Medicaid Transformation Demonstration (MTD) May 2017

Objectives Overview of MTD The importance of MTD Initiative 2 Programs Presumptive eligibility Services Highlights of Initiative 3

Healthier Washington

Overview – What Is MTD? MTD: Is a 5 year demonstration waiver funded by CMS (Centers for Medicare and Medicaid Services) Will be implemented July 2017 Includes 3 initiatives Init 1: Transforming the Medicaid medical delivery system using Accountable Communities of Health Init 2: Long-Term Services and Supports (LTSS) Init 3: Foundational Community Supports DJ Approved in January 2017 Init 1 is administered by HCA Init 2 is administered by ALTSA and AAAs Init 3 services are provided to HCA, ALTSA and BHA clients

Initiative 2 - Programs Medicaid Alternative Plan (MAC) Tailored Supports for Older Adults (TSOA)

Overview – Initiative 2 Importance of new programs/benefits Support unpaid caregivers Delay or avoid need for more intensive care Use evidence from Family Caregiver Support Program (FCSP) Kim - Importance of new programs/benefits: MTP has 3 initiatives: today we are focusing on Initiative Two: will serve unpaid family caregivers (CG) and their care receives (CR) Medicaid has not served unpaid family CGs before, new service population. Expand numbers: be able to serve twice as many unpaid family caregivers statewide under Initiative Two. Caregivers reaching out in crisis are a very vulnerable population

Caregiving: Impacts on Family In Washington State, approximately 80% of the care statewide is provided by family members and other unpaid caregivers Impact on families include: Loss of earnings/Decreased savings for retirement Decreased availability to meet needs of other family members Increased health care costs due to stress & burden

Medicaid Alternative Care Population Care Receiver is: Age 55 or older Eligible for Categorically Needy (CN) or Alternative Benefit Plan (ABP) Medicaid Nursing facility level of care (NFLOC) eligible Not receiving any Medicaid long term services and supports Examples of LTSS include Community First Choice (CFC), COPES, Medicaid Personal Care (MPC), etc.

Tailored Supports for Older Adults Population Care Receiver is: Age 55 or older A US citizen or have eligible immigrant status Not currently eligible for CN or ABP Medicaid Nursing facility level of Care (NFLOC) eligible Financially eligible Income up to 300% of the SSI Federal Benefit Rate and Has countable resources below $53,100 for single or $53,100 + state spousal resource standard for married couple ($107,826) Kim

Presumptive Eligibility Services may be received for a limited time period under presumptive eligibility (PE) Functional and Financial Time period = last day of month following the month in which services were 1st authorized (unless TSOA application is submitted) PE limited to once every 2 years

Initiative 2 - Services Five service packages: Caregiver Assistance Services Training and Education Specialized Medical Equipment & Supplies Health Maintenance and Therapy Supports Personal Assistance Services – only available for TSOA individual without a caregiver

Initiative 3 Foundational Community Supports Supported Employment Supportive Housing Services will be authorized by a third party administrator via Health Care Authority Procurement under way

Supported Employment What Is It? Supported employment means : Competitive employment in an integrated setting for individuals with the most significant disabilities when: It has not traditionally occurred Employment has been interrupted/intermittent as a result of significant disability There is a need for ongoing support services to maintain employment

SE Eligibility for ALTSA Individual must be: Age 18 or older Receiving LTC services defined in Chapter 388-106 WAC (such as Community 1st Choice, COPES, etc.) Interested in obtaining employment

What Does SE Look Like for the Individual? Person-Centered services may include: Pre-employment supports Services to help prepare for a job such as benefits counseling, vocational discovery and assessment, person-centered employment planning, resume development and other job preparations Job development services Assistance in identifying potential jobs and employers and support through the hiring process Job coaching and retention Support to become an effective employee and keep the job over time

Supportive Housing: The Basics People with Disabilities Access to Voluntary, Flexible support: Engagement Housing First Principles & Harm Reduction CHOICE Integrated with Full Rights of Tenancy AFFORDABLE To avoid increasing the capacity of our nursing homes despite the age wave , we are trying to find solutions to serve our more complex clients in the community. Many of our services fall short at helping clients who have behavioral health issues in conjunction with long term support needs. Looking for flexible, responsive, low barrier, independent solutions and SH is one of them. It’s a pretty simple model - but the “secret sauce” can be hard to implement and grapple with, particularly within “traditional” service provision.

Supportive Housing: More than Housing with Supports We’re focusing on ALTSA’s clients who need a high level of engagement, including those with a history of: Frequent institutional contacts, or Frequent adult residential care stays, or Frequent turnover of in-home caregivers or providers If people are doing fine using existing housing supports (including informal supports, waiver services, client training, housing vouchers) there’s no need to use Supportive Housing.

Supportive Housing: What Do the Services Look Like? Services may include activities that assist to: Identify appropriate housing Prepare for/transition to housing Connect with other collateral services Maintain housing Develop/maintain positive relationship with landlord and other tenants

Thank You! Home & Community Services Presenters: Kim Boon, Program Manager Kim.Boon@dshs.wa.gov Debbie Johnson, Program Manager Debbie.Johnson2@dshs.wa.gov