Working to Create “A Life Like Yours”Working to Create “A Life Like Yours”(ALLY)(ALLY)

Home and Community Based Home and Community Based Medicaid WaiversMedicaid Waivers

The Arc of Northern Virginia: The Arc of Northern Virginia: Who we are and What we doWho we are and What we doHistoryAdvocacyEducationInformation and ReferralDD Waiver Case ManagementGuardianship Pooled Special Needs Trusts

OutlineOutline1) Purpose and Description of Medicaid

Waivers2) Eligibility Criteria3) Waiver Services Definitions4) Waiver Services for each Waiver5) Screening Process/Summary & Criteria6) Other Steps

Waivers give States the flexibility to Waivers give States the flexibility to offer services to an individual in the offer services to an individual in the community rather than living and community rather than living and

receiving services in an institution. receiving services in an institution.

Purpose of the WaiversPurpose of the Waivers

What is a Medicaid Waiver?What is a Medicaid Waiver?

Medicaid: Medicaid is what pays for Medicaid: Medicaid is what pays for the services you can receive from a the services you can receive from a Medicaid WaiverMedicaid Waiver

Waiver: Waiving the choice of Waiver: Waiving the choice of institutional placement and choosing to institutional placement and choosing to accept services in the communityaccept services in the community

Six Waivers in VirginiaSix Waivers in Virginia

Elderly or Disabled with Consumer Direction Elderly or Disabled with Consumer Direction Waiver (EDCD)- now include the HIV/AIDS Waiver (EDCD)- now include the HIV/AIDS WaiverWaiver

Individual and Families with Developmental Individual and Families with Developmental Disabilities Waiver (DD Waiver)Disabilities Waiver (DD Waiver)

Intellectual Disability/formerly Mental Intellectual Disability/formerly Mental Retardation Waiver (ID/MR Waiver)Retardation Waiver (ID/MR Waiver)

Day Support WaiverDay Support WaiverTechnology Assisted Waiver (Tech) Technology Assisted Waiver (Tech) Alzheimer’s Assisted Living Waiver (AAL Alzheimer’s Assisted Living Waiver (AAL

Waiver)Waiver)

Three Criteria to Three Criteria to Determine EligibilityDetermine Eligibility

1) Financial Eligibility Criteria 1) Financial Eligibility Criteria

2) Diagnostic Criteria2) Diagnostic Criteria

3) Functional Criteria3) Functional Criteria

Financial Eligibility for Financial Eligibility for State Plan State Plan Medicaid Medicaid

Categorical CriteriaCategorical Criteria• Disabled or age 65 or olderDisabled or age 65 or older• Families with childrenFamilies with children• Pregnant womenPregnant women• Recipients of cash assistanceRecipients of cash assistance• Low income Medicare beneficiariesLow income Medicare beneficiaries

Financial ThresholdsFinancial Thresholds• Low income and asset guidelines (up to 80%) of Federal Low income and asset guidelines (up to 80%) of Federal

Poverty LevelPoverty Level• Thresholds vary by category groupThresholds vary by category group• Consideration of exceptionally high medical bills (spend-Consideration of exceptionally high medical bills (spend-

down)down)• Parental income/resources DO count for minor Parental income/resources DO count for minor

childrenchildren

Categorical CriteriaCategorical Criteria

Must Need Long-term CareMust Need Long-term CareCriteria defined for each WaiverCriteria defined for each WaiverAssessment of need requiredAssessment of need required

Financial ThresholdsFinancial Thresholds

$2130 per month (gross income)$2130 per month (gross income)Spend-down for 4 of the WaiversSpend-down for 4 of the Waivers$2000 resource limit$2000 resource limitParent income/resources do NOT count regardless of Parent income/resources do NOT count regardless of child’s agechild’s age

Financial Eligibility for Medicaid Financial Eligibility for Medicaid Long Long Term CareTerm Care (Waivers and Institutions) (Waivers and Institutions)

Financial EligibilityFinancial Eligibility

If someone has applied for the If someone has applied for the Waiver, does this mean they have Waiver, does this mean they have applied for Medicaid?applied for Medicaid?

No!No!

These are two separate process!These are two separate process!

To apply for Medicaid, contact the local Department of Social To apply for Medicaid, contact the local Department of Social Services!Services!

Financial EligibilityFinancial Eligibility

The household income is too high The household income is too high to qualify for Medicaid, should the to qualify for Medicaid, should the individual still apply for a waiver?individual still apply for a waiver?

Yes! Yes!

You CAN be on the waiting lists without receiving Medicaid You CAN be on the waiting lists without receiving Medicaid benefits. Once a slot becomes available, you can apply for benefits. Once a slot becomes available, you can apply for Medicaid under the “Long Term Care/Institutional Rules”.Medicaid under the “Long Term Care/Institutional Rules”.

And remember, different rules apply when it is State Plan And remember, different rules apply when it is State Plan Medicaid versus “long term care” Medicaid!Medicaid versus “long term care” Medicaid!

Explore a Special Needs Trust Explore a Special Needs Trust Like The Arc of Northern VA’s Pooled TrustLike The Arc of Northern VA’s Pooled Trust

A SNT is a legal document designed to:A SNT is a legal document designed to:Provide benefit to & protect the assets of a person Provide benefit to & protect the assets of a person with a disability while allowing the individual to be with a disability while allowing the individual to be qualified for and receive government benefits, such qualified for and receive government benefits, such as Medicaid, Medicaid Waivers and Supplemental as Medicaid, Medicaid Waivers and Supplemental Security Income. Security Income.

For more information, contact:For more information, contact:Tia Marsili, Director of TrustsTia Marsili, Director of Truststmarsili@thearcofnova.orgtmarsili@thearcofnova.org

(703) 532-3214 x115(703) 532-3214 x115www.thearcofnovatrust.comwww.thearcofnovatrust.com

Diagnostic EligibilityDiagnostic Eligibility

EDCD WaiverEDCD Waiver Individuals who have significant medical needs. The criteria used to Individuals who have significant medical needs. The criteria used to

determine eligibility is the nursing home criteria. determine eligibility is the nursing home criteria.

Day Support WaiverDay Support Waiver Individuals with ID/MR who have been determined to meet two of Individuals with ID/MR who have been determined to meet two of

the Level of Functioning Criteria.the Level of Functioning Criteria.

Technology Assisted WaiverTechnology Assisted Waiver Individuals who require ongoing skilled nursing care.Individuals who require ongoing skilled nursing care.

Individuals 21 and older who are dependent at least part of each Individuals 21 and older who are dependent at least part of each day on a mechanical ventilator or meet complex tracheotomy day on a mechanical ventilator or meet complex tracheotomy criteria.criteria.

Individuals under the age of 21 who meet certain criteria based on Individuals under the age of 21 who meet certain criteria based on various methods of respiratory or nutritional supportvarious methods of respiratory or nutritional support

Diagnostic EligibilityDiagnostic EligibilityID WaiverID Waiver

Must have a diagnosis of ID or be under the age of 6 and at Must have a diagnosis of ID or be under the age of 6 and at developmental riskdevelopmental risk

Children on the ID Waiver who do not have a diagnosis of Children on the ID Waiver who do not have a diagnosis of ID/MR at the age of 6, possible transfer to DD Waiver ID/MR at the age of 6, possible transfer to DD Waiver

IQ Score (70 or below) and psychological testing is required!IQ Score (70 or below) and psychological testing is required!

DD Waaiver

Must be 5 years and 9 months of age and have a Must be 5 years and 9 months of age and have a developmental disability or “related condition” to applydevelopmental disability or “related condition” to apply

Cannot have a diagnosis of an intellectual disability Cannot have a diagnosis of an intellectual disability IQ Score (71 or above) and psychological testing is required!IQ Score (71 or above) and psychological testing is required!

Functional CriteriaFunctional CriteriaID, DD, and Day Support Waivers:ID, DD, and Day Support Waivers: - All individuals must meet the Intermediate Care Facility-

Intellectual Disability (ICF-ID) level of care. This is established by meeting the indicated dependency level in two or more of the categories on the Level of Functioning Survey. - Categories include: Health Status, Communication, Task Learning Skills,

Personal/Self Care, Mobility, Behavior, and Community Living Skills.- View the LOF Survey online:

http://www.dbhds.virginia.gov/documents/forms/1157eMRwaiver.pdf

- EDCD, Alzheimer’s, and Technology Waivers:EDCD, Alzheimer’s, and Technology Waivers: - Individuals must meet the nursing facility eligibility criteria

determined by using the Universal Assessment Instrument (UAI)

- Assesses social, physical health and functional abilities

Waiver Services DefinitionsWaiver Services Definitions

Personal / Attendant CarePersonal / Attendant CareRespite CareRespite CareCompanion CareCompanion CareDay SupportDay Support In Home ResidentialIn Home ResidentialAssistive TechnologyAssistive TechnologyEnvironmental ModificationsEnvironmental ModificationsPersonal Emergency ResponsePersonal Emergency ResponseTransition Services Transition Services

Waiver Services DefinitionsWaiver Services DefinitionsOptions of CareOptions of Care

Agency DirectedAgency Directed ◦ Care that is rendered by a Medicaid approved agencyCare that is rendered by a Medicaid approved agency◦ The agency hires and manages and pays the workers The agency hires and manages and pays the workers ◦ The agency submits the paperwork necessary for payment to The agency submits the paperwork necessary for payment to

DMASDMAS Consumer DirectedConsumer Directed

◦ Workers are directly hired and managed by the individual Workers are directly hired and managed by the individual receiving the DD Waiver support servicesreceiving the DD Waiver support services

◦ The individual, or their family if the client is a child or is unable The individual, or their family if the client is a child or is unable to manage the task, is responsible for managing all aspects of to manage the task, is responsible for managing all aspects of the employment relationship, including recruiting, hiring, the employment relationship, including recruiting, hiring, training, supervising, ensuring payment through DMAS, and training, supervising, ensuring payment through DMAS, and firing if neededfiring if needed

◦ There is a service facilitator to assist you with this processThere is a service facilitator to assist you with this process

Waiver ServicesWaiver ServicesOffered by the EDCD WaiverOffered by the EDCD Waiver

No Case Management ServiceNo Case Management Service

DMAS Contracted Providers including institution, facility, DMAS Contracted Providers including institution, facility, agency, partnership, corporation, or associationagency, partnership, corporation, or association

Personal Care Aide Services Personal Care Aide Services   Adult Day Health Care Adult Day Health Care   Respite Care Respite Care   Personal Emergency Response System (PERS) Personal Emergency Response System (PERS)   Medication Monitoring Medication Monitoring   Consumer-Directed ServicesConsumer-Directed Services Transition ServicesTransition Services

Waiver ServicesWaiver ServicesOffered by the Tech WaiverOffered by the Tech Waiver

Case Managed by DMASCase Managed by DMAS

Personal care (Adults Only) Personal care (Adults Only)   Private duty nursing Private duty nursing   Respite care Respite care   Environmental Modifications Environmental Modifications   Assistive TechnologyAssistive Technology Personal Emergency Response SystemPersonal Emergency Response System

Waiver ServicesWaiver ServicesOffered by the Day Support WaiverOffered by the Day Support Waiver

Case Management by the Local CSBsCase Management by the Local CSBs

• Day support services

• Prevocational services

• Supportive Employment

Waiver ServicesWaiver ServicesOffered by the ID WaiverOffered by the ID Waiver

In addition to these the ID Waiver also offersIn addition to these the ID Waiver also offers Residential support (group home, sponsored Residential support (group home, sponsored

placement, 24 hour-care)placement, 24 hour-care)

Support Coordination provided by local CSBSupport Coordination provided by local CSB Day support Day support Supported employmentSupported employment Personal or Attendant Care Personal or Attendant Care Respite careRespite care In-Home Residential SupportIn-Home Residential Support Adult Companion CareAdult Companion Care Assistive technology Assistive technology Environmental modifications Environmental modifications Therapeutic consultationsTherapeutic consultations Personal Emergency Response System (PERS)Personal Emergency Response System (PERS) Transition Services (from institution to community via Money Follows the Transition Services (from institution to community via Money Follows the

Person Program)Person Program)

Waiver ServicesWaiver ServicesOffered by the DD WaiverOffered by the DD Waiver

Case Managed by Private Non-Profit Organizations contracted with Case Managed by Private Non-Profit Organizations contracted with DMAS, such as The Arc of Northern VirginiaDMAS, such as The Arc of Northern Virginia

Supported employmentSupported employment Day SupportDay Support Personal or Attendant Care Personal or Attendant Care Respite careRespite care In-Home Residential SupportIn-Home Residential Support Adult Companion CareAdult Companion Care Assistive technology Assistive technology Environmental modifications Environmental modifications Therapeutic consultationsTherapeutic consultations Personal Emergency Response System (PERS)Personal Emergency Response System (PERS) Transition coordination from an institution to the communityTransition coordination from an institution to the community

Screening ProcessesScreening ProcessesEDCD WaiverEDCD Waiver

EDCD WaiverEDCD Waiver

Call your local Department of Health or Department of Call your local Department of Health or Department of Social Services for intakeSocial Services for intake

Alexandria (703-746-5700), Arlington (703-228-1350), Fairfax Alexandria (703-746-5700), Arlington (703-228-1350), Fairfax (703-324-7500)(703-324-7500)

Set up Screening and intake appointment with Social Set up Screening and intake appointment with Social WorkerWorker

Schedule visit with the nurseSchedule visit with the nurse Meet with local County case workerMeet with local County case worker Meet with Home Health Care Agency or Service Meet with Home Health Care Agency or Service

FacilitatorFacilitator

Waiting ListWaiting List None – just the process of intakeNone – just the process of intake

Screening ProcessesScreening ProcessesTechnology Assisted WaiverTechnology Assisted Waiver

Technology Assisted WaiverTechnology Assisted Waiver

DMAS conducts the screenings for individuals DMAS conducts the screenings for individuals under the age of 21 who request Tech Waiver under the age of 21 who request Tech Waiver servicesservices

Call 804-786-1465 or local Health Department Call 804-786-1465 or local Health Department or Department of Social Servicesor Department of Social Services

If hospitalized, the hospital social worker or If hospitalized, the hospital social worker or discharge planner can assist in coordinating a discharge planner can assist in coordinating a screening with DMASscreening with DMAS

Waiting ListWaiting List None – just the process of intakeNone – just the process of intake

Screening ProcessesScreening ProcessesDay Support WaiverDay Support Waiver

Steps:Steps:

Contact the local CSB for Screening Contact the local CSB for Screening informationinformation

Waiting ListWaiting List Limited number of slots (300)Limited number of slots (300) First come, first serveFirst come, first serve Allocated by state office of ID ServicesAllocated by state office of ID Services

Screening ProcessesScreening ProcessesID WaiverID Waiver

Screenings are conducted by the local CSBsScreenings are conducted by the local CSBs

Arlington: Arlington: 703-228-1700703-228-1700

Alexandria: Alexandria: 703-746-3400703-746-3400 Fairfax: Fairfax: 703-324-4400 (refer to ID Services)703-324-4400 (refer to ID Services)

Steps:Steps:1) Call your local CSB to complete a screening process1) Call your local CSB to complete a screening process2) Complete application they send to you2) Complete application they send to you3) Make and attend intake process at the CSB3) Make and attend intake process at the CSB

Waiting ListWaiting ListID Waiver Urgent CriteriaID Waiver Urgent Criteria

Primary Caregiver (s) is/are 55 years or older. Living with a primary caregiver who is providing the service voluntarily

and without pay and they can’t continue care. There is a clear risk of abuse, neglect or exploitation. Primary caregiver has chronic or long term physical or psychiatric

condition significantly limiting ability to provide care. Individual is aging out of a publicly funded residential placement or

otherwise becoming homeless. Individual lives with the primary caregiver and there is a risk to the

health or safety of the individual, primary caregiver, or other individual living in the home because individual’s behavior presents a risk to himself or others

OR Physical care or medical needs cannot be managed by the primary

caregiver even with generic or specialized support arranged by the CSB.

Recap of ID WaiverRecap of ID WaiverID Waiver:ID Waiver:

• In Virginia the ID Waiver waiting list is served In Virginia the ID Waiver waiting list is served based on need and region populationbased on need and region population

• Approximately 9,457 people have ID Approximately 9,457 people have ID Waivers.Waivers.

• Approximately 6,529 people are on the Approximately 6,529 people are on the waiting lists.waiting lists.

• Over 3,762 of those are on the urgent care Over 3,762 of those are on the urgent care waiting listwaiting list

• The waiting list grows at a rate of one person The waiting list grows at a rate of one person per dayper day

Numbers as of 10/01/13Numbers as of 10/01/13

Screening ProcessesScreening ProcessesDD WaiverDD WaiverSteps:Steps:1) Complete the Screening Request Form 1) Complete the Screening Request Form

Available on Available on http://dmasva.dmas.virginia.gov/ or www.thearcofnova.org or www.thearcofnova.org

Send form to Regional Child Development Center:Send form to Regional Child Development Center:Alexandria - Alexandria - Veronica Aberle, Health Center - P: (703) 838-4300 , Health Center - P: (703) 838-4300 F: (703) 746-4938Arlington - Arlington - Margaret Jones, Arlington HS P: (703) 228-1640 F: (703) 228-1126Margaret Jones, Arlington HS P: (703) 228-1640 F: (703) 228-1126Fairfax - Fairfax - Terri Morris, Fairfax Co. Health Dept P: (703) 246-8628 F: Terri Morris, Fairfax Co. Health Dept P: (703) 246-8628 F: (703) 385-3681

2) Have an appointment with local Child Developmental Center (CDC) for Screening2) Have an appointment with local Child Developmental Center (CDC) for Screening

3) Receive letter from CDC stating eligibility3) Receive letter from CDC stating eligibility

4) Choose a Case Management Agency4) Choose a Case Management Agency

5) Complete Plan of Care with Case Manager5) Complete Plan of Care with Case Manager

***You are NOT on the waiting list until your screening and Plan of Care are completed!***You are NOT on the waiting list until your screening and Plan of Care are completed!

Waiting ListWaiting List

DD Waiver:DD Waiver:

• The DD Waiver waiting list is served on The DD Waiver waiting list is served on a first come, first serve basis. a first come, first serve basis.

• 948 people have DD Waivers948 people have DD Waivers

• 1,295 people are on the waiting list 1,295 people are on the waiting list

Numbers from DMAS as of 08/13Numbers from DMAS as of 08/13

Medicaid Waiver ServicesMedicaid Waiver Services

(Source: VA Department of Medical Assistance Services 8/13)(Source: VA Department of Medical Assistance Services 8/13)

Slot/Wait List Summary

EDCD ID DD TECH DAY SUPPORT

ALZ

Approved Slots

33,507 9,457 948 513 300 200

Current Enrollment

26,010 9,302 888 340 245 38

Current Wait List

6,488 1,295

While on the waiting list what While on the waiting list what else can you do?else can you do?Depending on level of need and eligibility criteria, you can apply for other

waivers:

◦ You can NOT be on both the ID Waiver List and the DD Waiver List.◦ You CAN be on either the ID Waiver list OR the DD Waiver list AND

Receive or be on the list for the Elderly or Disabled with Consumer Directed Services Waiver (EDCD), Day Support or the Technology Waivers.

Call your county for case management and other locally funded services or resources that may be available to you.

Utilize the Individuals and Families Support Program Funding Up to $3,000 per year for supports to serve you in the community Read more at http://www.dbhds.virginia.gov/ODS-default.htm Available September 3, 2013 and subsequently on July 1 each year

Access START Crisis Services- 24 hour crisis response and respite for people with ID/DD and behavioral or mental health needs who are over 18 years old

885-89-START

Become a Member of Become a Member of The Arc of Northern Virginia!The Arc of Northern Virginia!

Follow our lead in advocating for the needs Follow our lead in advocating for the needs of your loved one.of your loved one.

www.thearcofnova.org

Sign up for our newsletter!Sign up for our newsletter!

Where Do I Go For More Information?Where Do I Go For More Information?

All Waivers:All Waivers: Virginia Medicaid Waiver Technical Assistance CenterVirginia Medicaid Waiver Technical Assistance Center866-323-1088 (toll free) 866-323-1088 (toll free) 1-804-786-1465 1-804-786-1465 http://dmasva.dmas.virginia.gov

ID Waiver:ID Waiver:http://www.dbhds.virginia.gov/ODS-MRWaiver.htm

UAI ManualUAI Manual (Universal Assessment Instrument): (Universal Assessment Instrument): http://www.dmas.virginia.gov/Content_atchs/ltc/ltc-uai_umnl.pdf

Local Community Services BoardLocal Community Services Board

Arlington: Arlington: 703-228-1700703-228-1700

Alexandria: Alexandria: 703-746-3400 703-746-3400

Fairfax: Fairfax: 703-324-4400703-324-4400

Thank you!

The Arc of Northern Virginia

2755 Hartland Road

Falls Church, VA 22043 Lisa.Fong@TheArcofNova.org

703-532-3214 Ext 108 www.thearcofnova.org