Medicaid Waiver Services Overview

1. An Overview of Medicaid Waiver Services Presented By: Christina M. Devers, LCSW School Social Worker

2. Outline • Types of waivers • Eligibility • Applying for a waiver • Available services • Contact information & resources

3. Purpose of waivers Disability waivers give states the flexibility to offer services to an individual in the community rather than living and receiving services in an institution.

4. What is a waiver? • Medicaid: Medicaid is the insurance that pays for waiver services. • Waiver: Waiving the requirement that all Medicaid services be offered to everyone and allowing a special group to get extra long term care supports. • Funding – 50/50 split between federal and state governments. Fed pays for about 50% what happens = cost sharing. Centers for Medicaid (federal organization).

5. Types of waivers • Developmental disability waivers (DD) - all three have the same eligibility criteria • Community living waiver • Family & individual supports waiver • Building independence waiver • Alzheimer’s assisted living waiver (AAL) • Commonwealth Coordinated care plus waiver (ccc+) • Combined the elderly or disabled with consumer direction (edcd) & technology assisted waiver (tech) in July 2017

6. Tiered dd waiver design Building independence waiver Family & individual supports waiver Community living waiver For adults (18+) able to live independently in the community. Individuals own, lease, or control their own living arrangements and supports are complemented by non-waiver-funded rent subsidies. Supports are episodic/periodic in nature. For individuals living with their families, friends, or in their own homes, including supports for those with some medical or behavioral needs. Available to both children and adults. 24/7 services and supports for individuals with complex medical and/or behavioral support needs through licensed services. Includes residential supports and a full array of medical, behavioral, and non-medical supports. Available to adults and some children. **Information from DBHDS

7. Comparing waivers dd Ccc+ • Requires a diagnosis of a developmental disability prior to age 22. • Robust menu of services for home nursing, work & community. • Up to 24/7 support based on need. • Case management • Long waiting list • Requires a diagnosed disability & documented medical need – can be acquired after the age of 22. • Shorter menu of services aimed at home care & some nursing, but no employment or residential. • 56 hour weekly cap on personal care services • No case management • No waiting list

8. Three criteria to determine eligibility • Diagnostic criteria • Functional criteria • Financial criteria

9. Diagnostic eligibility • Disability waivers (DD) • Must have a diagnosis of a developmental disability • Provide documentation of overall iq – no minimum or maximum score applies • Developmental disability means a severe, chronic disability of an individual that: • (i) is attributable to a mental or physical impairment, or a combination or mental and physical impairments, other than a sole diagnosis of mental illness • (ii) is manifested before the individual reaches 22 years of age • (iii) is likely to continue indefinitely • (iv) results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive & expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency; and • (v) reflects the individual’s need for a combination and sequence of special interdisciplinary or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are 2 of 3 individually planned and coordinated. • An individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described in clauses (i) through (v) if the individual, without services and supports, has a high probability of meeting those criteria later in life.

10. Diagnostic eligibility, cont’d • CCC+ waiver • Individuals who have significant medical needs. Criteria used to determine eligibility is the nursing home criteria. • Includes individuals who require ongoing skilled nursing care; individuals 21 and older who are dependent at least part of each day on a mechanical ventilator or meet complex tracheotomy criteria; individuals under the age of 21 who meet certain criteria based on various methods of respiratory or nutritional support. • Enrollment process unchanged from former edcd process. • New manual under development • Self-assessment: • www.home-phone.com/momsinmotion/registration.asp?#

11. Functional criteria • Dd waivers: • All individuals must show functional need in three out of eight categories on the Virginia Intellectual and developmental disability eligibility survey (vides). • Three different versions of the vides: ages 0-3, 3-18, 18+ • Categories include: health status, communication, task learning skills, personal/self-care, mobility, behavior, community living skills, and financial self-sufficiency. • CCC+ waivers: • Individuals must meet the nursing facility eligibility criteria determined by using the Uniform assessment instrument (UAI) http://tinyurl.com/zdwfrl5 • focus on personal care and medical care needs

12. Financial eligibility thresholds for medical long term care, like waivers • $2250 per month income cap (300% of 2018 SSI amount) • Patient co-pay begins once someone is earning $1212 per month • $2000 resource limit for adults • No resource limit for children • parent income & resources do not ever count when applying on behalf of a child

13. Financial eligibility Q: if someone has applied for the waiver, does this mean they have applied for Medicaid? A: No! These are two separate processes To apply for Medicaid, visit: https://commonhelp.virginia.gov

14. Financial eligibility Q: the household income is too high to qualify for Medicaid, should the individual still apply for a waiver? A: Yes! you can be on the waiting lists without receiving Medicaid benefits. Once a slot becomes available, you can apply for Medicaid under the “long term care/institutional rules.” And remember, different rules apply when it is state plan Medicaid versus “long term care” Medicaid.

15. What services are available through waivers? See handouts

16. How do I apply? • For all developmental disability waivers screenings are conducted by local community services boards: • Prince William county csb: 703-792-4900 or 703-792-7800 – ask for Clarinda cajayon • Steps: • 1) call local CSB to complete the screening process • 2) complete the application they will send to you • 3) complete the process with the VIDES assessment, in person planning meeting, and get a letter confirming you are on the waiting list

17. How do I apply? • For ccc+ waiver: • Call your local department of social services for intake: • 703-792-7500 • Set up screening and intake appointment with a social worker • Schedule visit with nurse • Meet with local county case worker • Meet with home health care agency or service facilitator ** no waiting list**

18. resources • The Arc of northern virginia: • www.thearcofnova.org • https://thearcofnova.org/programs/waivers/ • Waiver hotline: • 1-844-603-9248 • Developmental disability waivers website: • http://www.mylifemycommunityvirginia.org/