Transcript Navigating the New System …Community Care Waiver, Waiting List Changes, and

Navigating the New
System
…Community Care Waiver,
Waiting List Changes, and
Individualized Budgets
Overview of Presentation
Who we are
 Three things you will know after
tonight:

• What Medicaid is
• What the Community Care Waiver is
• How to get services
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
What is Medicaid?
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Government funded health insurance
program for low income children and
families, and adults who are aged, blind or
disabled
Pays for doctor visits, prescription drug
coverage, other medical services
Covers services other insurance often
doesn’t: personal care, and long term
services & supports
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
What is the Community Care
Waiver…
Funding mechanism for services
 Funds services in group homes, day
programs, in-home supports
 Federal government contributes to
the cost of services
 When services are not covered under
waiver, the state pays the entire cost

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The Arc of New Jersey &
NJDHS-DDD
…and Why is it Important?
It allows people to receive services in
the community rather than in an
institution
 It offers a wider variety/range of
services & supports
 Because of the federal funds, it has
potential to provide more money so
the State can serve more people

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The Arc of New Jersey &
NJDHS-DDD
…and Why is it Important?
And, it is the only way to access long
term supports and ensure that your
son/daughter will be properly
supported throughout his/her
lifetime
 Extensive waiting list

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The Arc of New Jersey &
NJDHS-DDD
How Do You Get Services?
Become DDD eligible
 Get on the Waiver Waiting List
 While you are waiting, you may be
eligible for non-waiver-funded
services

• Contact your DDD case manager to find
out what services you can get while
waiting for a waiver “slot”
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The Arc of New Jersey &
NJDHS-DDD
Overview of New System &
Changes that are Coming

The only REAL/practical differences
are:
• The vocabulary
• What you get when you reach the top of
the waiting list
• You will have more choices in terms of
what services you can get and from
whom
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
New System

Self-direction Option
• Based more on in-home supports
• Funding flows from DDD through Fiscal
Intermediary
• Waiting list for “waiver slot”
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The Arc of New Jersey &
NJDHS-DDD
New System

Provider-Managed Option
• Individual chooses a provider agency
• Payment made directly to provider
• Waiting list for “waiver slot”
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
What We Know for Sure
National Trend
 DDD has stated that this change is
already being implemented
 Self advocates & families will need a
new set of skills & new vocabulary

2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
How does the Waiver System
Work?

Determination of eligibility for waiver
services
• Waiting list criteria
• Reserve capacity within the waiver
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Assessment
Individual Budget – Decision to self-direct
or not
Plan Development
If not eligible, then look at non-waiver &
waiver services funded with state dollars
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The Arc of New Jersey &
NJDHS-DDD
What does “Self-Direct” Mean?
Support Coordinator assigned
 How do I find service providers?
 Who checks to see if services are
being delivered?
 How does the money get paid to the
provider? How much? Can I
negotiate?
 What if my needs change?

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The Arc of New Jersey &
NJDHS-DDD
Waiver Waiting List
All move to waiver waiting list if not
currently enrolled on waiver
 When your name comes up on list,
you will receive services you need at
that time, and be removed from list
 If needs change, the changes will be
accommodated

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The Arc of New Jersey &
NJDHS-DDD
How Waiting List Will Work
Name comes up
On
Priority Waiting List
Enrolled on
Waiver; name
Removed from
WL
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Not eligible for
waiver; name removed from WL;
Services
provided with state
$$
The Arc of New Jersey &
NJDHS-DDD
Refuses enrollment;
name removed from
WL; some services
provided with
Reduced State $$
Changes in Need
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If needs change, an
updated plan is
completed
Services change to fit
the need
Waiver eligibility is
preserved regardless
of residence
Waiver is portable
The Arc of New Jersey &
NJDHS-DDD
Review of Covered Services in
CCW
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Case Management
Day Habilitation
Individual Supports
Respite
Supported Employment
Community Transition Services
Support Coordination
Assistive Technology Devices
Environmental and Vehicle Adaptations
Personal Emergency Response System (PERS)
Transportation
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The Arc of New Jersey &
NJDHS-DDD
Non-Medicaid Funded Services
Family Support
 Residential (room & board) after
contribution to care received
 Start-up costs for residential
placements, other than Transition
services
 Discussion of what should be covered
by state-only funds

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The Arc of New Jersey &
NJDHS-DDD
Questions
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The Arc of New Jersey &
NJDHS-DDD
Contact
Start with your Case Manager
 Contact me by email, if possible:

• [email protected]
• 609-631-6502
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The Arc of New Jersey &
NJDHS-DDD
Medicaid 101

What is Medicaid?
• Medical assistance to individuals who
are aged, blind or disabled and TANF
• Income test
• Resource test
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The Arc of New Jersey &
NJDHS-DDD
Medicaid 101

Services covered under Medicaid
• Mandatory services

E.g., physician, hospitalization, pharmacy
• Optional services
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E.g., therapy, private duty nursing
• Each state determines scope, duration,
and amount
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Waiver 101… or
Why Have a Waiver?
• Institutional eligibility vs. in-home
eligibility for Medicaid
• Non-traditional services needed
• Amendment to the Social Security Act in
1981
• Created 1915 (c) option for states
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The Arc of New Jersey &
NJDHS-DDD
Waiver 101

Home and Community
Based Services
• Allows state to limit
number of individuals
enrolled
• Allows state to refuse
enrollment if individual
cost is higher than
institutional
• Standards for providers
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Additional
“waivers”
requested:
• Statewideness
• Amount, duration
and scope
• Comparability
• Institutional income
The Arc of New Jersey &
NJDHS-DDD
Waiver 101

Eligibility
•
•
•
•
•
State specific
Income
Resources
Level of care
Service need
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The Arc of New Jersey &
NJDHS-DDD
CMS Oversight
Level of Care
 Services
 Plan
 Qualified Providers
 Financial Accountability
 Administrative Oversight by Medicaid
Agency
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The Arc of New Jersey &
NJDHS-DDD
New Jersey Waivers
AIDS Community Care Alternatives
Program (ACCAP)
 Community Resources for People
with Disabilities (CRPD)
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• combined three model waivers
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Acquired Traumatic Brain Injuries
(TBI)
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The Arc of New Jersey &
NJDHS-DDD
New Jersey Waivers

Global Options (GO) –
combined Community Care Program for the
Elderly and Disabled (CCPED) and Enhanced
Community Options (ECO)

Community Care Waiver (CCW)
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The Arc of New Jersey &
NJDHS-DDD
Community
Care Waiver
Nationally, the second waiver
approved by federal government
 Refinanced group home services
 Model used by many other states
 Changes needed to update model
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The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW
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Philosophical
Changes
Changed Services
New Services
Deleted Services
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW
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Services where
you live
•
•
•
•
With family
Apartment
Supportive living
Group home
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW

Self-direction
• added as option (includes Real Life
Choices, Self-Determination, and
Olmstead individuals who self-direct,
and individuals served from Waiting
List)
• Provider directed model still available
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Essential Life Plan
• added as alternate plan of care for
individuals who self-direct or have an
individual budget
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The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW
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Regional Monitor for Individuals who
Self-direct (new administrative service)
• Assures that the following is completed:
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Assessment for waiver eligibility
Level of care
Assignment of budget amount
Review & approve service plan
Assure health & safety factors considered
Approves expenditures
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW

Retainer days paid for absences from day
program and residential supports
• “Therapeutic” days
• Hospital days & related stays in other
facilities
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
New Service

Support Coordination
• For persons who self-direct
• Connects people to services
• Providers of Support Coordination are
employed by agencies other than the
Division
• Conflict of Interest provision
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The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW
New individuals enrolled on waiver
are assigned funding maximum
based on the Developmental
Disability Review Tool (DDRT)
 Remove Psychiatry & ITN as a
covered service
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The Arc of New Jersey &
NJDHS-DDD
New Services

Transition Services
• For people being discharged from
institutional settings
• Must be entering a non group home
setting
• Pays for deposits, furniture, one time
services (cleaning, extermination, etc.),
moving
• Up to 180 days prior to move
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The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW
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Respite changes
• Clarify respite payment cannot be
made to relative who lives with
individual
• Expands eligible providers
Camp (no out of state)
 ICF/MR
 Group respite at no more than 1:4 ratio
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2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW

Day Habilitation
• Changed name
• Added hourly units (no more than
25/wk)
• Distance between individual’s residence
& day habilitation site is not greater
than 38 miles
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW

Individual Supports
• Added hourly units (ratio cannot exceed
1:4)
• Requires drug & alcohol testing &
orientation training
• Permits family member residing in home to
provide services for a limited period (no
more than 40 hours per week for no more
than 30 days annually) during transition of
staff
2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD
Revisions to CCW

Environmental/Vehicle Modification
• Total expenditure of $11,000 every
three years in conjunction with
Assistive Technology Devices (new
service)
 Transportation (new service)
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2009 - Rev 8/24/09
The Arc of New Jersey &
NJDHS-DDD