1. Medicaid Transformation Demonstration (MTD)
May 2017

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

3. Healthier Washington

4. 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

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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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.

17. 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.

18. 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

20. Thank You! Home & Community Services Presenters:
Kim Boon, Program Manager
Debbie Johnson, Program Manager