A Waiver for Children with a Serious Emotional Disturbance (SEDW) - PowerPoint PPT Presentation

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A Waiver for Children with a Serious Emotional Disturbance (SEDW). A collaborative effort to achieve better outcomes for children with serious emotional disturbance September 9, 2009. Welcome & Introductions. Presenters. Connie Conklin, MDCH Joan Deschamps, MDCH Debbie Milhouse-Slaine, MDCH

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A Waiver for Children with a Serious Emotional Disturbance (SEDW)

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A Waiver for Children with a Serious Emotional Disturbance(SEDW)

A collaborative effort to achieve better outcomes for children with serious emotional disturbance

September 9, 2009

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Welcome & Introductions

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  • Connie Conklin, MDCH

  • Joan Deschamps, MDCH

  • Debbie Milhouse-Slaine, MDCH

  • Andy Thalhammer, MDHS

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Today’s Presentation

  • Overview the SEDW

    • Eligibility requirements

    • Services

  • Currently participating sites

  • Wraparound

  • Funding

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History of 1915 (c) Waivers

  • Legislation

    • Enacted under the Reagan administration

    • Title XIX of the Social Security Act

  • Michigan DCH’s (c) and (b)(c) Waivers

    • Waiver for children with a serious emotional disturbance

    • Children’s Waiver Program

    • Habilitation Supports Waiver

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  • The SEDW is a 1915 (c) waiver that:

    • Is separate from the Mental Health 1915 (b) (c) Medicaid managed care waiver for specialty mental health services and supports, using a capitation payment system

    • Is billed “fee for service”, and

    • Provides enhancements or additions to Medicaid State Plan mental health coverage

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  • Currently approved through Sept. 2013

  • Administered by the DCH and managed by CMHSPs

  • Provide in-home services and supports to children with serious emotional disturbance and their families

  • Available in enrolled counties only

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Purpose of 1915 (c) Waiver

  • Provide Medicaid coverage to children who:

    • Without the provisions of this waiver would require hospitalization or institutionalization

    • Would otherwise not be Medicaid eligible while residing with their birth or adoptive families

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  • The waiver provides:

    • Services that are enhancements or additions to Medicaid State Plan coverage

    • Federal match funds to support collaborative service delivery in a child’s community

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SEDW Eligibility Criteria

  • The child must:

    • Be under the age of 18,

    • Reside with his/her birth/adoptive parents(s), a relative who is the child’s legal guardian, or in foster care with a permanency plan.

    • Have a primary DSM Axis I mental health diagnosis,

    • Be in need of and receive at least one Waiver service per month

    • MeetCMHSP contract criteria for and is at risk of inpatient hospitalization in the state psychiatric hospital

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Inpatient Admission Criteria: Children Through Age 21

“Inpatient psychiatric care may be used to treat a child or adolescent with mental illness or serious emotional disturbance who requires care in a 24-hour medically structured and supervised facility. The SI/IS criteria for admission are based on the assumption that the beneficiary is displaying signs and symptoms of a serious psychiatric disorder, demonstrating functional impairments and manifesting a level of clinical instability (risk) that are, either individually or collectively, of such severity that treatment in an alternative setting would be unsafe or ineffective.”

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Eligibility Criteria…continued

  • The child must have at least one of the following:

    • Severe psychiatric signs and symptoms

    • Disruptions of self-care and independent functioning

    • Harm to self or others

    • Drug/Medication complications or co-existing general mental condition requiring care

    • Special consideration: If Substance Abuse Psychiatric condition must be primary

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Eligible Criteria … continued

  • The Child must demonstrate serious functional limitations that impair his/her ability to function in the community (functional criteria is identified using the Child and Adolescent Functional Assessment Scale [CAFAS])

    • CAFAS score of 90 or greater for children age 12 or younger; or

    • CAFAS score of 120 or greater for children age 13 to 18.

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Financial Eligibility

  • The Child must meet Medicaid eligibility criteria

    • Note: If a child is not Medicaid eligible while residing with his/her family and determined clinically eligible for the SEDW, the child can be viewed as a “family of one” to meet financial eligibility for Medicaid.

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Covered Waiver Services

  • Wraparound Services

  • Community Living Supports

  • Family Training

  • Family Training & Support (family support partners)

  • Respite Care

  • Therapeutic Activities (art, music, rec)

  • Therapeutic Child Foster Care

  • Therapeutic Overnight Camp

  • Transitional Services

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OtherCovered Services

  • Mental Health State Plan services that can be billed to Medicaid on a fee for service basis by the CMHSPs

  • Natural supports

  • In-kind services provided by community agencies

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Skill development activities of daily living Skills, such as:

Personal hygiene

Household chores

School attendance

Staff assistance, support and/or training with:

socialization skills,

interactions, and

internal controls

Community Living Services (CLS)

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Family Home Care Training

  • Training and counseling services provided by professional staff for the families of individuals served on the waiver.

    • Instruction about treatment interventions and support intervention

    • Counseling service for family members

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Family Support & Training (FS&T)

  • FS&T, provided by a parent support partner, which supports parents/families of children with SED to:

    • Be empowered,

    • Be confident, and

    • Have skills that will enable them to assist their child to improve in functioning.

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Respite Care

  • Respite care is a service provided to individuals unable to care for themselves that are furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care.

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Therapeutic Activities

  • The focus of therapeutic activities is to interact with the child to accomplish the goals identified in the POS.

  • Service Activities include:

    • Music Therapy,

    • Recreation Therapy, and

    • Art Therapy.

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Child Therapeutic Foster Care

  • Provides an intensive therapeutic living environment for a child with challenging behaviors. Important components of CTFC include:

    • Intensive parental supervision

    • Positive adult-youth relationships

    • Reduced contact with other children with behavioral disorders

    • Family behavior management skills

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Therapeutic Overnight Camp

  • A group recreational and skill building service in a camp setting aimed at meeting goals detailed in the child’s plan of service. A session can be one or more days and nights of camp.

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Transition Services

  • This is a one-time-only expense to assist a child returning to the family home and community while the family is in the process of securing other benefits (e.g. SSI) or resources (e.g., governmental rental assistance and/or home ownership programs) that may be available to assume these obligations and provide needed assistance.

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  • Wraparound Service Facilitation and Coordination for Children and Adolescents is:

    • a highly individualized planning process

    • performed by specialized wraparound facilitators

    • coordinate the planning for, and delivery of, services and supports for the identified child

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Currently participating

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Participating CMH/Counties

  • CMH for Central Michigan (Isabella and Midland)

  • CMH Authority of Clinton-Eaton-Ingham Counties (Ingham)

  • Kalamazoo CMH Services

  • Livingston County CMH Authority

  • Macomb County CMH Services

  • Northern Lakes CMH Authority (Grand Traverse/Leelanau)

  • Saginaw County CMH Authority

  • Van Buren Community Mental Health Authority

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Ages Of Children Served By SEDW

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Desired Outcomes

  • Children are able to reside in the community with their families

  • Children have improved functioning across life domains

  • Maximized fiscal efficiencies across service systems

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Systems Outcomes: Maximizing Fiscal Efficiencies

  • Identify and implement cost-effective opportunities to increase access to mental health services for children with SEDW

  • Maximize federal match dollars with local General Funds

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Systems Outcomes: Maximizing Fiscal Efficiencies

  • Reduce impediments to improve local collaboration by:

    • Implementing a system of care

    • Streamline service opportunities

    • Use of braided funding

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Falling Through the Cracks






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How does Wraparound Fit In?

  • Wraparound is a planning process: It is about ACTION

  • The planning process identifies strengths, needs, strategies (staffed services and non-staff items) and outcomes.

  • Wraparound utilizes a Child and Family Team with team members determined by the family, often representing multiple agencies, and informal supports.

  • The Child and Family Team creates a highly individualized plan for the child and family that consists of services and supports

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Key Features

  • Child and Family Team

  • Team Facilitator

  • Strengths and normalized needs

  • Family access, voice and ownership

  • Unconditional

  • Cultural Competency

  • Creativity

  • Monitoring/evaluation: Outcome oriented

  • Community ownership

  • Community safety

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  • Federal match funds to support collaborative service delivery in a child’s community

  • Billed “fee for service” by the responsible CMHSP

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Projected Annual Waiver Costs vs. Hospitalization Costs

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Local Funding

  • Mental Health/CMHSP General local funds

  • Child Care Fund (DHS/Court)

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Why do Blended Braided Funding?

  • Helps your local system of care

  • Builds capacity and trust across systems

  • Cost share vs. Cost shift

  • Share gate-keeping of high need children

  • Bring additional state and federal revenue to your community

  • Make children eligible for Medicaid who would not otherwise be eligible

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Things to Think About

  • Who are the underserved children in our community?

  • Who do we fight the most over trying not to serve?

  • What are their financial and personal eligibility characteristics SED/CMH, Court CCF-CW or JJ, DHS, Special Ed

  • Will the children meet the above eligibility criteria?

  • What percent are Medicaid eligible or CCF eligible?

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Things to Think About

  • Will the children benefit from intensive community based services?

  • Do we have experience in providing intensive community based services?

  • Do we currently have wraparound available in our community? Do we have other funding to serve non-waiver eligible children

  • Do we currently blend/braid funds?

  • Do we have a community gate-keeping team?

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The Child Care Fund

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Child Care Fund

  • Cost share between state and county

  • County incurs expenses

  • State reimburses 50% (without limit)

  • Used to fund

    • Out of home costs

    • In-home community based care

  • While a large majority of Child Care Funds are for Juvenile Justice, 54% of the children are neglect/abuse

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Child Care Fund

  • Local agencies develop contracts/agreements with county commissioners/administrators for services and identify $$$

  • $$$ added to the CCF “Expanded” child care fund

  • Purchase reimbursable services for CCF eligible children

  • For every $100 spent locally, receive $50 back (50/50 match)

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Considering CCF for Blended Funds?

  • Potential for matching state, federal and donated funds

  • Ability to use CCF for community programs

  • Local decisions to meet local needs

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Eligible Youth – CCF In-Home Care

  • Delinquent Youth

  • Abuse/neglect Youth


  • A petition has been accepted by court

  • Abuse or neglect category I, II or III

    at risk of out-of-home placement

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Eligible Programs - CCF In-Home Care

  • Programs must be intensive

  • Prevent need for out-of-home placement


  • Provide for an early return home from placement

  • Meet documentation and reporting requirements

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Social Welfare Act (Excerpt) 400.117c

  • County treasurer as custodian of money; creation and maintenance of child care fund; deposits in fund; use of fund; separate account for fund; subaccounts; plan and budget for funding foster care services; records of juvenile services and expenditures; applicability of section to county juvenile agency.

    • (f) All funds made available to the county for the foster care of children from any other source, except gifts that are conditioned on a different disposition or reimbursement of the general fund

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“Building a Collaborative Community budget, No It’s My Money”

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Sources of Funding:Using CCF and SEDW

$1 from


$1 from State

$2 CCF

$2 CMH

“State Share”


“Federal Share”

$4 Total

SEDW Effort

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$1,140 Federal



Contracts for $860

“Expanded” County Child Care Fund



$430 Reimbursement



Child Care Fund and Medicaid




County $430 Commissioners

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Finance Planning

  • Discussion about current funding and how it works (Medicaid, Child Care Fund)

  • Finance matrix

  • Finance strategies identified (maximize Medicaid, redirect out of home care, reallocate existing revenue, new funding)

  • Interagency agreements developed

  • Target population more specific (juvenile justice – child care fund involved only, foster care-not abuse or neglect, SED at risk of hospitalization only)

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Readiness Checklist

  • Systems Planning

  • CMHSP Infrastructure

  • Wraparound Experience

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System of Care Planning

Common interagency vision, mission, values about your system of care

Interagency goals

Interagency planning structure

Preliminary target population identified juvenile justice, child welfare, seriously emotionally disturbed

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Contact Information

  • Connie Conklin, MDCH

    517.241.5765, Conklinc@michigan.gov

  • Joan Deschamps, MDCH

    517.241.5754, Deschampsj@michigan.gov

  • Deb Milhouse, MDCH

    517.241.5757, Milhouse@michigan.gov

  • Andy Thalhammer, MDHS

    517.335.4256, ThalhammerA@Michigan.gov

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