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Date Submitted DHSDD730 09/16CHOICES WAIVER HOME/COMMUNITYBASED SERVICES EFFECTIVE DATE FOR INITIAL HUBS Eligibility:, DSS Medical CaseworkerFrom:, DHS DDD CDDP/QUALIFIED Stagnate:Medicaid Number:
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Specify the type of homecommunity-based services needed, whether it is medical care, assistance with daily activities, or social support.
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Home community-based services are a range of support services designed to help individuals with disabilities or chronic illnesses live independently in their own homes or communities rather than in institutional settings.
Typically, individuals or families seeking to access home community-based services for persons with disabilities or chronic illnesses are required to file applications or requests for these services.
To fill out home community-based services applications, individuals should provide their personal information, details about the services needed, and supporting documentation of their condition or situation.
The purpose of home community-based services is to provide individuals with the necessary support to maintain their independence and improve their quality of life while receiving care in their own homes or communities.
Information that must be reported includes personal details of the individual, medical or disability documentation, financial information, and specific services requested.
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