An Overview of Federal and State Services for

Adults with Autism

AANE Adult Benefits Conference January 20, 2017 Kerry Mahoney

The Arc of Massachusetts

What is The Arc of Massachusetts?

State and National Presence

A national movement with 700 Chapters

18 Chapters of The Arc in Massachusetts

Mission:

The mission of The Arc of Massachusetts is to enhance the lives of people with intellectual and developmental disabilities, including autism, and their families. We fulfill this through advocacy for community supports and services that foster social inclusion, self-determination, and equity across all aspects of society.

Federal Subsidies

Federal Subsidies: Supplemental Security

Income ( SSI)

• Provides money for basic needs and requires that the disabled adult must have little or no income (wages under $1170/month) or assets (assets under $2000)

• Incentive programs to work- Ticket to Work and IRWE- Impairment Related Work Expenses

• An entitlement benefit

• Recipients also receive Medicaid

(MassHealth) benefits

Federal Subsidies: Social Security Disability Insurance ( SSDI)

• Provides benefits for disabled adult who qualifies as a worker, survivor or DAC (disabled adult child)

• No Limits on Unearned Income. While a disabled (nonblind) person applying for or receiving SSDI cannot earn more than $1,170 per month by working, a person collecting SSDI can have any amount of income from investments, interest, or a spouse's income. No income limits

• Recipients also receive Medicare benefits after the 24 month waiting period.

Qualified for SSI?

• Food stamps ( SNAP)

• Transportation services ( The Ride, community elder/disabled programs)

• Section 8 housing voucher

• Fuel Assistance

Massachusetts Services

Organizational Chart

Commonwealth of Massachusetts

Legislative Judiciary

Executive

Constitutional Officers Governor

Lieutenant Governor

Governor's Council

Attorney General

Treasurer and Receiver General

Secretary of the Commonwealth

State Auditor

8 Executive Departments [State agencies report to the Governor]

Executive Office of Health

and Human Services ( EOHHS)

Office of Health Services

Office of Disability and Community Services

Secr

etar

y Su

dd

ers

Massachusetts Commission for the

Blind

Massachusetts Rehabilitation Commission

Commission for the Deaf and Hard of

Hearing

Soldiers Home in Massachusetts

Soldiers Home in Holyoke

Department of Developmental

Services

MassHealth (Medicaid)

Note: You can apply for MassHealth even if you aren’t applying for SSI

What Does MassHealth Cover?

• Healthcare

• Drugs or RX

• Transportation

• Dental Care

• Hospitalizations

• Emergencies

• Long Term Support Services ( LTSS) • Adult Family Care ( AFC)

• Personal Care Assistance ( PCA)

• Group Adult Foster Care

• Day Habilitation

• Adult Day Health

• Continuous Nursing and Home Health Aids

http://www.mass.gov/eohhs/consu

mer/insurance/masshealth-

member-library/

Eligibility for MassHealth for Children and Adults

with Disabilities

Adults: (under age 65) MassHealth Standard • Receives SSI • Individual is permanently and totally disabled • Individuals meet the level of care criteria of a nursing

home or institutional care but are able to live at home CommonHealth • For working disabled. Payment depends on income

Children: ( Under age 19) MassHealth Standard: • Is determined by parent’s income CommonHealth: • Premium is charged based on family income.

Is a supplemental plan

Beware of Changes in MassHealth! • MassHealth must meet the goal of

reducing the trend of increased costs in

Medicaid in year 5 by 2.5% (quality,

avoidable use of expensive care, will also

be tracked)

• Starting March 1st, 2018 recipients must

choose an Accountable Care Organization

(ACO) ACOs are responsible for costs &

integrated care; develop approaches to

reduce unnecessary hospitalization and

emergency room care.

Medicaid & Managed Care

From Medicaid: “Currently, MassHealth pays providers on a fee-for-service basis for each visit, procedure, or test. This can result in uncoordinated care and high costs.”

Goal: a new managed care effort through major health care providers called Accountable Care Organizations (ACOs). Choices of MassHealth Insurance programs will be: ACOs, MCOs (existing managed care options) and Primary Care Clinician programs.

See pp 2-5 of MassHealth enrollment guide for more of an overview & detail on options explained here

MassHealth Choices

Two types of ACOs both dependent on your choice of primary care physician (PCP) –

• ACO Partnership plan- In this type of ACO, a group of PCPs work with just one managed care organization to create a full network

• Primary Care ACO –physicians group contracts with MassHealth, the full network is defined in conjunction with MassHealth and MCO

• Managed Care Organizations (MCO) – existing option which has a full network defined by region

• Primary Care Clinician (PCC) – which is fee for service, open network but you do more to coordinate care. MassHealth wants to move away from this option

Where to Find the MassHealth Brochure

• Posting of MassHealth Brochure explaining ACOs and program and MassHealth location of member information below…

• http://thearcofmass.org/resources/services/

• http://www.mass.gov/eohhs/consumer/insurance/masshealth-member-library/

Applying for MassHealth

Good Advice! Use a MassHealth Navigator

to assist you with your application!

• http://caringhealth.org/navigators.html

• http://www.masslegalservices.org/system/fi

les/library/List%20of%20Massachusetts%2

0Navigator%20Orgs%2011%2028%2014.p

df

• Autism Insurance Resource Center

Premium Assistance

• Reimburses you for your contribution of maintaining the MassHealth family member on their private insurance.

• Private insurance must meet basic benefit services

• Will cover cost of COBRA

• Reimbursement varies depending on type of coverage – ie Commonhealth. Range is $314-1314/year. Changes yearly

• You do not qualify if you have Medicare and Medicaid at the same time

• Apply after you become eligible for MassHealth

• Call Premium Assistance 800-862-4840

Massachusetts Rehabilitation Commission -MRC https://www.mass.gov/orgs/massachusetts-

rehabilitation-commission

3 Divisions:

• Vocational Rehabilitation : To provide vocational counseling and other support services to people with disabilities to assist them in obtaining or retaining employment.

• Community Living: Services to help support people to live independently. Independent Living Centers

• Disability Determination Services for SSI and SSDI

Vocational Rehab ( VR) Eligibility

• Have a physical or mental impairment that is a large barrier to employment

• You must want to work and need services to train, find, or keep a job.

• If you are unemployed or underemployed, you may benefit from vocational services.

• Live in Massachusetts • Be eligible to work in the United States • Meet income requirements for paid services • seLink for eligibility https://www.mass.gov/service-details/am-i-

eligible-for-vocational-rehabilitation

• limits your ability to get and keep a

Vocational Rehabilitation

Since every person has different goals and needs, you may need only

some of the VR services MRC provides. Many services are subject to

financial eligibility. VR services include: • Counseling and guidance

• Interest and aptitude testing

• Job placement assistance

• Job Coaching

• Diagnostic evaluations

• College or vocational training

• Benefits counseling

• Assistive and/or rehabilitation technology

• Transitional services for High School services

• Employer consultation

• Housing Modifications

• Vehicle Modification

• Communication access services (ASL interpreters, oral transliterators,

Communication Access Real-time Translation (CART)

Services for Transition Age Youth Federal Mandate- Work Innovation Opportunity Act ( WIOA) Increase opportunities for paid work experiences for students ages 16 until graduation or age 22. • Students must be eligible for MRC • MRC counselor in every High School See Link -

http://www.mass.gov/eohhs/docs/mrc/mrc-vr-high-school-coverage-report-fy17.pdf

• Attend IEP, career counseling /guidance/assessment • Pre-Employment Transition Services ( Pre- ETS): Offers paid internships through contracted provider agencies. Works on job readiness, resume building, interviewing, internships , work experiences • Can occur during school hours, after school, summers • https://www.mass.gov/service-details/mrc-services-for-students-

and-youth

Department of Developmental Services ( DDS) Doors to Eligibility

I/DD Autism

without

I/DD

https://www.mass.gov/orgs/departm

ent-of-developmental-services

DDS Services Provided to Adults with

Autism • Service Coordination

• Individual Supports-adult companion and individualized home supports

• Referral to Clinical Supports- ie. behavioral, psychiatric, ancillary services, assistive technology

• Community Based Day Supports and Employment Supports

• Family Support

• Stipend/Flexible Funding to purchase a variety of goods and services

• Autism coaching service statewide

• Respite care for family caregivers

DDS Family Support Services

For anyone who lives with a family. Services include: • Information and Referral

• Service Navigation

• Family Trainings

• Social /Recreational Activities

• Parent Networking

• Community Connections and Resources

• Family led events

• Directory of Services and Guide to Centers

https://www.mass.gov/lists/dds-family-support-services-information

Family Support Centers

Autism Support Centers

Cultural/Linguistic Family Support

Centers

Role of the Autism Service Coordinator

• Manages the budget allocations for individuals who are allocated funding from DDS

• Coordinates referrals to provider agencies and oversees services

• Encouraging self direction

• Attends IEP meetings and Transition meetings

• Leads ISP meetings and other Team meetings

How are Services Determined?

Level of Need • DDS currently using Supports Intensity Scale (SIS) : most likely used for prioritization in the future. http://www.mass.gov/eohhs/docs/dmr/reports/sis-flyer.pdf Available Funding • Align with Advocacy groups to secure adequate

funds in the budget!

Transportation

MassMobility

• Partnership between two state agencies:

– Executive Office of Health and Human Services and MassDOT

• Statewide initiative to increase mobility for people with disabilities, seniors, low-income commuters, veterans, and others who lack access to transportation

• www.mass.gov/orgs/massmobility

Available Resources

• Transit : www.tinyurl.com/HST-RTAs

• Ride Match is a searchable, online database

• Regional Elder Services: call 1-800-AGE-INFO for information on regional senior services

• MBTA Travel Training Program https://www.mbta.com/accessibility/travel-instruction-training

• Regional Planning Agencies serve each region

Housing

Thinking About Housing

• Letting Go

• Building Independence

• Importance of Planning

• Options

• Resources

Housing : How does this all get funded?

• State Dollars

• Mass Health

• SSI

• State and Federal Benefits- food stamps, section 8

• Special Needs Trusts

• Mom and Dad

• Your paycheck

Ways to Prepare

• Consider person centered planning • Know your negotiables and non-negotiables • Put your name on waiting lists and check back • Keep a notebook with important documents; ie

evaluations., medications, contact people, etc • Take advantage of online planning tools • Connect with other families and individuals • Meet with legal and financial personnel • Take advantage of navigators to assist you with

obtaining services