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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. What is Medicaid?.

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navigating the new system community care waiver waiting list changes and individualized budgets

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

overview of presentation
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

The Arc of New Jersey & NJDHS-DDD

what is medicaid
What is Medicaid?
  • 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

The Arc of New Jersey & NJDHS-DDD

what is the community care waiver
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

The Arc of New Jersey & NJDHS-DDD

and why is it important
…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

The Arc of New Jersey & NJDHS-DDD

and why is it important1
…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

The Arc of New Jersey & NJDHS-DDD

how do you get services
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”

The Arc of New Jersey & NJDHS-DDD

overview of new system changes that are coming
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

The Arc of New Jersey & NJDHS-DDD

new system
New System
  • Self-direction Option
    • Based more on in-home supports
    • Funding flows from DDD through Fiscal Intermediary
    • Waiting list for “waiver slot”

The Arc of New Jersey & NJDHS-DDD

new system1
New System
  • Provider-Managed Option
    • Individual chooses a provider agency
    • Payment made directly to provider
    • Waiting list for “waiver slot”

The Arc of New Jersey & NJDHS-DDD

what we know for sure
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

The Arc of New Jersey & NJDHS-DDD

how does the waiver system work
How does the Waiver System Work?
  • Determination of eligibility for waiver services
    • Waiting list criteria
    • Reserve capacity within the waiver
  • 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

The Arc of New Jersey & NJDHS-DDD

what does self direct mean
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?

The Arc of New Jersey & NJDHS-DDD

waiver waiting list
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

The Arc of New Jersey & NJDHS-DDD

how waiting list will work
How Waiting List Will Work

The Arc of New Jersey & NJDHS-DDD

changes in need
Changes in Need
  • 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
Review of Covered Services in CCW
  • 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

The Arc of New Jersey & NJDHS-DDD

non medicaid funded services
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

The Arc of New Jersey & NJDHS-DDD

questions
Questions

The Arc of New Jersey & NJDHS-DDD

contact
Contact
  • Start with your Case Manager
  • Contact me by email, if possible:
    • linda.lewis-day@dhs.state.nj.us
    • 609-631-6502

The Arc of New Jersey & NJDHS-DDD

medicaid 101
Medicaid 101
  • What is Medicaid?
    • Medical assistance to individuals who are aged, blind or disabled and TANF
    • Income test
    • Resource test

The Arc of New Jersey & NJDHS-DDD

medicaid 1011
Medicaid 101
  • Services covered under Medicaid
    • Mandatory services
      • E.g., physician, hospitalization, pharmacy
    • Optional services
      • E.g., therapy, private duty nursing
    • Each state determines scope, duration, and amount

The Arc of New Jersey & NJDHS-DDD

waiver 101 or why have a waiver
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

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

Additional “waivers” requested:

Statewideness

Amount, duration and scope

Comparability

Institutional income

Waiver 101

The Arc of New Jersey & NJDHS-DDD

waiver 1011
Waiver 101
  • Eligibility
    • State specific
    • Income
    • Resources
    • Level of care
    • Service need

The Arc of New Jersey & NJDHS-DDD

cms oversight
CMS Oversight
  • Level of Care
  • Services
  • Plan
  • Qualified Providers
  • Financial Accountability
  • Administrative Oversight by Medicaid Agency

The Arc of New Jersey & NJDHS-DDD

new jersey waivers
New Jersey Waivers
  • AIDS Community Care Alternatives Program (ACCAP)
  • Community Resources for People with Disabilities (CRPD)
    • combined three model waivers
  • Acquired Traumatic Brain Injuries (TBI)

The Arc of New Jersey & NJDHS-DDD

new jersey waivers1
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)

The Arc of New Jersey & NJDHS-DDD

community care waiver
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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw
Revisions to CCW
  • Philosophical Changes
  • Changed Services
  • New Services
  • Deleted Services

The Arc of New Jersey & NJDHS-DDD

revisions to ccw1
Revisions to CCW
  • Services where you live
    • With family
    • Apartment
    • Supportive living
    • Group home

The Arc of New Jersey & NJDHS-DDD

revisions to ccw2
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
  • Essential Life Plan
    • added as alternate plan of care for individuals who self-direct or have an individual budget

The Arc of New Jersey & NJDHS-DDD

revisions to ccw3
Revisions to CCW
  • Regional Monitor for Individuals who Self-direct (new administrative service)
    • Assures that the following is completed:
      • Assessment for waiver eligibility
      • Level of care
      • Assignment of budget amount
      • Review & approve service plan
      • Assure health & safety factors considered
      • Approves expenditures

The Arc of New Jersey & NJDHS-DDD

revisions to ccw4
Revisions to CCW
  • Retainer days paid for absences from day program and residential supports
    • “Therapeutic” days
    • Hospital days & related stays in other facilities

The Arc of New Jersey & NJDHS-DDD

new service
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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw5
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

The Arc of New Jersey & NJDHS-DDD

new services
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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw6
Revisions to CCW
  • 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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw7
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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw8
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

The Arc of New Jersey & NJDHS-DDD

revisions to ccw9
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)

The Arc of New Jersey & NJDHS-DDD