Intermediate Care Facilities for individuals with Intellectual disability (ICF/ID) is an optional Medicaid benefit that enables states to provide comprehensive and individualized health care and rehabilitation services to individuals to promote their functional status and independence. Although it is an optional benefit, all states offer it, if only as an alternative to home and community-based services waivers for individuals at the ICF/ID level of care.
Eligibility for ICF/ID Benefit
ICF/ID is available only for individuals in need of, and receiving, active treatment (AT) services. AT refers to aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. AT does not include services to maintain generally independent clients who are able to function with little supervision and who do not require a continuous program of habilitation services. States may not limit access to ICF/ID service, or make it subject to waiting lists, as they may for Home and Community Based Services (HCBS). Therefore, in some cases ICF/ID services may be more immediately available than other long-term care options. Many individuals who require this level of service have already established disability status and Medicaid eligibility.
Need for ICF/ID is specifically defined by states, all of whom have established ICF/ID level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in federal law and regulation. In addition to level of care for AT, the need for AT must arise from ID or a related condition. The definition of related condition is primarily functional, rather than diagnostic, but the underlying cause must have been manifested before age 22 and be likely to continue indefinitely. States vary in practical application of the concept of related condition. In some states individuals applying for ICF/ID residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution.
Services Included in the ICF/ID Benefit
ICF/ID provides AT, a continuous, aggressive, and consistent implementation of a program of specialized and generic training, treatment, and health or related services, directed toward helping the enrollee function with as much self-determination and independence as possible. ICF/ID is the most comprehensive benefit in Medicaid.
Federal rules provide for a wide scope of required services and facility requirements for administering services. All services including health care services and nutrition are part of the AT, which is based on an evaluation and individualized program plan (IPP) by an interdisciplinary team. Facility requirements include staffing, governing body and management, client protections, client behavior and physical environment, which are specified in the survey and certification process.
Many ICF/ID residents work in the community, with supports, or participate in vocational or other activities outside of the residence, and engage in community interests of their choice. These activities are collectively often referred to as day programs. The ICF/ID is responsible for all activities, including day programs, because the concept of AT is that all aspects of support and service to the individual are coordinated towards specific individualized goals in the IPP.
Where ICF/ID Services are Provided
Medicaid coverage of ICF/ID services is available only in a residential facility licensed and certified by the state survey agency as an ICF/ID. Medicaid ICF/ID services are available only when other payment options are unavailable and the individual is eligible for Medicaid. There are few resources like an ICF/ID under any payment source.