Medicaid Waivers and Interest Lists JOHN 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