Medicaid Waivers and Interest ListsJOHN E SCHNEIDER

Medicaid Waivers

The waivers give states flexibility as to how they spend money to provide long-term services to individuals with disabilities

Medicaid Waivers in Texas

Community Based Alternatives

Community Living and Support Services (CLASS)

Deaf Blind with Multiple Disabilities (DBMD)

Home and Community Based Services Program (HCS)

Medically Dependent Children Program (MDCP)

Texas Home Living Program (TxHmL)

Community Based Alternatives

Age 21 or over

Need skilled nursing care

Income not exceed 300% of SSI ($1911/month)

Resource cap - $2000

Can be used for living at home, assisted living as alternative to nursing home

Services include adaptive aids, dental, home delivered meals, minor home modifications, nursing services, occupational therapy, personal Assistance services, respite care, hearing and speech services, and transition services.

CLASS

No age limit

Medicaid eligible

Service Plan can not exceed $63,369/year

Require habilitation services

Services include adaptive aids, Dietary/nutrition, Habilitation attendant/training, Home modifications, nursing services, Occupational and Physical Therapy, Prevocational training, Respite care, supported employment and support family services.

Consumer Directed Option

Deaf Blind With Multiple Disabilities

18 or older

Deaf-Blind with other disability that interferes with independent functioning; have ID or related condition

Service Plan not exceed $59,750/year

Services include: adaptive aids, assisted living; Behavior communication specialist, chore services, day habilitation, Dietary/Nutrition, Intervenor, home modifications, Nursing services, Occupational and Physical therapy, residential habilitation services, respite care, speech and hearing services,

Home and Community Services

No age limit

Must have ID or related diagnosis

Medicaid eligible

Service plan limits depending on level of need, ranges from max of $86,313 for LON 1,5 to $173,876 for LON 9

Services include: adaptive aids, audiology, day habilitation, dental care, Dietary/nutrition, Foster/companion care, home modifications, nursing services, occupational and physical therapy, psychology services, respite care, social work, speech and hearing services, supervised living, supported employment, and supported home living.

Medically Dependent Children Program

Under 21

Eligible for Medicaid

Meet criteria for admission to nursing facility

Meet SSI criteria

If under 18 must live with family member or with foster parents

Services include: adaptive aids, adjunct support services, minor home modifications, and respite care

Texas Home Living

ID or related condition

Meets criteria for Level of Care at an ICF-ID

Receives Medicaid

Not require intensive one on one supervision

Not operating under another waiver

Elects to receive TxHml

Annual limit - $10,000

Services include: adaptive aids, audiology, behavioral support, community support, day habilitation, dental care, employment assistance, home modifications, nursing services, occupational and physical therapy, respite care, speech and hearing, and supported employment

Interest Lists

Each Waiver has its own interest list

Wait differs depending on the waiver Currently up to 11 years for HCS

Over 100,000 people on the lists.

Need to get on the lists as soon as eligible

Can be on multiple lists

Can use one waiver while waiting for another

Diversion slots – certain emergencies can justify getting a waiver NOW.

Consumer Directed Services

Allows the consumer to control services delivered

Depending on the waiver on certain services fall under this option

Examples HCS – limited to supported Home living and respite services

Texas Home Living - All services

Where do I go to get on the lists?

CBA, CLASS, DBMD and MDCP – DADS

HCS and TxHmL – Local ID Authority