LTSS Eligibility

How do I qualify for the Blue Cross Community MMAI (Medicare-Medicaid Plan)SM LTSS program?
You must be eligible for a Home and Community Based Service (HCBS) waiver program or the Nursing Facility program. We do not decide if you are eligible for these programs. Instead, either the Department on Aging or the Department of Rehabilitative Services will decide.

For LTSS to be covered by our plan:

  • The care you get must be a plan benefit. This means that it must be included in the plan’s Benefits Chart.
  • The care must be medically necessary. This means you need services to prevent, diagnose, or treat your medical condition or to maintain your current health status.
  • You must have a network primary care provider (PCP) order the care or tell you to see another doctor.

How do I learn about what is required to be eligible?
Check the HCBS Waivers program and Nursing Facilities program pages. If you do not meet or maintain the requirements, you may be removed from the waiver program.

For more information about LTSS, check the Member Handbook on the Forms & Documents page.