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 101 - 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 101 - 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
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 Physically 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 Cognitively Disabled
Case Management Responsibilities SEP Responsible for all Authorization of Home Health SEP/CCB Responsibilities Eligibility Determination HCBSWaivers Quality Assurance Case Management Referral and Information Distribution Service Coordination
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 mustnot 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
IHSS George Good-deCurnou in Denver metro: 303-866-2704 in state: 1-800-221-3843 x 2704 CDAS Marie Garcia in Denver metro: 303-866-2755 in state: 1-800-221-3943 x 2755 Contact Information
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.