the waiver your questions--- almost answered!. the waiver what’s going on in nj and pa? your...
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The WaiverYour questions---almost answered!
The Waiver
What’s going on in NJ and PA?
Your questions---almost answered
Entitlement First
Under the Social Security Act, if you meet the requirements for institutionalized care, you are entitled to that service.
Parental income is not considered Medical care, nursing, therapy, staffing, recreation are
covered expenses. Segregated, congregate settings Freedom restricted
What is a Waiver?
You are “waiving” your entitlement to institutionalized care.You want services and supports in the community.
It has aliases! HCBS Medicaid Home and Community Based Waiver
Program
It’s funding depends on the state Federal and State match NJ’s ratio is?????federal to % state monies
Omnibus Budget Reconciliation Act of 1981Medicaid Home and Community-Based Services (HCBS) waiver program signed by President Reagan on August 13, 1981.For the first time, states can use long-term care money available through Medicaid to pay for home and community based services instead of nursing homes and institutional care.
State HCBS Waiver programs must:
45%state55% federal (2011)
Don’t underestimate your power!
Katie Beckett ‘s parents advocated for a change in federal rules and in 1981, Congress created the Katie Beckett Waiver.
“
Goal For people to live in their own communities with family and
friends and given appropriate supportsFocus
Habilitation, not Rehabilitation
REHABILITATION VS HABILITATIONREHABILITATION HABILIATION
REGAIN RELEARN
ACQUIRERETAIN
IMPROVE
FOCUSSelf-help, Socialization and Adaptive skills necessary to reside successfully in home
and community based setting
Waivers are dependent upon States willingnessStates can offer a variety of services under a State Plan
and Home and Community-Based Services (HCBS) benefit.
People must meet State-defined criteria: specific needs risk conditionhttp://www.socialsecurity.gov/OP_Home/ssact/title19/1902.htm
State’s FlexibilityWhat’s Covered?States can offer a variety of unlimited services under an HCBS Waiver program. a combination of standard medical services and non-medical services.not limited to:
case management (i.e. supports and service coordination), homemaker, home health aide, personal care, adult day health
services, habilitation (both day and residential), and respite care.
States can also propose “other” types of services that may assist in diverting and/or transitioning individuals from institutional settings into their homes and community.
Service Community Care Waiver Comprehensive Care Waiver (Supports Program)
Assistive Technology
Behavioral Management
Career Planning
Case Management
Community TransitionServices
Day Habilitation
Environmental Mod
Individual Supports
Occupational Therapy
Service Community Care Waiver(BIG)
Comprehensive Care Waiver (Supports Program)
Personal Emergency Response System (PERS)
Physical Therapy
Prevocational Training
Respite
Speech, Language/Hearing Therapy
Support Coordination
Supported Employment (Individual Support((Small Group Support)
TransportationVehicle Modification
Service Community Care Waiver(BIG)
Comprehensive Care Waiver (Supports Program)
Cognitive Rehabilitation
Community Based SupportsCommunity InclusionServices
Financial Management Services (Fiscal Intermediary)
Good and Services
Interpreter Services
Natural Supports Training
Supports Brokerage
PA Services
Home and Community Services:Home and Community HabilitationLicensed Day HabilitationPrevocational ServicesResidential HabilitationTransitional Work Services
Specialized Therapies and Related Clinical Services:Physical TherapyOccupational TherapySpeech and Language TherapyVisual and Mobility TherapyBehavioral TherapyNursing Services
Employment Services (Competitive Employment)Job FindingJob Support
Transportation ServicesVendor ServicesBase Funded Services (FSS)
Respite Other Community ServicesHomemaker/Chore
Supports Coordination Financial Management
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