Virginia’s Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver  

Program Description

The Virginia Commonwealth Coordinated Care Plus Medicaid Waiver, is abbreviated as CCC+. CCC+ provides services to elders and individuals with physical disabilities in the community (as opposed to in a nursing home) to prevent the premature institutionalization of seniors and physically disabled individuals. Many services are available via this waiver, including assistance with the Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, dressing, light housecleaning, preparation of meals, and monitoring of medications.

This Medicaid Waiver allows for consumer direction of personal assistance services and respite care services, meaning eligible applicants are able to choose the caregiver from whom they receive services. This includes friends and select relatives. Spouses and legal guardians cannot be hired to provide care, but the adult children who wish to work as caregivers for their aging parents can be compensated for their caregiving efforts.

Full Medicaid benefits are available via CCC+ and include behavioral health services and medical benefits. For those who are also on Medicare, there is an option to coordinate Medicaid and Medicare services through one health plan. However, one does not have to choose this option. (Those who are on both Medicaid and Medicare are commonly referred to as dual eligible).

CCC+ is administered by the Virginia Department of Medical Assistance Services’ (DMAS) Division of Aging and Disability Services (DADS) and provides services to approximately 210,000 Virginia residents. This waiver is the result of two former Medicaid Waivers merging: The Assisted Technology Waiver and the Elderly or Disabled with Consumer Direction Waiver.

This statewide Home and Community Based Services (HCBS) Medicaid waiver is a long-term managed care program that operates via six Managed Care Organizations (MCOs). As of 2018, these MCOs include Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Magellan Complete Care of Virginia, Optima Health Community Care, United Healthcare, and Virginia Premier Elite Plus. For those who are eligible, program participation is mandatory.

 

Eligibility Guidelines

To be eligible for the Commonwealth Coordinated Care Plus Medicaid Waiver, one must be a Virginia resident 65 years of age or older OR under the age of 65 and disabled. Applicants must also require a hospital or nursing home level of care. Those who require technology-assisted services must be dependent on a medical device due to the loss of functioning of a vital body part, require skilled nursing services, and have a live-in caregiver.

As of 2018, the income limit is set at 300% of the Federal Benefit Rate (FBR). For a single individual, this is equivalent to $2,250 / month, or said another way, $27,000 / year. The asset (resource) limit, as of 2018, is $2,000 for a single individual. While this asset figure might seem low, there are several resources that are considered non-countable. Examples include one’s primary home, given the applicant or their spouse lives in it and the home is valued at or under $572,000, household furnishings, personal effects, and an automobile.

For those who are over the income and / or asset limits, this does not mean automatic disqualification from CCC+. Applicants with high medical bills may still qualify via the Medically Needy Pathway. In very simple terms, this means that one can deduct out-of-pocket medical costs from their income, effectively lowering their countable income. If one is over the income and / or asset limits, it is highly recommended that they consult with a professional Medicaid Planner, who can assist in reallocating income and assets in order to meet eligibility requirements.

 

Benefits and Services

Both care services and benefits to help promote independence are available via the CCC+ Medicaid Waiver. In addition to case management, the below services and benefits may be provided. As mentioned previously, personal care assistance and respite care may be self-directed by the program participant.

  • Adult Day Health / Adult Day Care
  • Personal Care Assistance (assistance with ADLs and IADLs - up to 56 hours / week)
  • Respite Care (available both in-home and out-of-home - up to 480 hours / year.) 
  • Assistive Technology / Durable Medical Equipment (up to $5,000 / year)
  • Technology Assistive Services
  • Home / Vehicle Modifications (up to $5,000 / year)
  • Personal Emergency Response Systems (PERS or commonly called Medical Alert services)
  • Skilled Private Duty Nursing (up to 112 hours / week)
  • Transition Services (assistance moving from an institution, such as a nursing home, back into the community – up to $5,000 limit per person)

Medical and behavioral health services are also available via CCC+. These benefits may include counseling, diagnostic testing (x-rays and lab work), emergency care, medical transportation, therapies (physical, occupational, and speech), prescription drugs, eye exams, and more.

 

How to Apply / Learn More

Commonwealth Coordinated Care Plus Medicaid Wavier is mandatory for all Virginia residents who are eligible. For more information about CCC+, click here or call DMAS at 804-786-9159. To apply, one should contact their local Department of Social Services’ office.