medicaid waivers and interest lists john e schneider
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Medicaid Waivers and Interest ListsJOHN 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
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