The Waiver Your questions--- almost answered!

The Waiver What’s going on in NJ and PA? Your questions--- almost answered

Entitlement First Under the Social Security Act, if you meet the requirements for institutionalized care, you are entitled to that service.  Parental income is not considered  Medical care, nursing, therapy, staffing, recreation are covered expenses.  Segregated, congregate settings  Freedom restricted

What is a Waiver? You are “waiving” your entitlement to institutionalized care. You want services and supports in the community. It has aliases!  HCBS  Medicaid Home and Community Based Waiver Program It’s funding depends on the state  Federal and State match  NJ’s ratio is?????federal to % state monies

Omnibus Budget Reconciliation Act of 1981 Medicaid Home and Community-Based Services (HCBS) waiver program signed by President Reagan on August 13, For the first time, states can use long-term care money available through Medicaid to pay for home and community based services instead of nursing homes and institutional care. State HCBS Waiver programs must: 45%state 55% federal (2011)

Don’t underestimate your power! Katie Beckett ‘s parents advocated for a change in federal rules and in 1981, Congress created the Katie Beckett Waiver. “ Goal For people to live in their own communities with family and friends and given appropriate supports Focus Habilitation, not Rehabilitation

REHABILITATION VS HABILITATION REHABILITATIONHABILIATION REGAIN RELEARN ACQUIRE RETAIN IMPROVE FOCUS Self-help, Socialization and Adaptive skills necessary to reside successfully in home and community based setting

Waivers are dependent upon States willingness States can offer a variety of services under a State Plan and Home and Community-Based Services (HCBS) benefit. People must meet State-defined criteria:  specific needs  risk  condition htm

State’s Flexibility What’s Covered? States can offer a variety of unlimited services under an HCBS Waiver program. a combination of standard medical services and non-medical services.not limited to: case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health services, habilitation (both day and residential), and respite care. States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

ServiceCommunity Care WaiverComprehensive Care Waiver (Supports Program) Assistive Technology Behavioral Management Career Planning Case Management Community Transition Services Day Habilitation Environmental Mod Individual Supports Occupational Therapy

ServiceCommunity Care Waiver (BIG) Comprehensive Care Waiver (Supports Program) Personal Emergency Response System (PERS) Physical Therapy Prevocational Training Respite Speech, Language/Hearing Therapy Support Coordination Supported Employment (Individual Support( (Small Group Support) Transportation Vehicle Modification

ServiceCommunity Care Waiver (BIG) Comprehensive Care Waiver (Supports Program) Cognitive Rehabilitation Community Based Supports Community Inclusion Services Financial Management Services (Fiscal Intermediary) Good and Services Interpreter Services Natural Supports Training Supports Brokerage

PA Services Home and Community Services: Home and Community Habilitation Licensed Day Habilitation Prevocational Services Residential Habilitation Transitional Work Services Specialized Therapies and Related Clinical Services: Physical Therapy Occupational Therapy Speech and Language Therapy Visual and Mobility Therapy Behavioral Therapy Nursing Services Employment Services (Competitive Employment) Job Finding Job Support Transportation Services Vendor Services Base Funded Services (FSS) RespiteOther Community Services Homemaker/Chore Supports CoordinationFinancial Management

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