Home and Community Based Services Waiver by Glenn Vatter
In the early 1990's the federal government made available funding so that services could be provided to developmentally disabled children and adults via Medicaid, with the parent/caregiver income and assets being waivered. The state pays 50% and the federal government pays 50%. In 1992, New York was the 32nd state to establish a program for this funding. New York calls it the Home and Community Based Services Waiver. Other states may call it by another name and may have services set up differently. Readers should contact their local department of social services and inquire about any program they have, under Medicaid, for persons with developmental disabilities in which the family income and assets are waived.
In the state of New York, the child is allowed his own income of up to $600 per month and assets of up to $3500 before his HCBS benifits start to become prorated.
We are using the program for our son Billy. We have a wonderful young man who picks him up every day and takes him into the community for various volunteer jobs, recreation, to eat, and so forth.
The following article tells more about Waivered Services available in the state of New York. Readers should check with their local Department of Social Services to find out what is available in their area.
WHAT IS THE HCBS WAIVER?
The HCBS Waiver is a funding mechanism that allows us to use the Individualized Service Environment (ISE) approach.
THE HCBS WAIVER:
- Provides Medicaid funding for certain services which, in the absence of the waiver, are Medicaid-funded only for persons admitted to an ICF/MR;
- Eliminates consideration ("deeming") of parental income for Medicaid eligibility for persons under the age of 18 who live with their parents;
- Eliminates Medicaid requirements that services be offered on a comparable basis to all Medicaid eligible persons in NYS.
WHAT SERVICES CAN YOU RECEIVE?
- Waiver Case Management - a required HCBS Waiver service that provides comprehensive service coordination from initial assessment and choosing personal goals to satisfaction of services received. The case manager is an agent of the consumer who assists with planning for services, finding and
accessing services, monitoring services, and coordinating all phases of chosen services that create and sustain the Individualized Service Environment.
- Residential Habilitation - a service that provides assistance to acquire, retain, or improve the skills needed to perform daily activities in the home. These activities can include housekeeping, personal care, meal preparation, communication, health care, and social engagements.
- Day Habilitation - a service that provides assistance to acquire, retain, or improve the skills needed to perform daily activities away from the home. These activities might include purchasing goods and services, communicating with fellow employees, traveling, community meetings or gatherings, or running errands. Also includes recreation.
- Supported Employment - a service which provides competitive work in integrated settings for individuals for whom competitive employment has been interrupted or intermittent as a result of their disabilities, and need ongoing services to continue to work. These services are reimbursable by HCBS Waiver Medicaid only to persons who have previously resided in a
SNF, ICF, or ICF/MR at some time prior to the receipt of these services.
- Prevocational Services - a service that prepares individuals for paid or unpaid employment. Services include teaching such concepts as attending, task completion, problem solving and safety. Activities included in this category are not primarily directed at teaching specific job skills, but are directed at underlying habilitative goals, such as increasing attention
span and improving motor skills. These services are reimbursable through HCBS Waiver Medicaid only to persons who have previously resided in an SNF, ICF, or ICF/MR.
- Respite - a service that provides short term "substitute services" on behalf of a primary caregiver who is either a family member, a legal guardian, an advocate, or a Family Care Provider or live-in/house parent staff. It is a means of providing services when the persons who normally provide care are absent or in need of relief.
Hourly - Occurs in a person's home, family care home, or OMRDD certified or approved site.
Residential - overnight stay in an OMRDD operated, certified, or approved site that is not a private residence.
- Adaptive Technologies - devices, aids, controls, appliances, or supplies of either a communication or adaptive type, which are necessary to enable the person to increase or maintain his or her ability to live at home with independence and safety. Some examples are personal emergency response
systems, communicators, speech amplifiers, standing boards/frames, and motorized wheelchairs.
- Environmental Modifications - changes and/or additions to the home environment necessary to ensure the health, welfare, and safety of the individual with developmental disabilities; or to enable the individual to function with greater independence in the home. Some examples are ramps, lifts, hand railings, roll-in showers, water faucet controls, cabinetry.
WHAT ARE THE ELIGIBILITY REQUIREMENTS?
- Developmental Disability
- Medicaid Eligibility
Limited income and assets for disabled person
Family income and assets waived for persons under 18, n/a for persons over 18
- Appropriate Living Arrangement -
Family Care (ASFC or State Operated)
Own Home (not certified by OMRDD or any other state agency)
Individual Residential Alternative (IRA) (Subclass of Community Residence)
Living with parents or caregiver
- Choice of Waiver Services Over ICF/MR Services
- Availability of Services (availability of funds within the DDSO spending plan), i.e., its not an entitlement. Based on the "squeaky wheel" approach.i,c,
HOW DO YOU APPLY?
Application is made through your case manager(agency) or through the DSO.
WHO PROVIDES HCBS WAIVER SERVICES?
Any not-for-profit agency or individual may apply to be a provider of waiver services. Applications are made to the DDSO. A Medicaid Provider Agreement with the State Department of Social Services gives the authority to provide waiver services.
