Enrollment and various questions

What does the enrollment process involve?

Once a person has decided that they would like to enroll for services with KALIX and there is an opening, a meeting is held to discuss what will be happening in the following 30 days.  This initial meeting is an excellent opportunity to meet the people who will be a part of the person's planning team and to answer any questions that the person/guardian may have at that time.

Items discussed during the enrollment/admissions meeting include the agency's mission, personal outcomes, the various assessments utilized to get an understanding of where the person is in regards to health, safety, money management and rights.  The information that is learned from these assessments will be used to help write the person's plan.

A registered nurse (KALIX has three on staff) will be in attendance to address any medical issues and medications currently prescribed.  The nurse will ask for the names and locations of the person's current physicians, dentists, optometrists, etc.  This information will become a part of their medical file.

An accounting representative also attends the meeting to discuss financial details.   The person and/or his or her legal representative is asked to complete a Financial Planning Questionnaire.  This document assists the team to define the kind of supports necessary regarding money management.  The information obtained from this questionnaire will be used to assist the person in establishing a budget that will enable him or her to plan to meet their expenses. The budget will assure that the person's money will be used to meet her/her needs, including personal spending, clothing, supplies, equipment, and recreation/leisure.
 
The person and/or legal guardian will also decide who will have legal responsibility for determining how government benefits will be used and reported according to current rules and regulations.  KALIX offers to act as the person's representative payee if they so choose.   

What is a Representative Payee? 

When a government agency determines that a beneficiary may be unable to manage or direct the management of benefit checks in his or her own interest, a responsible party may be designated to act as the person's representative payee. The representative payee may be a family member, legal representative, or a private or public agency representative. 

The representative payee first must make sure the beneficiary's day-to-day needs for food and shelter are met. Then the benefits may be used for the beneficiary's personal needs, such as clothing, recreation, and other expenses. Benefits also can be used to pay for medical needs (for example, eyeglasses and hearing aids) and dental care which are not provided by Medicare, Medicaid, or a residential facility.

Do I still have input into the financial planning if KALIX is the representative payee?  Can I get financial information to show me how the money is being spent?

On request and with the proper documentation (current release of information or guardianship papers), the agency can provide information about the person's income and expenses.  

What is Recipient Liability?

Recipient Liability is the amount that you must pay towards the cost of your medical services if you are on Medical Assistance.  If you are enrolled in a residential or vocational training program (except Vocational Rehabilitation or Mental Health), you will be required to either pay the entire cost of the program or apply for Medical Assistance.   When you receive Medical Assistance, the county computes a dollar amount that you must pay each month (similar to an insurance deductible) towards the cost of "medical" services, which includes training/support costs.

If you are employed, without enrolling in a program funded through the Department of Human Services Developmental Disabilities Division, you will not be charged a recipient liability by KALIX.  If your income is below minimum levels established by the county, you will not be charged a recipient liability.

The recipient liability system has been developed, implemented, and maintained through a cooperative effort between the Centers for Medicare & Medicaid Services, a division of the US Department of Health & Human Services, the North Dakota Department of Human Services, and County Social Service offices.  KALIX is required to collect fees as directed in compliance with the law.  More information can be found at Centers for Medicare and Medicaid Services, the Medical Services Division -  at the ND Department of Human Services website or by reading the  North Dakota Administrative Code 75-02-02.1-41.1.

What is Workers with Disabilties Coverage (WWD)?

The Workers with Disabilities coverage allows people with disabilites who want to work or increase their earnings to do so without losing their Medicaid health care coverage. 

Click on Workers with Disabilities coverage (WWD)  for more detailed information or you can also contact your local County Social Service Office.