Working to Create “A Life Like Yours”
(ALLY)
Home and Community Based
Medicaid Waivers
The Arc of Northern Virginia:
Who we are and What we do
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History
Advocacy
Education
Information and Referral
DD Waiver Case Management
Guardianship
Pooled Special Needs Trusts
Outline
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Purpose and Description of Medicaid
Waivers
Eligibility Criteria
Waiver Services Definitions
Waiver Services for each Waiver
Screening Process/Summary & Criteria
Other Steps
Purpose of the Waivers
Waivers give States the flexibility to
offer services to an individual in the
community rather than living and
receiving services in an institution.
What is a Medicaid Waiver?
Medicaid: Medicaid is what pays for
the services you can receive from a
Medicaid Waiver
Waiver: Waiving the choice of
institutional placement and choosing to
accept services in the community
Six Waivers in Virginia
Elderly or Disabled with Consumer Direction
Waiver (EDCD)- now include the HIV/AIDS
Waiver
 Individual and Families with Developmental
Disabilities Waiver (DD Waiver)
 Intellectual Disability/formerly Mental
Retardation Waiver (ID/MR Waiver)
 Day Support Waiver
 Technology Assisted Waiver (Tech)
 Alzheimer’s Assisted Living Waiver (AAL
Waiver)
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Three Criteria to
Determine Eligibility
1) Financial Eligibility Criteria
2) Diagnostic Criteria
3) Functional Criteria
Financial Eligibility for State Plan
Medicaid
Categorical Criteria
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Disabled or age 65 or older
Families with children
Pregnant women
Recipients of cash assistance
Low income Medicare beneficiaries
Financial Thresholds
Low income and asset guidelines (up to 80%) of Federal
Poverty Level
• Thresholds vary by category group
• Consideration of exceptionally high medical bills (spenddown)
• Parental income/resources DO count for minor
children
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Financial Eligibility for Medicaid Long
Term Care (Waivers and Institutions)
Categorical Criteria
Must Need Long-term Care
Criteria defined for each Waiver
Assessment of need required
Financial Thresholds
$2130 per month (gross income)
Spend-down for 4 of the Waivers
$2000 resource limit
Parent income/resources do NOT count regardless of
child’s age
Financial Eligibility
If someone has applied for the
Waiver, does this mean they have
applied for Medicaid?
No!
These are two separate process!
To apply for Medicaid, contact the local Department of Social
Services!
Financial Eligibility
The household income is too high
to qualify for Medicaid, should the
individual still apply for a waiver?
Yes!
You CAN be on the waiting lists without receiving Medicaid
benefits. Once a slot becomes available, you can apply for
Medicaid under the “Long Term Care/Institutional Rules”.
And remember, different rules apply when it is State Plan
Medicaid versus “long term care” Medicaid!
Explore a Special Needs Trust
Like The Arc of Northern VA’s Pooled Trust
A SNT is a legal document designed to:
Provide benefit to & protect the assets of a person with a disability
while allowing the individual to be qualified for and receive
government benefits, such as Medicaid, Medicaid Waivers and
Supplemental Security Income.
For more information, contact:
Tia Marsili, Director of Trusts
tmarsili@thearcofnova.org
(703) 532-3214 x115
www.thearcofnovatrust.com
Diagnostic Eligibility
EDCD Waiver
 Individuals who have significant medical needs. The criteria used to
determine eligibility is the nursing home criteria.
Day Support Waiver
 Individuals with ID/MR who have been determined to meet two of
the Level of Functioning Criteria.
Technology Assisted Waiver
 Individuals who require ongoing skilled nursing care.
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Individuals 21 and older who are dependent at least part of each
day on a mechanical ventilator or meet complex tracheotomy
criteria.
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Individuals under the age of 21 who meet certain criteria based on
various methods of respiratory or nutritional support
Diagnostic Eligibility
ID Waiver
Must have a diagnosis of ID or be under the age of 6 and at
developmental risk
 Children on the ID Waiver who do not have a diagnosis of
ID/MR at the age of 6, possible transfer to DD Waiver
 IQ Score (70 or below) and psychological testing is required!
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DD Waiver
Must be 5 years and 9 months of age and have a
developmental disability or “related condition” to apply
 Cannot have a diagnosis of an intellectual disability
 IQ Score (71 or above) and psychological testing is required!
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Functional Criteria
ID, DD, and Day Support Waivers:
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All individuals must meet the Intermediate Care FacilityIntellectual Disability (ICF-ID) level of care. This is
established by meeting the indicated dependency level in two
or more of the categories on the Level of Functioning Survey.
- Categories include: Health Status, Communication, Task Learning Skills,
Personal/Self Care, Mobility, Behavior, and Community Living Skills.
- View the LOF Survey online:
http://www.dbhds.virginia.gov/documents/forms/1157eMRwaiver.pdf
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EDCD, Alzheimer’s, and Technology Waivers:
Individuals must meet the nursing facility eligibility criteria
determined by using the Universal Assessment Instrument
(UAI)
- Assesses social, physical health and functional abilities
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Waiver Services Definitions
Personal / Attendant Care
 Respite Care
 Companion Care
 Day Support
 In Home Residential
 Assistive Technology
 Environmental Modifications
 Personal Emergency Response
 Transition Services
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Waiver Services Definitions
Options of Care
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Agency Directed
◦ Care that is rendered by a Medicaid approved agency
◦ The agency hires and manages and pays the workers
◦ The agency submits the paperwork necessary for payment to
DMAS
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Consumer Directed
◦ Workers are directly hired and managed by the individual
receiving the DD Waiver support services
◦ The individual, or their family if the client is a child or is
unable to manage the task, is responsible for managing all
aspects of the employment relationship, including recruiting,
hiring, training, supervising, ensuring payment through DMAS,
and firing if needed
◦ There is a service facilitator to assist you with this process
Waiver Services
Offered by the EDCD Waiver
No Case Management Service
DMAS Contracted Providers including institution, facility,
agency, partnership, corporation, or association
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Personal Care Aide Services
Adult Day Health Care
Respite Care
Personal Emergency Response System (PERS)
Medication Monitoring
Consumer-Directed Services
Transition Services
Waiver Services
Offered by the Tech Waiver
Case Managed by DMAS
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Personal care (Adults Only)
Private duty nursing
Respite care
Environmental Modifications
Assistive Technology
Personal Emergency Response System
Waiver Services
Offered by the Day Support Waiver
Case Management by the Local CSBs
• Day support services
• Prevocational services
• Supportive Employment
Waiver Services
Offered by the ID Waiver
Support Coordination provided by local CSB
 Day support
 Supported employment
 Personal or Attendant Care
 Respite care
 In-Home Residential Support
 Adult Companion Care
 Assistive technology
 Environmental modifications
 Therapeutic consultations
 Personal Emergency Response System (PERS)
 Transition Services (from institution to community via Money Follows
the Person Program)
In addition to these the ID Waiver also offers
 Residential support (group home, sponsored
placement, 24 hour-care)
Waiver Services
Offered by the DD Waiver
Case Managed by Private Non-Profit Organizations contracted with
DMAS, such as The Arc of Northern Virginia
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Supported employment
Day Support
Personal or Attendant Care
Respite care
In-Home Residential Support
Adult Companion Care
Assistive technology
Environmental modifications
Therapeutic consultations
Personal Emergency Response System (PERS)
Transition coordination from an institution to the community
Screening Processes
EDCD Waiver
EDCD Waiver
Call your local Department of Health or Department of Social Services
for intake
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Alexandria (703-746-5700), Arlington (703-228-1350), Fairfax (703-324-7500)
Set up Screening and intake appointment with Social Worker
Schedule visit with the nurse
Meet with local County case worker
Meet with Home Health Care Agency or Service Facilitator
Waiting List
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None – just the process of intake
Screening Processes
Technology Assisted Waiver
Technology Assisted Waiver
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DMAS conducts the screenings for individuals under the age
of 21 who request Tech Waiver services
Call 804-786-1465 or local Health Department or Department
of Social Services
If hospitalized, the hospital social worker or discharge planner
can assist in coordinating a screening with DMAS
Waiting List
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None – just the process of intake
Screening Processes
Day Support Waiver
Steps:
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Contact the local CSB for Screening information
Waiting List
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Limited number of slots (300)
First come, first serve
Allocated by state office of ID Services
Screening Processes
ID Waiver
Screenings are conducted by the local CSBs
Arlington:
703-228-1700
Alexandria:
703-746-3400
Fairfax:
703-324-4400 (refer to ID Services)
Steps:
1) Call your local CSB to complete a screening process
2) Complete application they send to you
3) Make and attend intake process at the CSB
Waiting List
ID Waiver Urgent Criteria
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Primary Caregiver (s) is/are 55 years or older.
Living with a primary caregiver who is providing the service voluntarily
and without pay and they can’t continue care.
There is a clear risk of abuse, neglect or exploitation.
Primary caregiver has chronic or long term physical or psychiatric
condition significantly limiting ability to provide care.
Individual is aging out of a publicly funded residential placement or
otherwise becoming homeless.
Individual lives with the primary caregiver and there is a risk to the
health or safety of the individual, primary caregiver, or other individual
living in the home because individual’s behavior presents a risk to
himself or others
OR
Physical care or medical needs cannot be managed by the primary
caregiver even with generic or specialized support arranged by the
CSB.
Recap of ID Waiver
ID Waiver:
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In Virginia the ID Waiver waiting list is
served based on need and region population
Approximately 9,457 people have ID
Waivers.
Approximately 6,529 people are on the
waiting lists.
Over 3,762 of those are on the urgent care
waiting list
The waiting list grows at a rate of one
person per day
Numbers as of 10/01/13
Screening Processes
DD Waiver
Steps:
1) Complete the Screening Request Form
Available on http://dmasva.dmas.virginia.gov/ or www.thearcofnova.org
Send form to Regional Child Development Center:
Alexandria - Veronica Aberle, Health Center - P: (703) 838-4300 F: (703) 746-4938
Arlington - Margaret Jones, Arlington HS P: (703) 228-1640 F: (703) 228-1126
Fairfax - Terri Morris, Fairfax Co. Health Dept P: (703) 246-8628 F: (703) 385-3681
2) Have an appointment with local Child Developmental Center (CDC) for Screening
3) Receive letter from CDC stating eligibility
4) Choose a Case Management Agency
5) Complete Plan of Care with Case Manager
***You are NOT on the waiting list until your screening and Plan of Care are completed!
Waiting List
DD Waiver:
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The DD Waiver waiting list is served on
a first come, first serve basis.
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948 people have DD Waivers
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1,295 people are on the waiting list
Numbers from DMAS as of 08/13
Medicaid Waiver Services
(Source: VA Department of Medical Assistance Services 8/13)
Slot/Wait List
Summary
EDCD
ID
DD
TECH
DAY
SUPPORT
ALZ
Approved
Slots
33,507
9,457
948
513
300
200
Current
Enrollment
26,010
9,302
888
340
245
38
6,488
1,295
Current Wait
List
While on the waiting list what
else can you do?
Depending on level of need and eligibility criteria, you can apply for other
waivers:
◦ You can NOT be on both the ID Waiver List and the DD Waiver List.
◦ You CAN be on either the ID Waiver list OR the DD Waiver list AND
Receive or be on the list for the Elderly or Disabled with Consumer
Directed Services Waiver (EDCD), Day Support or the Technology
Waivers.
Call your county for case management and other locally funded services or
resources that may be available to you.
Utilize the Individuals and Families Support Program Funding
 Up to $3,000 per year for supports to serve you in the community
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Read more at http://www.dbhds.virginia.gov/ODS-default.htm
 Available September 3, 2013 and subsequently on July 1 each year
Access START Crisis Services- 24 hour crisis response and respite for people
with ID/DD and behavioral or mental health needs who are over 18 years
old
 885-89-START
Become a Member of
The Arc of Northern Virginia!
Follow our lead in advocating for the needs
of your loved one.
www.thearcofnova.org
Sign up for our newsletter!
Where Do I Go For More Information?
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All Waivers:
Virginia Medicaid Waiver Technical Assistance Center
866-323-1088 (toll free)
1-804-786-1465
http://dmasva.dmas.virginia.gov
ID Waiver:
http://www.dbhds.virginia.gov/ODS-MRWaiver.htm
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UAI Manual (Universal Assessment Instrument):
http://www.dmas.virginia.gov/Content_atchs/ltc/ltc-uai_umnl.pdf
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Local Community Services Board
Arlington:
703-228-1700
Alexandria:
703-746-3400
Fairfax:
703-324-4400
Thank you!
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The Arc of Northern Virginia
2755 Hartland Road
Falls Church, VA 22043
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Lisa.Fong@TheArcofNova.org
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703-532-3214 Ext 108
www.thearcofnova.org
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