1. Coweta County Schools Workshop Series - #2 Medicaid Waivers, SSI, Estate Planning and Advocacy

2. Judy Floyd Parent Mentor, Coweta County School System 770-254-2810 x219 Judy.floyd@cowetaschools.net Linda Wilson Partners in Policymaking Graduate Coweta Supporters 770-463-1658 lpwilson@numail.org

3. Medicaid eligibility As a result of receiving SSI –Family income for children under age 18 –Based on individual’s income at age 18 Medicaid Deeming Waiver (also known as the Katie Beckett Waiver)

4. Deeming Waiver Not based on family income Eligible if child requires –Skilled nursing care –Hospitalization –Intermediate care facility – active treatment with a deficit in 3 self help areas Apply through DFACS

5. Deeming Waivers Many denials for new and renewals Be sure that your paper work is complete Appeal decision Be specific about things that need supervision – safety issues, health issues, detailed level of care and support Being addressed by GAO (Georgia Advocacy Office) and GCDD (Governor’s Council on Developmental Disabilities)

6. SSI Supplemental Security Income Eligible when child becomes adult according to law at age 18 Parent income no longer considered Less than $2000 in the bank Can own home and auto Income limits apply

7. SSI Needs based program Maximum of $579/month in 2005 Will increase to $603 in 2006 Automatically receive Medicaid for medical, therapies, and waivers Can earn up to $22,192 per year and still retain Medicaid although payments maybe reduced

8. SSI How to Apply Contact SSA (Social Security Administration) at 1-800-772-1213 Set up an appointment (phone or in person in LaGrange) Provide requested information Parent can be designated the payee Yearly report on how funds are spent

9. SSI Benefits Navigator Benefits Navigator Project – work with individuals who are eligible for Social Security based on a disability Will assist you in making informed decisions when you work and have Social Security benefits If an individual is still in school, he may qualify for a Student Earned Income Exclusion

10. SSI Benefits Navigator Contact Division of Rehabilitation Services (GROUP) at 866-489-0001 Help with transition from school to work Will attend IEP meetings Help DD population become informed consumers No cost

11. SSDI Social Security Disability Insurance Entitlement program Medicare included May jeopardize SSI benefits

12. SSDI Based on child’s or parent’s work record For a child to receive benefits on a parent’s work record –Disability must have started prior to age 22 –Must meet definition of disability for adults –Parent must become disabled, retired, or die If received SSI and Medicaid, may be able to retain Medicaid

13. Trusts Setup to prevent assets from disqualifying child for SSI Legal arrangement regulated by state law in which one party holds property for the benefit of another Often called “special needs” trusts Better than relying on others to use funds appropriately

14. Trusts Funds must be paid by someone to provide you with items other than food and shelter Supplemental discretionary trust – specifies that funds are not to be used for items covered by Medicaid or SSI Discretionary trust – more freedom to use funds. Must be careful to not provide goods or services (shelter or food) which are covered by Medicaid or SSI

15. Trusts Setting up a trust –Testamentary – sets up in a will –Inter vivos (or Living) – sets up a trust before dying Funding the trust –Family’s assets –Assistance and inheritance from friends and family –Life insurance

16. Wills Legal document that is a statement of what you want to have happen after your death A Will can provide –Property distribution –Naming a guardian –Creating a trust

17. Wills If you do not have a Will, your property is distributed to your heirs according to the laws of the state It is important that a child with developmental disabilities not receive funds as they may jeopardize their government benefits

18. Wills Should indicate that a family member has a disability Relatives should consider making arrangements to not leave property to an individual with developmental disabilities. This includes life insurance.

19. Guardianship Court-approved legal relationship between a competent adult and a minor or adult with a disability Limits a person’s independence and rights At age 18, individuals are considered to be adults. Personal, medical and financial decisions should be made by the individual

20. Guardianship Parents are legal guardians of a minor child Only the court can make one person the guardian of an adult Need for guardianship varies for each individual with disabilities Handled by the Probate Court

21. Guardianship Types –Person – personal issues including living arrangements, medical treatment, signing for services –Property – money or property –Full or Plenary - person’s personal and property

22. Guardianship Annual report required If receiving SSI, consider Person only since will be doing a financial report for SSA Alternatives –Representative Payee –Joint accounts –Durable power of attorney for health care, property or advocacy

23. Medicaid Waivers MHDDAD – Division of Mental Health, Developmental Disabilities, and Addictive Diseases – part of DHR (Department of Human Resources) Regions have been reduced from 7 to 5 Coweta County is in Region 1

24. Medicaid Waivers To contact Region 1 Charles Fetner, Regional Coordinator 1305 Redmond Circle, Building 401 Rome, GA 30165 Phone706-802-5272 Fax706-802-5280 Toll Free1-800-646-7721

25. Medicaid Waivers To Apply for Waiver Services Columbus Community Services Phone706-494-5929 Toll Free1-800-579-7609

26. Medicaid Waivers Types ICWP – Independent Care Waiver – physical disability or traumatic brain injury Deeming Waiver – Katie Beckett – chonic medical condition, under age 18 CHSS – Community Habilitation Support Services – moving individuals out of institutions MRWP – Mental Retardation Waiver Program – developmental disabilities

27. Medicaid Waivers Types CCSP – Community Care Services Program – elderly and DD who need nursing home level care SOURCE – Service Options Using Resources in a Community – care management – not available in Coweta GAPP – Georgia Pediatric Program – medically fragile under age 21 Autism Family Support

28. Medicaid Waivers MRWP 7079 being served 3200 on short term waiting list 3126 on long term waiting list 700 age out of the school system annually

29. Medicaid Waivers MRWP Residential Options –Residential Training and Supervision Group home/personal care home 24x7 Training tailored for individual – self care, independent living skills, communication skills, leisure skills –Personal Support Similar to Residential Training Occurs in family’s or individual’s home

30. Medicaid Waivers MRWP Day Services Options –Day Habilitation Offered in a facility or community, non-work, training in areas of communication, social, leisure, and self help skills –Supported Employment Opportunity for individuals to work a minimum of 80 hours per month, provides job development, coaching and follow-up –Day Support Services Provides for facility day habilitation, prevocational, and supported employment

31. Medicaid Waivers MRWP Specialized Medical Supplies Specialized Medical Equipment Personal Emergency Response Systems Environmental Modifications Vehicle Adaptation Respite Care Home Based Services Natural Support Enhancements Natural Support Therapies Consumer Directed Natural Support Enhancements

32. New Medicaid Waivers Proposed by Dr. Stephen Hall, Director of the Department of Developmental Disabilities, DHR Recognize that parents are the primary service providers – always! Current waivers established in 1987 Medicaid is a states program that is federally funded Will take advantage of the flexible Federal Medicaid Rules Template Will send to federal govt in Dec, 2005 Plan to implement starting July, 2006

33. New Medicaid Waivers Bring fairness, choice, accountability and self- determination to the system Assessment process will be the same statewide using SIS (Supports Intensity Scale) – www.aamr.org More flexibility on what services are obtained by individual’s funding Will not provide more funding Will provide more choice Money will follow the individual

34. New Medicaid Waivers Reduce current waivers to two waivers –Supports Waiver Live in own home or family’s home Participate in community life –Comprehensive Waiver More intense, urgent and extensive out of home residential services Funding will be based on level of support that is needed

35. New Medicaid Waivers Individualized budgeting– can spend dollars where you want Community Connection/Community Guide/Brokerage Services – help connect to community activities Dental services will be available Transportation services Behavioral Support Services

36. New Medicaid Waivers Participant Direction – same as Consumer- Directed Natural Supports Enhancements Services. –Choose and direct services to extent desired –Can be employer of record and pay providers Support Coordination – monitoring of supports and services as necessary Extenuating Circumstances Payment –Payment to family member for services when providers not available and is cost effective

37. New Medicaid Waivers Providers Group Providers – same as today Individual Providers – expedited process to establish small providers that support 1-3 individuals Specific Providers – a particular specialty such a dental, health, behavior Will result in increased number of providers

38. New Medicaid Waivers Gradual move to new services – must be selected by the family Current waiver will be converted on individual’s birthday Process –Determine eligibility –Assess needs –Choice of services

39. New Medicaid Waivers Will use Utilization Management –Ensure efficient and effective use of funds –Outcomes that lessen dependence on funding –Shifts from program funding to individualized budgeting that controls costs

40. Unlock the Waiting Lists! We must reduce the number of individuals on the waiting lists for services Georgia’s annual budget determines how many additional people receive services We need to tell our elected officials and state officials how important this issue is!

41. Unlock the Waiting Lists! Budget Process DHR and DCH submit proposed budget to the Governor in September Governor develops budget and submits to the legislature in January Legislators debate, modify, and approve budget Returns to the Governor for approval

42. Unlock the Waiting Lists! Previously (2004-2005) budget – 10 waivers funded Last year (2005-2006) budget – 925 additional waivers were funded This year (2006-2007) budget – DHR is asking for 1500 additional waivers

43. Unlock the Waiting Lists! Goals Funding, with new money, for at least 1,500 services for people who want and need alternatives to institutions and nursing homes. Funding, with new money, an increase for provider rates that ensures direct service professionals for disability supports are given fair and livable wages, provided training and assure quality services Implementation of a multi-year funding plan for home and community-based services

44. Unlock the Waiting Lists Go to www.unlockthewaitinglists.com for more information Write/call/visit the Governor and your Legislators Attend Disability Day at the Capitol – February 23, 2006