No. There is not an exception process for the AC and EW $20,000 limit. The entire modification expense comes from the person’s individual waiver budget (i.e., no county or tribal nation aggregate contribution).
No. DHS needs state and federal approval to increase the $20,000 cap.
Yes. For more information, see the questions in this section and CBSM – EAA – Service limits.
DHS may approve an exception when certain criteria are met and the modification increases the person’s functional use of the home or provides them with greater access to the community.
When a request exceeds the $40,000 limitation, the lead agency must submit the following completed documents to DHS:
DHS will review the information and issue an approval, partial approval or denial. For more information about this process, see CBSM – EAA – Service limits.
The lead agency should submit an exception request when the person is on a disability waiver and has a home or vehicle modification and associated assessment(s) that exceed $40,000. For an example, see Exception Request for EAA that Exceed $40,000, DHS-5504B.
Yes. Splitting a project across two service agreement years is acceptable, as long as it can be done safely to meet the person’s disability-related assessed needs. The lead agency should ensure a partially incomplete modification does not create an unsafe situation.
No. Project management is not covered under EAA. An assessment provider’s role is to:
No. EAA does not cover the purchase or installation of automatic locks.
EAA covers non-automatic locks when the locks:
Example: EAA could cover a lock that prevents a child from entering a room they do not need to access, such as a furnace room, sibling’s bedroom or parent’s bedroom, as long as the lock meets the criteria above. Non-automatic locks cannot be used to seclude the person. The lead agency must ensure the person’s service plan complies with the 245D home and community-based services (HCBS) rights restrictions or HCBS rule rights modification requirements (see DHS – HCBS settings rule rights modification FAQ and HCBS Rights Modification Support Plan Attachment, DHS-7176H).
No. EAA cannot be used to purchase appliances. Water heaters are household appliances that typically are found in every home. Therefore, water heaters are considered the homeowner’s responsibility.
EAA can be used to purchase a tub that meets the person’s assessed need, but it cannot be used to purchase a larger water heater. The lead agency may consider other options that do not require a larger water heater (e.g., water heater capacity booster, soaker tub that does not require a larger water heater).
The Rehabilitation Loan/Emergency and Accessibility Loan Program is available to some homeowners who need to replace or repair appliance(s) or pay for other homeowner responsibilities.
The homeowner is responsible for items or repairs related to a home for which any homeowner would be responsible (e.g., appliances, home repairs). These items are not directly related to the person’s assessed need and the accessibility modification.
Example 1: A family wants to install a ceiling track and lift system in their home, but the contractor discovers the electrical system does not meet building codes. The homeowner is responsible to pay to get their electrical system up to code before the lift system installation.
Example 2: A family wants to install a ceiling track and lift system in their home, and their electrical system currently meets building codes. However, they need an electrical system in their home that accommodates the use of the ceiling track and lift. This electrical system is covered by EAA under the home modification.
If the person or family needs to pay for something that is the homeowner’s responsibility, they may qualify for a low-income home loan from Minnesota Housing.
No. EAA cannot be used to pay for repairs or damage to personal items due to a behavioral incident.
EAA may cover a modification that protects property from future damage (e.g., shatterproof windows, solid-core doors, wall protection) when:
An item could be considered a comfort and/or convenience if it is not directly related to a person’s assessed need or is a “nice to have” item. An example of a comfort and convenience item is a whirlpool tub.
EAA does not cover items that are for comfort or convenience.
For technical assistance, the lead agency can contact:
No. Jetted tubs are not covered under EAA because they are not considered a cost-effective option. They are considered a comfort and convenience item.
If the person has an assessed need (e.g., a person with a circulation disability who needs circulated water flow to limbs or a person with spasticity), the lead agency must use options available under Medicaid state plan services and consider the most cost-effective option (e.g., hydrotherapy mat, bubble massage mat or soaker tub).
The modification must meet all basic waiver criteria for allowable expenditures before the lead agency approves it. The lead agency cannot approve an item solely based on a doctor’s prescription or a recommendation from a doctor, occupational therapist or physical therapist.
As a reminder, all services must fit within the EAA covered services description and meet the services criteria outlined on CBSM – Waiver and AC programs overview.
Yes. The home modification must be:
If the modification does not meet all of the above criteria and the service criteria on CBSM – Waiver and AC programs overview, the lead agency can deny parts of it. The person always has the right to appeal a denial if they disagree with the decision.
No. The lead agency should consider using the EAA home modification assessment service when they need support to determine the person’s home or vehicle modification needs. If the project is complex, an EAA assessment professional (e.g., occupational therapist, aging-in-place specialist, accessibility specialist, physical therapist) can help. For more information, see CBSM – Guide to home modifications under EAA.
All home or vehicle modification assessment costs and installation costs must fit within the EAA service limits listed on CBSM – EAA.
Yes. If the residence meets the EAA definition of the person's primary home, the lead agency may authorize a home modification to meet the person's assessed need.
Yes. The lead agency should always get permission from the landlord or property owner before modifying the property. Landlords have a responsibility to ensure common areas are accessible under the public accommodations section of the ADA.
The lead agency can partner with the Minnesota Housing Finance Agency (MHFA) for technical assistance about modifications to Section 8 or other subsidy-funded apartments or living situations.
The person can receive up to $20,000 of EAA per service agreement/waiver year. The amount authorized for EAA and all other AC or EW CDCS services must fit within the person’s case mix budget cap.
EAA billing for people who use CDCS works the same way as traditional AC or EW. When the work is done, the lead agency can submit the bill to be paid.
The person can use their CDCS budget flexibly. EAA costs can be spread out over the waiver year to fit within the monthly budget, but bills are paid as the provider does the work.
If the person closes to CDCS because of a death or nursing facility admission during an EAA project, the lead agency pays for the work that has been authorized and completed.
If the person closes to CDCS and moves to traditional AC or EW, the lead agency must prorate the budget based on what was paid under CDCS during that waiver/AC year. The $20,000 cap is based on the waiver/AC year, regardless of whether the person uses CDCS or traditional AC or EW. If the EAA project was authorized under CDCS, it will be paid for when the project is completed.
The person must pay the first $5,000 for the project(s) from their CDCS budget. When costs exceed $5,000 and the lead agency approves additional funding, the lead agency can use its overall waiver allocation (when applicable) to pay for item(s). For more information, see CDCS – Environmental modifications and provisions.
No. When a single project is split over two different plan years, there is no need for the person to contribute an additional $5,000 out of their next plan year because it is not a new project.
No. The person pays the first $5,000 from their CDCS budget during the plan year, regardless of the number of modifications completed during the plan year.
No. For people who use CDCS, the lead agency is required to follow the $40,000 service limit and exception process (if applicable). The service limit is $40,000 per service agreement/waiver year, regardless of whether the person uses CDCS. For more information, see CDCS – Environmental modifications and provisions.
DHS cannot approve an EAA exception request that exceeds the federally approved maximum of $80,000.
The following projects require at least two comparison bids:
For all other projects, it is best practice to obtain at least two comparison bids to ensure the project is cost-effective and the person’s assessed needs are met.
Yes. The person can choose from any willing and qualified providers who meet the provider requirements listed on CBSM – EAA.
The modification must be the most cost-effective option to meet the person’s need. The most cost-effective option does not always mean the cheapest option.
When considering options to modify the person’s home, the lead agency should always incorporate the person’s choice, within the policy limits.
Example: The person needs a bathroom modified to meet their assessed needs. The person’s house has two bathrooms that can safely be modified to meet the person’s needs. It is reasonable to modify the person’s chosen bathroom, even if it is more expensive to modify that bathroom. The lead agency must review two comparable bids for the same project (i.e., for the same bathroom). The lead agency can also consider whether the person will need support from additional items or services after the bathroom is modified (e.g., stair lift if the bathroom is downstairs and the person uses a wheelchair).
No. The lead agency should not share one contractor's bid with another contractor because it would prevent the lead agency from being able to compare and determine the most cost-effective bid. The lead agency may share a scope-of-work template to ensure each contractor is bidding on the same project.
The lead agency can use the following resources if they have concerns about a provider’s integrity:
The lead agency may decide to pay the contractor on a payment schedule, with the last payment paid after the final walk-through or inspection of the project. The lead agency must determine the payment schedule with the contractor.
The lead agency has the option to authorize the home modification project on multiple line items in MMIS, but they are not required to do so. Each home modification project is different.
For more information, see CBSM – Guide to home modifications under EAA.
No. The person cannot be charged for items or services that are covered by Medicaid or authorized through the person’s waiver. Any costs incurred will affect the amount of another EAA authorization during the same service agreement year.
Spenddowns and waiver obligations for EAA work just like any other Medicaid service. If the person has a spenddown or a waiver obligation and the EAA provider bills, the claim comes back to indicate there is an adjustment due to a spenddown or waiver obligation. The provider must bill the person for that portion of their spenddown or waiver obligation. For more information, see MHCP Provider Manual – Billing the member (recipient).
There are different types of spenddown payment options. Some payment options could prevent the EAA provider from encountering a spenddown when billing, such as designating the spenddown to DHS or a specific provider (fee for service only; people enrolled in managed care do not have designated providers).
The EAA provider likely will encounter a spenddown when the person’s payment option is set up as “potluck.” This means the provider who bills first has all or a part of the medical spenddown amount deducted from their claim. For more information, see the spenddown payment options section of MHCP Provider Manual – Health care programs and services.
If the EAA provider has questions about spenddown or waiver obligation billing, they can contact the MHCP Provider Resource Center.