after we re gone part 2 where can we find support
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After We’re Gone: Part 2: Where Can We Find Support?

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After We’re Gone: Part 2: Where Can We Find Support?. Topics for Today. What publicly funded supports are available for my loved one who has a developmental disability or serious mental illness? Medicaid Mental Health Home Help Services. Topics for Today.

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topics for today
Topics for Today

What publicly funded supports are available for my loved one who has a developmental disability or serious mental illness?

  • Medicaid
  • Mental Health
  • Home Help Services
topics for today3
Topics for Today
  • MI-Choice Waiver (for people who are aging or have physical disabilities, need assistance and meet income requirements
  • Other Services for Individuals who are Aging
medicaid basics
Medicaid Basics
  • Needs-based health care program funded by both federal and state money
  • In general, to qualify for Medicaid, a person must
      • Be included in an eligibility category, such as being aged, blind, or disabled
      • Have income below a specified amount
      • Have assets below a specified amount
  • In Michigan, anyone who receives SSI (Supplemental Security Income) also qualifies for Medicaid – 35 other eligibility categories
medicaid basics5
Medicaid Basics
  • Pays for both medical care and long-term care
  • Medicaid is secondary payer to Medicare or third-party insurance
    • Medicaid is payer of last resort
    • Providers accept Medicaid as payment in full unless co-pays are required such as for prescriptions
  • In Michigan, many Medicaid beneficiaries are enrolled in a Health Plan for medical care
medicaid basics6
Medicaid Basics
  • If eligible for Medicaid, most Mental Health Services and Supports are funded by Medicaid
  • Medicaid pays for services that are medically necessary
    • A Medicaid card “entitles” a person to services that are medically necessary.
    • Medically necessary services that the person is entitled to are subject to Medicaid Fair Hearing.
michigan s public mental health system
Michigan’s Public Mental Health System
  • Background
  • Medicaid Basics
  • Eligibility
  • Access
  • How It Works
  • Covered Services
background
Background
  • Michigan has made changes to its Medicaid mental health services in order to:
    • Provide flexibility
    • Support individual choice
    • Promote independence
    • Build upon existing strengths of the individual, his or her network, and his or her community
    • Develop relationships and natural supports
background9
Background
  • This redesign intended the system to move the system toward:
    • Funding supports and services instead of programs or “bricks and mortar”
    • Ensuring a full array of options and opportunities for people
      • Example: supported employment so people can get jobs in integrated workplaces instead of being in places that only serve people with DD and pay nominal wages (if any)
      • Example: activities to promote growing and learning at home and in the community so people can interact with and develop relationships with other members of their communities
      • Example: living in own home or shared with roommates of the person’s choosing
medicaid basics10
Medicaid Basics
  • In Michigan, mental health Medicaid services are provided through a managed care system
  • Called the Managed Specialty Supports and Services Program and includes
    • Medicaid State Plan Services (also known as “b-waiver services)
    • 1915(b)(3) supports and services (also known as additional supports and services)
    • 1915(c) Waiver or Habilitation Supports Waiver (also known as HAB Waiver)
medicaid basics11
Medicaid Basics
  • The Managed Specialty Supports and Services Program is operated by 18 Prepaid Inpatient Health Plans (or PIHPs)
  • PIHPs are comprised of one Community Mental Health Services Program (CMHSP) or a group of CMHSPs called an affiliation
medicaid basics12
Medicaid Basics
  • Waivers waive certain requirements of Medicaid regulations.
  • Medicaid covered services are entitlements and therefore subject to the Fair Hearing Process when a beneficiary disputes an action that denies, reduces, suspends or terminates the service.
eligibility
Eligibility
  • For the Managed Specialty Supports and Services Program (or the “b-waiver”), a person must:
    • Be Medicaid eligible and enrolled
    • Have a serious mental illness or emotional disturbance, substance use disorder and/or developmental disability
    • No age restrictions
eligibility14
Eligibility
  • For the HAB Waiver, a person must:
    • Have a developmental disability – no age restriction
    • Reside in a community setting or will reside in a community setting when HAB waiver services are received
    • Be Medicaid eligible and enrolled
    • Otherwise need the level of services available in an institution
    • Receive at least one HAB waiver service per month once enrolled
access
Access

To access the Managed Specialty Supports and Services Program (b-waiver) or the HAB Waiver (c-waiver),

You can start with calling the local Community Mental Health Services Program (CMHSP) in your area to find out how to access mental health services in your area

access16
Access

Every PIHP must have a Customer Services Department that can assist with questions about how to request an intake assessment for services

If you are unsure or need help accessing mental health services, you can also contact your local advocate

how it works
How It Works
  • Once a determination is made by the PIHP that the person is eligible for services, a planning meeting is held to discuss strengths, needs, and personal goals the individual has.
  • The person may choose an Independent Facilitator to assist him or her in running the meeting and developing the plan. This was discussed in more detail in the first session of the series.
how it works18
How It Works
  • Michigan requires a person-centered planning approach (and for children and youth, planning also is family-focused and youth-driven)
  • Medically necessary supports and services are identified in the individual plan of service resulting from the process of person-centered planning
  • The plan must specify:
    • Amount (how much).
    • Duration (how long).
    • Scope (who, how and where).
    • Plans should also identify when services are to begin and end.
medical necessity
Medical Necessity

Includes Services and Supports that are designed to assist with attaining or maintaining sufficient function to achieve goals of community integration and participation, independence, productivity, or recovery

services
Services
  • Detailed services descriptions are found in the Medicaid Provider Manual

www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf

services 1915 b waiver
Services - 1915(b) Waiver
  • Includes 25 “covered” services which are the State Plan Services
  • See handout for list of services
1915 b 3 additional services
1915(b)(3) Additional Services
  • The intent is to fund supports that promote community inclusion and participation, independence and/or productivity
  • Michigan has defined 15 “(b)(3)” services available to persons with MI or DD
1915 b 3 additional services23
1915(b)(3) Additional Services
  • Community Inclusion & Participation
    • Uses community services and participates in community activities in the same manner as the typical community citizen
    • Examples of supports that could help with community inclusion and participation
      • Community Living Supports
        • Can assist someone in getting to and participating in regular community activities
      • Respite
        • Temporary relief for caregivers
      • Support and Service Coordination
        • Links individuals with community activities in which they wish to participate
1915 b 3 additional services24
1915(b)(3) Additional Services
  • Independence
    • What this means to someone needs to be discussed during the Person Centered Planning process
    • May mean different things for different people, for example
      • Living apart from mom and dad
      • Being able to take a bus to where they want to go
      • What to eat, when to get up, what to watch on television
      • Learning to do something instead of needing help
1915 b 3 additional services25
1915(b)(3) Additional Services
  • Independence
      • Examples of supports that could help with independence:
      • Assistive Technology.
        • Vehicle adaptations, Lifeline, communication devices, etc.
      • Community Living Supports.
        • Assistance and training in areas of life activities
      • Environmental Modifications.
        • Adaptations to the home to increase independence.
      • Housing Assistance.
        • Short term, interim or one-time expenses.
1915 b 3 additional services26
1915(b)(3) Additional Services
  • Independence
      • More examples of supports that could help with independence:
      • Skill-Building Assistance.
        • Learning skills needed to get a job or to engage in meaningful activities such as school and/or volunteering.
      • Supported/Integrated Employment Services.
        • Job development, job placement, job coaching etc.
      • Fiscal Intermediary Services.
        • Helps to manage budget, conform with IRS requirements for hiring staff, etc.
1915 b 3 additional services27
1915(b)(3) Additional Services
  • Productivity.
    • Activities that lead to maintenance of or increase in self-sufficiency, typically work or school. Examples might include:
      • Skill-Building Assistance.
        • Learning skills needed to get a job or to engage in meaningful activities such as school and/or volunteering.
      • Supported/Integrated Employment Services.
        • Job development, job placement, job coaching etc.
      • Assistive Technology.
        • Devices or equipment not covered by Michigan Rehabilitation Services or school that is necessary for productivity
hab waiver services
HAB Waiver Services
  • The Habilitation Supports Waiver
    • See handout for the list of 13 services
    • Restricts eligibility to certain target populations – only people with developmental disabilities
    • Enables people who would otherwise need institutional level of care to choose community alternatives
so what s the difference
So, What’s the Difference?
  • The 1915(b) waiver serves people with mental illness, children with serious emotional disturbances, people with substance use disorders, as well as people with developmental disabilities.
  • 1915(b) eligibility requirements are not as stringent, services are more flexible.
  • Private duty nursing and Goods & Services are not available in the 1915(b) waiver. It is offered under the 1915(c) HAB waiver.
recap
Recap
  • Michigan has a managed care system for delivering mental health services to people with Medicaid who meet eligibility
  • Access is through the PIHP or the CMHSP
  • The person-centered planning process is used to learn what the person wants and needs to develop the individual plan of services
  • The individual plan of services specifies the services to be provided and the amount, scope, and duration
slide31

Home Help Services

The Medicaid State Plan service for personal care in a home setting.

slide32

Who is eligible for Home Help services ?

People who need for help with activities of daily living (ADL)‏

and or instrumental activities of daily living (IADL)‏

Medicaid eligible

Medical need identified on DHS medical needs form (DHS 54A)‏

and signed by a Medicaid enrolled professional (Physician,

Nurse Practitioner, Occupational Therapist, or Physical Therapist)‏

Access: Request Home Help Services through Department of Human

Services either by telephone or mail or in-person.

See handout for more details

slide33

Services Covered by the

Home Help Program

Activities of Daily Living (ADL)‏

Eating

Toileting

Bathing

Grooming

Dressing

Mobility

Transferring

Instrumental Activities of Daily Living (IADL)

Medication

Meal Preparation

Shopping

Laundry

Housework

All ADL and IADL services must be hands on care

Supervision is not a covered service

home help and community living supports
Home Help and Community Living Supports
  • People living in their own homes or with family (not in a licensed group home) may be eligible for both Home Help (HHS) and Community Living Supports (CLS)
  • HHS provides hands-on assistance while CLS generally provides training, cueing, guidance, and supervision.
home help and community living supports35
Home Help and Community Living Supports
  • CLS cannot supplant HHS because it is a state plan service.
    • the person must apply for HHS if he or she may be eligible
    • The person cannot decide to skip applying for HHS through DHS and ask for CLS instead
home help and community living supports36
Home Help and Community Living Supports
  • CLS can compliment HHS
    • The person is authorized for a monthly amount of HHS, but needs more and appeals – CLS can be used for those hours until the Medicaid fair hearing is completed
    • The maximum amount of HHS still does not meet the person’s needs for hands-on assistance – CLS can be used for the additional hours
    • The person has hands-on care needs (HHS) and training or supervision needs (CLS)
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