CCC is or don’t think you have one but think you qualify for the program, call the Member Services department at 866-606-3700. Care Coordination is available to you free of charge. You may choose to participate in or leave this program at any time.
MeridianHealth does not determine your eligibility into the Waiver or Nursing Home programs. Eligibility determination is under either the Department on Aging or the Department of Rehabilitative Services.
Freedom of Choice
As part of Meridian's MLTSS Program, you have the choice of nursing facility placement, supportive facility placement or home and community-based services. You also have the right to choose not to get services. You may choose which provider/agency you want to give your MLTSS. The Illinois Department of Rehabilitative Services and the Illinois Department of Aging has a list of doctors who provide services in your service area. This list will be reviewed with you by your CCC. You also have the right to choose not to get services.
MeridianHealth ensures you have the freedom to choose providers for waiver services. MeridianHealth’s team of Care Coordinators will work with you to find the provider that best meets your needs. You will need to choose a provider from MeridianHealth’s network of waiver service providers. You can search for providers on our website at www.mhplan.com or call Member Services at 866-606-3700 and we can send you a list of providers in your area. If you want to see a provider that is out of our network, we will work with you and the provider on a solution.
Transfer to Other Provider/Agency
You may ask to change from one provider to another. If you want to change, you should call your CCC to help arrange the transfer.
Temporary Change in Residence
If you will be temporarily residing in another location in Illinois and want to continue to receive services, contact your MeridianHealth Care Coordinator. Your Care Coordinator will assist you by arranging service transfer to your temporary location.
Below is information on the different types of MLTSS Waiver programs covered by Meridian.
|Waiver Program||Waiver Services||Additional Eligibility Requirements|
You must be 60 years of age or older and meet nursing facility level of care.
Persons with Disabilities Waiver
You must have a physical disability, be 0-59 years of age and meet nursing facility level of care (this includes adults dependent on a ventilator). Those 60 years old and older who began waiver services before age 60 may stay in this waiver.
Persons with Brain Injury Waiver
You must have a brain injury and meet nursing facility level of care.
People with HIV/AIDS Waiver
Supportive Living Program Waiver (SLP)
You must be a person with a disability 22 years old and older or be 45 years old and older and otherwise would be institutionalized in a nursing facility.
Adult Day Health (also known as Adult Day Services)
This is a daytime, community-based program for adults not living in Supported Living Facilities. Adult Day Health offers many types of social, recreational, health, nutrition and related support services in a protective setting. One ride to and from the center each day and lunch are part of this service.
These services are behavioral therapies designed to help members with brain injuries manage their behavior and thinking functions and enhance their ability to live independently.
Day Habilitation (also known as: Habilitation)
For members with brain injuries, this service gives training with independent living skills, such as help with gaining, keeping or improving self-help, socialization and adaptive skills. This service also helps the member to gain or keep his or her greatest functional level.
Emergency Home Response (also known as Personal Emergency Response System (PERS))
This electronic equipment gives members 24-hour access to help in an emergency. The equipment is linked to your phone line and calls the response center and/ or other forms of help once the help button is pressed.
Environmental Accessibility Adaptations
These are physical changes to a member’s home. The changes must be needed to support the health, welfare and safety of the member and to let the member to function with greater independence in his or her home. Without the change, a member would need some type of institutionalized living, such as nursing facility or assisted living.
Adaptations that do not help the member’s safety or independence are not part of this service, such as new carpeting, roof repair, central air or home additions.
An in-home caregiver is hired through an agency. The caregiver helps with housekeeping such as meal preparation, shopping, light housekeeping and laundry. The caregiver can also help with hands-on personal care such as personal hygiene, bathing, grooming and feeding.
Home Delivered Meals
Prepared food is brought to the member’s home each day. The meals may include a heated lunch meal and a dinner meal (or both), which can be refrigerated and eaten later. This service is designed for a member who cannot make his or her own meals but is able to feed him/herself.
Home Health Aide
A person who works under the supervision of a medical professional, nurse or physical therapist, to help the member with basic health services such as help with medication, nursing care or physical, occupational and speech therapy.
This service offers skilled nursing services to a member in his or her home for short-term acute healing needs. The goal of this service is to restore and keep a member’s highest level of function and health. This service is supplied instead of a hospital stay or a nursing facility stay. A doctor’s order is needed for this service.
Nursing – Intermittent
This service focuses on long term needs rather than short-term acute healing needs, such as weekly insulin syringes or medication set up for members who cannot do this for themselves. These services are supplied instead of a hospital stay or a nursing facility stay. A doctor’s order is needed for this service.
Nursing Facility Program
The Nursing Facility Program is also called a Nursing Home, Long Term Care Facility, or Skilled Nursing Facility. It is a licensed facility that provides skilled nursing or long-term care services after you have been in the hospital. These facilities offer medical and non-medical needs of residents who need assistance and support to care for themselves due to chronic illness or disability.
A Personal Assistant is an in-home caregiver hired and managed by the member. The member must be able to manage many parts of being an employer such as hiring the caregiver, managing the caregiver’s time and timesheets and completing other employee paperwork. The caregiver helps with housekeeping items such as meal preparation, shopping, light housekeeping and laundry. The caregiver can also help with hands-on personal care items such as personal hygiene, bathing, grooming and feeding. Personal Assistants can include other independent direct care givers such as RNs, LPNs and Home Health Aides.
Physical, Occupational and Speech Therapy (also known as Rehabilitation Services)
These services are designed to improve and/or restore a person’s functioning and include physical therapy, occupational therapy and/or speech therapy.
This service is for members with brain injuries and offers work experience and training designed to help develop skills to work in the general workforce. Services include teaching concepts such as compliance, attendance, task completion, problem-solving and safety. These services are for members whose plan of care notes that they will be able to work within one year.
This service gives relief for unpaid family or primary caregivers who are meeting all the needs of the member. The respite caregiver helps the member with all daily needs when the family or primary caregiver is absent. Respite can be given by a homemaker, personal assistant, nurse or in adult day health center.
Supported employment involves activities needed to keep paid work by people getting waiver services, including supervision and training.
Supportive Living Program (also known as Supportive Living Service)
An assisted living facility is a housing choice that gives members many support services to meet their needs to help keep members as independent as possible. Examples of support services to meet those needs are: housekeeping, personal care, medication oversight, shopping and social programs. Supportive Living does not offer complex medical services or supports.
If you have any questions regarding Meridian’s HCBS Program, or the MLTSS Program in general, contact Member Services at 866-606-3700.
*Meridian does not determine your eligibility into the Waiver or Nursing Home programs. Eligibility determination is under either the Department on Aging or the Department of Rehabilitative Services.