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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 l.jpg

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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  • 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 as:

  • 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) as:

  • 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 as:

  • 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 as:

  • 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 as:

  • 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 as:

  • 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 as:

  • 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 as:

  • 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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Participating CMH/Counties as:

  • 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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Desired Outcomes as:

  • 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: as: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: as: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 as:






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How does Wraparound Fit In? as:

  • 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 as:

  • 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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Funding as:

  • 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. as: Hospitalization Costs

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Local Funding as:

  • Mental Health/CMHSP General local funds

  • Child Care Fund (DHS/Court)

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Why do Blended Braided Funding? as:

  • 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 as:

  • 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 as:

  • 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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Child Care Fund as:

  • 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 as:

  • 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? as:

  • 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 as:

  • 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 as:

  • 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 as:

  • 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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Sources of Funding: Money”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 Money”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 Money”

  • 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 Money”

  • Systems Planning

  • CMHSP Infrastructure

  • Wraparound Experience

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System of Care Planning Money”

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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questions? Money”






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Contact Information Money”

  • 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