The WaiverYour questions---almost answered!

The Waiver

What’s going on in NJ and PA?

Your questions---almost answered

Entitlement First

Under the Social Security Act, if you meet the requirements for institutionalized care, you are entitled to that service.

Parental income is not considered Medical care, nursing, therapy, staffing, recreation are

covered expenses. Segregated, congregate settings Freedom restricted

What is a Waiver?

You are “waiving” your entitlement to institutionalized care.You want services and supports in the community.

It has aliases! HCBS Medicaid Home and Community Based Waiver

Program

It’s funding depends on the state Federal and State match NJ’s ratio is?????federal to % state monies

Omnibus Budget Reconciliation Act of 1981Medicaid Home and Community-Based Services (HCBS) waiver program signed by President Reagan on August 13, 1981.For the first time, states can use long-term care money available through Medicaid to pay for home and community based services instead of nursing homes and institutional care.

State HCBS Waiver programs must:

45%state55% federal (2011)

Don’t underestimate your power!

Katie Beckett ‘s parents advocated for a change in federal rules and in 1981, Congress created the Katie Beckett Waiver.

“

Goal For people to live in their own communities with family and

friends and given appropriate supportsFocus

Habilitation, not Rehabilitation

REHABILITATION VS HABILITATIONREHABILITATION HABILIATION

REGAIN RELEARN

ACQUIRERETAIN

IMPROVE

FOCUSSelf-help, Socialization and Adaptive skills necessary to reside successfully in home

and community based setting

Waivers are dependent upon States willingnessStates can offer a variety of services under a State Plan

and Home and Community-Based Services (HCBS) benefit.

People must meet State-defined criteria: specific needs risk conditionhttp://www.socialsecurity.gov/OP_Home/ssact/title19/1902.htm

State’s FlexibilityWhat’s Covered?States can offer a variety of unlimited services under an HCBS Waiver program. a combination of standard medical services and non-medical services.not limited to:

case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health

services, habilitation (both day and residential), and respite care.

States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.

Service Community Care Waiver Comprehensive Care Waiver (Supports Program)

Assistive Technology

Behavioral Management

Career Planning

Case Management

Community TransitionServices

Day Habilitation

Environmental Mod

Individual Supports

Occupational Therapy

Service Community Care Waiver(BIG)

Comprehensive Care Waiver (Supports Program)

Personal Emergency Response System (PERS)

Physical Therapy

Prevocational Training

Respite

Speech, Language/Hearing Therapy

Support Coordination

Supported Employment (Individual Support((Small Group Support)

TransportationVehicle Modification

Service Community Care Waiver(BIG)

Comprehensive Care Waiver (Supports Program)

Cognitive Rehabilitation

Community Based SupportsCommunity InclusionServices

Financial Management Services (Fiscal Intermediary)

Good and Services

Interpreter Services

Natural Supports Training

Supports Brokerage

PA Services

Home and Community Services:Home and Community HabilitationLicensed Day HabilitationPrevocational ServicesResidential HabilitationTransitional Work Services

Specialized Therapies and Related Clinical Services:Physical TherapyOccupational TherapySpeech and Language TherapyVisual and Mobility TherapyBehavioral TherapyNursing Services

Employment Services (Competitive Employment)Job FindingJob Support

Transportation ServicesVendor ServicesBase Funded Services (FSS)

Respite Other Community ServicesHomemaker/Chore

Supports Coordination Financial Management

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