Presentation on theme: "WHAT ARE HOME & COMMUNITY-BASED MEDICAID WAIVERS? Presented by: Michele Elliott, Hanover Community Services MR Case Management Program Coordinator & Joanna."— Presentation transcript:
WHAT ARE HOME & COMMUNITY-BASED MEDICAID WAIVERS? Presented by: Michele Elliott, Hanover Community Services MR Case Management Program Coordinator & Joanna Frank, The Resource Connection, Inc Founder/ Executive Director
Medicaid Waiver Workshop Are you currently on a waiting list for waiver? Which waiting list? MR Waiver Urgent or Non Urgent or DD WAIVER Do you know your waiting list number? (DD Waiver) How long have you been on the waiting list? Have you applied for the EDCD Waiver? Did you receive EDCD waiver?
? MYTH OR FACT ? 1. I have to need the level of care provided in an institution to qualify for waiver services. 2. Waiver eligibility for children depends on parents income. 3. Each waiver offers the same services. 4. I can choose my provider from a list of qualified providers. 5. My needs and decisions are the primary things that determine how I receive services. 6. All persons with a disability of mental retardation or developmental disabilities will qualify for the MR or DD waiver. 7.I can be on a waiting list for the DD waiver or the MR waiver while I am receiving services through another waiver. 8.Once an individual receives a waiver he/she can keep it forever.
WHY WERE HOME & COMMUNITY-BASED WAIVERS ESTABLISHED? Waivers were developed to encourage people with disabilities and the elderly to access services in their home and community. Federal Government created waivers. Waivers give States the flexibility to develop and implement alternatives to institutionalization Permit federal Medicaid funds to be used for community services by people who would otherwise be institutionalized
DIFFERENT INSTITUTION - DIFFERENT WAIVER NURSING HOMES 'AIDS 'Elderly or Disabled with Consumer Direction 'Technology Assisted 'Alzheimer's Assisted Living Waiver HOSPITAL ' AIDS ' Technology Assisted ICF/MR ' Mental Retardation ' Developmental Disabilities ' MR Day Support
Department of Medical Assistance Services Also Known As “DMAS” DMAS is designated as the single state agency charged with administering Medicaid in Virginia DMAS contracts or has agreements with other entities for most screening, case management, service and billing related activities DMAS is responsible for ensuring that the Medicaid program operates in compliance with state and federal laws and system
MEDICAID IS A JOINT PROGRAM BETWEEN FEDERAL & STATE GOVERNMENTS CENTERS FOR MEDICARE & MEDICAID SERVICES “CMS” –Federal agency –Previously HCFA –www.cms.hhs.gov DEPARTMENT FOR MEDICAL ASSISTANCE SERVICES “DMAS” –State agency –www.dmas.virginia.gov
Medicaid Services Must meet low income and resource threshold eligibility. These are examples of services and are subject to state funding changes. Hospital Services Nursing Facility Care Rural Health Clinics Federally Qualified Health Center Clinic Services Lab and X-Ray Services Mental Health/Psychological Services Optometrist Services Prescription Drugs Case Management Physician Services Home Health Service EPSDT Family Planning Nurse-Midwife Services Certified Nurse Practitioner Services Transportation ICF/MR
Medicaid Waivers Virginia has 7 Home and Community Based Care Waivers Alzheimer’s Assisted Living (AAL) Waiver managed by the Facility and Home-Based Care Unit Technology Assisted Waiver (Tech Waiver) HIV/AIDS Waiver Mental Retardation Waiver (MR/ID Waiver) Individual and Family Developmental Disabilities Support Waiver (DD Waiver) Elderly Disabled Consumer Direction Waiver (EDCD Waiver) Day Support Waiver for Individuals with Mental Retardation (Day Support Waiver)
SCREENING PROCESS=WHERE DO I BEGIN ? Community Services Board 804-365-6600 MR/ID Waiver MR/ID Day Support Waiver Pre-Admission Screening Teams: Department of Health 804-365-4313 Department of Social Services 804-365-4100 Elderly or Disabled and Consumer Direction Waiver AIDS Waiver Department of Medical Assistance Services 804-786-1465 Technology Assisted Waiver Developmental Disabilities Waiver Alzheimer's Assisted Living Waiver
MR/ID Waiver/DD Waiver & EDCD Waiver Let’s Break It Down
MR/ID Waiver Must have a diagnosis of mental retardation or be under the age of 6 and have a developmental delay (25% or more cognitive delay). Children on the MR Waiver who do not have a diagnosis of MR at the age of 6, possible transfer to DD Waiver Screenings are conducted by Community Services Board. Adults (18 and over) must be eligible for Medicaid / Children (18 and under) the family income limits are waived and the child should not have more than $2,000 in resources/savings. Level of Functioning (LOF) survey is the screening instrument used, an individual must meet at least two of the seven categories. Health, Communication, Community Living, Personal/Self Care, Task Learning, Behavior, Mobility To receive MR Waiver services, an individual must meet the criteria for admission to an ICF/MR. There is a statewide waiting list for the MR Waiver Must meet eligibility for entrance into a state institution – ICF/MR Screening for all Waivers must be provided without any charge to the individual
MR/ID Waiver Services Residential support (group home or individual’s home) Day support and prevocational services Supported employment Personal assistance (CD & agency) Respite care (720 hours max/year) (CD & agency) Assistive technology ($5,000 max/year) Environmental modifications ($5,000 max/year) Skilled nursing services Therapeutic consultation Crisis stabilization (60 days max/year) Adult companion (8 hours max/day) (CD & agency) Personal Emergency Response System (PERS)
MR/ID Waiver Waiting Lists The waiting list is broken down into two categories – Urgent Individuals on the Urgent List must be served before anyone on the Non Urgent List can receive a waiver Non Urgent Once you receive a slot, the money will move with you within the state. Must be able to say that if you receive a slot you would use it within 30 days. Statewide there are a total of over 4,000 individuals on the waiting list. Slots are allocated to CSBs by the General Assembly.
URGENT CRITERIA FOR THE MR WAIVER Primary caregiver(s) is/are 55 years or older Living with a primary caregiver who is providing the service voluntarily and without pay and they can’t continue care There is a clear risk of abuse, neglect, or exploitation Primary caregiver has chronic or long term physical or psychiatric condition significantly limiting ability to provide care Individual is aging out of a publicly funded residential placement or otherwise becoming homeless Individual lives with the primary caregiver and there is a risk to the health or safety of the individual, primary caregiver, or other individual living in the home because: –Individual’s behavior presents a risk to himself or others OR physical care or medical needs cannot be managed by the primary caregiver even with generic or specialized support arranged or provided by the CSB
MENTAL RETARDATION DAY SUPPORT WAIVER (DS Waiver ) After CSB screening and placement on the MR Waiver Waiting List the State Office of Mental Retardation allocates the slot based on chronological order (what year you were placed on the list). State Office of MR contacts the CSB with the name of person who receives the slot and the Case Manager then must have the individual sign if they accept the slot. If receive a DS Waiver, individual’s name remains on MR Waiver Waiting List Includes Day Support, Waiver based After-School Day Support, Prevocational and Supported Employment services. 300 slots are available in the state of Virginia = 300 individuals
In a Nut Shell: MR/ID Waiver/DS Waiver MR Waiver/DS Waiver – must have diagnosis of Mental Retardation (under age 6 must have a cognitive developmental delay). Must meet entrance criteria to a state ICF/MR. To be screened contact your local Community Services Board. Adults – must be Medicaid Eligible. Children – family income limits are waived. There is a waiting list for the services. Eligibility through the LOF/Medicaid eligibility has to be determined yearly. Can graduate from MR Waiver.
MR/ID Waiver Services To be screened for MR Waiver eligibility and placed on the MR Waiver Waiting List in Hanover County Contact: Michele Elliott, MR Case Management Program Coordinator, Hanover Community Services 804-365-6600
Individual and Family Developmental Disabilities Support “DD” Waiver Eligibility Criteria Overseen by DMAS. Contact DMAS (804) 786-1465 to request a Request for Screening Form or go to www.dmas.virginia.gov/content/ltc-dd uvr request for services.htm www.dmas.virginia.gov/content/ltc-dd uvr request for services.htm Must be 6 years of age and older and meet “related conditions” criteria Cannot have a diagnosis of mental retardation Level of Functioning (LOF) survey used for screening Individuals must require the level of care provided in an ICF/MR Children who have MR Waiver under the age of 6 are required to obtain a new psychological by their 6 th Birthday. If they don’t have a diagnoses of MR they become ineligible for MR waiver but could possibly transition to the DD Waiver if they meet eligibility requirements. The state and county work together to provide seamless transition to DD waiver. Families should obtain a new psychological prior to the child’s 6 th birthday. At that time they can be screened for eligibility for the DD WAIVER, if found eligible they will receive a DD Waiver slot without being placed on the DD WAIVER waiting list Once found eligible DMAS will send a list of Case Management providers to choose from to the individual/family.
RELATED CONDITIONS also referred to as developmental disability Severe chronic disability Attributable to a condition, other than mental illness Manifested before the age of 22 Likely to continue indefinitely Results in substantial limitations in 3 or more areas of major life activity Self-care Understanding and use of language Learning Mobility Self-direction Capacity for independent living
DD Waiver Services Adult companion services (8 hrs per day limit) Assistive technology ($5,000 per year limit) Crisis stabilization (60 day max/year) Environmental modifications ($5,000 per year limit) In-home residential support (not congregate) Day Support Skilled Nursing Supported employment Therapeutic consultation Personal emergency response system (PERS) Family/caregiver training (80 hours max/year) Respite care 720 hours per year (CD & agency) Personal assistance services (CD & agency)
DD Waiver Services Waiting List Slots are allocated by “first come, first serve” basis except for those who meet Emergency Criteria Emergency Criteria: Primary caregiver has serious illness/hospitalized/died; individual has been found by Dept. Social Services to have been abused, neglected and in need of immediate waiver; individual has behaviors that present risk to personal or public safety; individual presents extreme physical/emotional/financial burden on caregiver and they can no longer care for individual; individual lives in an institution and has a viable discharge plan. When there is funding for Emergency Slots, the DD Waiver Case Manager will be notified to complete paperwork and DMAS allocates the slot.
In a Nut Shell: DD Waiver DD Waiver - can not have diagnosis of Mental Retardation, must meet “related conditions” criteria. Individual must be at least 6 years olds. Must meet entrance criteria to a state ICF/MR. To be screened contact DMAS – 786-1465 or complete Request for Screening form. There is a waiting list for this waiver. Eligibility through the LOF has to be determined yearly. Can graduate from DD Waiver.
MR/ID Waiver and DD Waiver both have long waiting lists… Then Are there any services that can assist me?
Elderly or Disabled with Consumer Direction Waiver (EDCD) Eligibility Criteria –Individuals seeking Waiver services are eligible at any age. –Must meet nursing facility eligibility criteria including both medical needs and functional needs (assistance with activities of daily living) –Screening is conducted by the Preadmission Screening Team using the Uniformed Assessment instrument (UAI) –An individual can remain on the waiting list for another waiver while being served by the EDCD Waiver –Apply for Medicaid by calling Hanover County Department of Social Services 804-365-4100 Contact Department of Health to apply for Long Term Care Services 804-365-4313 www.dmas.virginia.gov/manual/NHPAS/appendixB nhpas.pdf
Elderly or Disabled with Consumer Direction Waiver Services –Services that are available statewide: Adult Day Health Care Personal Care Services (CD or Agency) Personal Emergency Response System (PERS) Respite up to 720 hours per year (CD, Agency, or Skilled Nursing) –Personal assistance services can be provided outside of the individual’s home.
EDCD Waiver Currently there is no waiting list for this service.
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid benefits available to children under the age of 21 Must be eligible for Medicaid Monitor to prevent health and disability conditions from occurring or worsening, including services to address such conditions Treatment to “correct or ameliorate conditions,” including maintenance services Hanover Department of Social Services= 804-365-4100
EPSDT Immunizations Check ups and lab tests Mental health assessment and treatment Health education Eye exams and glasses Hearing exams and hearing aids & implants Dental services Personal care, nursing services Other needed services, treatment and measures for physical and mental illnesses & conditions
HIPP Health Insurance Premium Payment program DMAS program Pays health insurance premiums Application must be completed separately from the Medicaid application Application info 800-432-5924
Final Thoughts Each Waiver has a re-assessment component. Individuals can “test out” of waiver if they no longer meet eligibility. Individuals have a right to appeal any/all decisions. Waiver slots are allocated by the state General Assembly. The Va. State budget adds the number of slots for each waiver service. Advocate to your Delegate that more funding needs to be allocated for slots.
Final Thoughts Hanover County Senate Ryan McDougle 804-730-1026 or 804-698-7504 email@example.com www.ryanmcdougle.com Hanover County Delegate Frank Hargrove Sr. 804-550-2900 or 804-698-1055 www.Delwww.Del Hargrove@House.state.va.usHargrove@House.state.va.us The ARC of Virginia Lobbying for change for individuals with disabilities. 804-649-8481 www.arcofva.org
? MYTH OR FACT ? 1. I have to need the level of care provided in an institution to qualify for waiver services. 2.. Waiver eligibility for children depends on parents income 3. Each waiver offers the same services 4. I can choose my provider from a list of qualified providers 5. My needs and decisions are the primary things that determine how I receive services 6. All persons with a disability of mental retardation or developmental disabilities will qualify for the MR or DD waiver 7.I can be on a waiting list for the DD waiver or the MR waiver while I am receiving services through another waiver. 8. Once an individual receives a waiver, he/she can keep it forever.
Thank you giving use an opportunity to give you a brief overview on some of the programs available in your community. This overview was created by Michele Elliott and Joanna Frank for more detailed information regarding all waiver services for the state of Virginia contact DMAS at 804-786-1465. www.dmas.virginia.gov/content/ltc-dd uvr request for services.htm Please feel free to contact the presenters for further direction and support or use of this tool. Michele Elliot Hanover Community Services 804-365-6600 Joanna Frank The Resource Connection 804-746-4303 x 360 www.dmas.virginia.gov/content/ltc-dd uvr request for services.htm