Transitioning a Child to Consumer Directed Health Care Preventing Service Gaps and Planning the Move to the Consumer Directed Adult System of Care Consumer Direction Regional Conferences - June, 2006 Sponsored by Colorado Department of Health Care Policy and Financing Independence Plus Grant #18-P-92019/8-01

Colorado Medicaid Offers a range of consumer directed service options Maintains a leadership position among states’ Medicaid programs with consumer direction program innovations Receives broad community, legislative and executive support of consumer direction initiatives

Workshop Objectives: Identify barriers to seamless transition to the adult system of care Identify resources and skills to ease the transition to consumer directed adult health care

Workshop Content Parents’ transition activities –Skills and timing Quick review of Medicaid (very quick) –State plan, HCBS, consumer direction Intro to the adult system of care Authorized Representatives

When Should Transition Begin? Parents should begin to plan at the initial onset of the child’s disability –Birth, or –Date of injury Children can begin to absorb pertinent info at the age of 14 START EARLY!

Seamless Transition Depends On: The wishes of the child and family Complexity of child’s health condition Presence (or absence) of adult health care resources in the community Parent’s knowledge (and willingness to teach the child) of transition process and community resources

Building Appropriate Skills in the Transitioning Child/Consumer Identify and communicate changes in health condition Communicate effectively with a provider –Obtain appointments –Evaluate interventions –Express the child’s/family’s wishes COMMUNICATION!

Building Appropriate Skills: SHARE YOUR KNOWLEDGE Prevent injury and/or illness Manage child’s health needs Coordinate services

Medicaid 101 Federal and state partnership providing payment for health care services for the disabled and low-income populations –Federal/state share of costs is 50/50 Financial Eligibility is determined by results of an asset/means test –Consult the county in which you live

Medicaid 101 State Plan: –A package of medically necessary services available to all Medicaid eligible clients. Includes: –Acute care –Home health care

Medicaid Waivers Home and Community Based Services Allow the state to offer services in addition to the State Plan services Services are appropriate and specific to a population with a specific diagnosis Called “waivers” because the equal access to equal services requirement of the state plan are “waived” for specific populations

Medicaid Waivers HCBS eligibility requirements Client must be eligible for Medicaid Client must need long-term care at an institutional level of care HCBS offers a spectrum of client choice Traditional agency model – least choice IHSS (agency with choice) – moderate choice CDAS – most choice

Medicaid 101 – Consumer Direction IHSS – “agency with choice”- consumer direction option available to HCBS-EBD and C-HCBS clients only. CDAS – most flexible consumer directed option available to all eligible Medicaid clients with long term care needs

Two Systems in Long Term Care Physically Disabled Children Waiver: C-HCBS Apply: SEP, CCB, CMA Wait list: Yes Adult Waivers: EBD (18+), BI (16-64), PLWA (all) Apply: SEP Wait list: No, except SLP in BI waiver

Two Systems in Long Term Care Cognitively Disabled Children Waiver: CES Apply: (CCB) Waiting List: Yes Adult Waivers: SLS, DD, MI Apply: CCB SEP (MI only) Waiting List: SLS: Yes DD: Yes

Two Systems in Long Term Care Physically Disabled Children (Birth -17) Waiver: C-HCBS Where to Apply: SEP, Community Centered Board (CCB), or Case Management Agency Waiting List: Yes Adults Waivers: HCBS-EBD (Age 18 and up) HCBS-PLWA (All Ages) HCBS-MI (Age 18 and up) HCBS-BI (Age ) Where to apply: SEP Waiting List: HCBS-EBD: none HCBS-PLWA: none HCBS-MI: none HCBS-BI: Yes, for SLP Cognitively Disabled Children (Birth-17) Waiver: HCBS-CES Where to Apply: (CCB) Waiting List: Yes Adults Waivers: HCBS-SLS HCBS-DD Where to apply: CCB Waiting List: HCBS-SLS: Yes HCBS-DD: Yes

Case Management Responsibilities SEP/CCB Responsibilitie s Eligibility Determination HCBS Waivers Case Management Service Coordination Referral and Information Distribution Quality Assurance SEP Responsible for all Authorization of Home Health

Authorized Representative (AR) AR may be a family member, a friend or a legal guardian of the client AR may assist the client in the direction of the client’s care AR assists the client to define quality, risk and safety in the client’s care

Requirements to be an AR AR must be at least 18 years old AR must know client for two years AR must not be convicted of abuse, exploitation or assault AR must not have a condition that could result in harm to the client

Preventing conflicts of interest AR may not be paid AR may not be a paid caregiver AR must enjoy the trust of the client AR must be willing to accept client’s responsibilities for the client’s consumer directed care AR must be able to distinguish between the client’s and AR’s wishes

Authorized Representative - Benefits for the Consumer Any eligible client may choose this option AR option enables cognitively disabled clients to transition into consumer directed services Transitioning clients may choose an AR to help identify service quality standards With an AR, transitioning clients can turn service deficiencies to strengths and improve support quality

Authorized Representative in IHSS Client’s physician determines need for an AR to assist in client’s care Client and AR select provider agency Client and AR select attendant Client and AR determine training needs of attendant

Authorized Representative in IHSS – (cont) Client and AR conduct training Client and AR select back-up attendants Client and AR establish procedures for critical incident management, back-up utilization – within the confines of the provider agency’s requirements

Authorized Representative in CDAS Client or legal guardian designates Complete affidavit and questionnaire May not be paid May not have a conviction for abuse, exploitation, or assault May not have a mental, emotional, or physical condition that could harm client

Emergency Backup, Safety and Prevention Strategies See the Strategies Resource Manual –Safety and Prevention –Decision tree –Back-up care –Community disaster –Identity and property safety –Health care emergency forms

Finally….. What you risk reveals what you value Jeanette Winterson When you're through changing, you're through William Safire

Contact Information IHSS George Good-deCurnou in Denver metro: in state: x 2704 CDAS Marie Garcia in Denver metro: in state: x 2755

Questions? Please write down questions you have for the Q&A panel and leave them in the box provided on the registration table.

Please complete the evaluation form in the “Additional Information” section of your conference binder. We appreciate your feedback! If you would like additional conference materials, please complete the conference materials request form.