1 / 55

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

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

veata
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 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

  2. Welcome & Introductions

  3. Presenters • Connie Conklin, MDCH • Joan Deschamps, MDCH • Debbie Milhouse-Slaine, MDCH • Andy Thalhammer, MDHS

  4. Today’s Presentation • Overview the SEDW • Eligibility requirements • Services • Currently participating sites • Wraparound • Funding

  5. 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

  6. SEDW • 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

  7. SEDW • 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

  8. 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

  9. Purpose • 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

  10. 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

  11. 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.”

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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)

  18. 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

  19. 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.

  20. 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.

  21. 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.

  22. 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

  23. 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.

  24. 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.

  25. Wraparound • 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

  26. Currently participating

  27. 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

  28. Ages Of Children Served By SEDW

  29. 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

  30. 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

  31. Systems Outcomes: Maximizing Fiscal Efficiencies • Reduce impediments to improve local collaboration by: • Implementing a system of care • Streamline service opportunities • Use of braided funding

  32. Falling Through the Cracks DHS EDUC CMH SA COURT

  33. 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

  34. 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

  35. Funding • Federal match funds to support collaborative service delivery in a child’s community • Billed “fee for service” by the responsible CMHSP

  36. Projected Annual Waiver Costs vs. Hospitalization Costs

  37. Local Funding • Mental Health/CMHSP General local funds • Child Care Fund (DHS/Court)

  38. 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

  39. 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?

  40. 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?

  41. The Child Care Fund

  42. 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

  43. 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)

  44. 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

  45. Eligible Youth – CCF In-Home Care • Delinquent Youth • Abuse/neglect Youth IF • A petition has been accepted by court • Abuse or neglect category I, II or III at risk of out-of-home placement

  46. Eligible Programs - CCF In-Home Care • Programs must be intensive • Prevent need for out-of-home placement OR • Provide for an early return home from placement • Meet documentation and reporting requirements

  47. 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

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

  49. Sources of Funding:Using CCF and SEDW $1 from County/CMH/UW $1 from State $2 CCF $2 CMH “State Share” $2 “Federal Share” $4 Total SEDW Effort

  50. $1,140 Federal $860 $860 Contracts for $860 “Expanded” County Child Care Fund DCH State $430 Reimbursement Request DHS Child Care Fund and Medicaid CMH $2,000 $430 County $430 Commissioners

More Related