1. What’s on the Horizon For Adult Services Loria Hubbard Richardson Tuberous Sclerosis Conference April 16, 2016 1

2. Topics Vocational Rehabilitation Ticket to Work Postsecondary Opportunities for Students with IDD Medicaid/TennCare Medicaid Waiver Family Support Program CHOICES Waiver ECF CHOICES Waiver Social Security 2

3. Vocational Rehabilitation Helps people with disabilities get meaningful, paying jobs Find your local VR office: http://tn.gov/humanservices/article/office-locator-trc-ttap “Getting a Head Start with Vocational Rehabilitation” http://thearctn.org/Assets/Docs/Getting-a-Head-Start-Voc- Rehab.pdf 3

4. Vocational Rehabilitation Changes with the Work Force Investment Opportunity Act 15% of VR Budget to go to Pre-Employment Transition Job Exploration Work-Based Learning Work Place Readiness Self-Advocacy Post-Secondary Counseling and Enrollment Assistance Students do not have to be eligible for VR to access these services! 4

5. Vocational Rehabilitation Service Examples 5 DiagnosisPost Secondary Training Job PlacementSelf-Employment Supports Nutrition ServicesSpeech and Language Therapy Secondary Training Note Taker Personal Care Assistance MaintenanceIndependent Living Services Interpreter ServiceTransportation

6. Ticket to Work 1.“Virtual Ticket.” 2.Voluntary program 3.MAXIMUS Re: Employment Network (EN): 866/968-7842 4.www.yourtickettowork.com for information 6

7. Ticket to Work Services 1.Interests testing 2.Skills testing 3.Job search/job development services 4.Job coaching/job training 5.Interview skills training 6.Resume writing/preparation 7

8. Ticket to Work Recipient Rights 1.Full explanation of the services offered by Employment Network (EN) 2.Confidentiality 3.Access to your information EN records 4.Copies of your records 5.Work in partnership with your EN 8

9. Ticket to Work Recipient Rights 6. Copy of your work plan in an accessible format 7. Qualified providers 8. Take back or reassign your Ticket 9. Appeal any decision, or have dispute resolution 10. Disability Rights Tennessee http://www.disabilityrightstn.org/ 800/342-1660 9

10. IDD Post Secondary Education Opportunities Edge: Union University FUTure Program: University of TN IDEAL: Lipscomb University Next Steps: Vanderbilt University Tiger Life: University of Memphis 10

11. Medicaid/TennCare 1.TN’s Medicaid Program 2.For people with low incomes 3.Fourteen Mandatory Primary Health Care Services 4.TennCare contracts with state agencies and private organizations 11

12. Medicaid Waiver 1.Home and Community Based Services (HCBS) Waiver Program People with intellectual disabilities live in their communities Three HCBS waiver programs in Tennessee: o Statewide Waiver (The “Big Waiver”) o Arlington Waiver (closed to new enrollment) o Self-Determination Waiver 12

13. Medicaid Waiver: Where to Start Applying for Medicaid Waiver Services Requirements 1.Intellectual disability diagnosed before 18 2.IEP noting the intellectual disability; or 3.Proof of Tennessee Residence 4.Medicaid Eligible 5.Need the same level of care as provided in an institution 6.Getting services and supports that will keep them safe 13

14. Medicaid Waiver Intake Intake is through DIDD Regional Offices West Tennessee: (866) 372-5709 Middle Tennessee: (800) 654-4839 East Tennessee: (888) 531-9876 14

15. Medicaid Waiver Case Manager Decides 1.Eligibility 2.Assigns Category 3.Develops the initial plan of care 4.Helps develop a needs-based support plan 15

16. Medicaid Waiver Application Process Family Member, Person, or Someone Else Makes a Referral Then... 1.Intake/Application Meeting 2.Evaluations 3.Eligibility 4.Priority Category 16

17. The Medicaid Waiver Waiting List: 6000 + Priority Categories 1.Crisis: homeless, no caregiver, danger to self or others - needs services immediately 2.Urgent: Significant risk of abuse/neglect, caregiver aging or in poor health, needs services soon 3.Active: Has applied 4.Deferred: Requesting services more than 12 months in the future 17

18. Examples of Medicaid Waiver Services 18 Adult Dental ServicesBehavioral Services Case ManagementNursing Services Nutrition ServicesSpeech and Language Therapy Environmental Accessibility Personal Assistance Physical TherapyOccupational Therapy Assistive TechnologySpecialized Medical Equipment

19. Family Support Program 1.Families who have child/adult member living in the home with severe disabilities 2.Adults are not supported by other state or federal funded programs 3.Amount can vary each year 4.Call to apply: a. Statewide: (615) 532-6552 b. West: (901) 745-7348 c. Middle: (615) 231-5057 d. East: (865) 594-9288 http://www.tn.gov/didd/section/family-support 19

20. CHOICES Waiver 1.Home and Community Based Service (HCBS) 2.Individualized, Long-term Services and Supports (LTSS) 4. Services needed to keep people living in their communities 5. Income must be less than $2,094 per month 6. AND the total value of things you own cannot be more than $2,000 - The home where you live does not count 7.Applicants cannot have given away or sold anything for less than what it is worth in the last five years 20

21. Employment and Community First CHOICES Waiver 1.July 1, 2016 2.Administered through TennCare 3.Managed Care Organizations (MCOs) similar to the CHOICES Waiver 4.People with DD Will be Eligible 5.Focus on employment and independent living 6.Three Capped Benefit Groups Essential Family Supports Essential supports for employment and community living Comprehensive supports for employment and community living 7.Will use nursing facility need to determine eligibility 21

22. Supplemental Security Income 1.Stipends to low income people 2.Eligibility: i. 65 + ii. Blind iii. Have a disability And... 22

23. Supplemental Security Income 1.Under 18 with a disability or certain other categories 2.Many recipients are also eligible for SSDI 3.Child may also be eligible as a dependent 4.The dependent child's benefits end at 18 unless they continue to be a full-time student 5.Adults who became disabled in childhood can qualify for SSDI based on their parent’s earnings record http://www.bazelon.org/LinkClick.aspx?fileticket=k4W7Msxsmv4%3D&tabid=382 23

24. Supplemental Security Income 1.Limited income and resources 2.Citizen, National, Legal Resident 3.Resident of the 50 States, DC, or Northern Mariana Islands 4.Not absent from the US for 30 + consecutive days 5.Apply for other cash benefits first (e.g. pensions) 6.Gives SSA permission to contact any financial institution to review financial records 7.File the application for benefits 24

25. Social Security Disability Income Eligibility 1.Must have worked and paid Social Security taxes 2.Five Step Eligibility Requirements: Person is unable to work for at least 12 months Medical impairment Severe medical condition that interferes with work-related activities Have an impairment in the SSA Listing or equal in severity If unable to do previous work, are they able to do other work? 3.No benefits for partial or short-term disability 4.Working? $1000 +? No benefits 25

26. Resources 1.Tennessee Disability Pathfinder : 800/640-4636 or http://kc.vanderbilt.edu/pathfinder 2.Vocational Rehabilitation: http://tn.gov/humanservices/topic/vocational-rehabilitation 3.TennCare Already: 800/535-9725 4.Choices Waiver: http://www.tn.gov/tenncare/long_choices.shtml 5.Area Agency on Aging and Disability: 866/836-6678 6.Social Security Administration: https://www.socialsecurity.gov 26

27. For More Information... 27