Coweta County Schools Workshop Series - #2 Medicaid Waivers, SSI, Estate Planning and Advocacy

1. Coweta County SchoolsWorkshop Series - #2Medicaid Waivers, SSI,Estate Planning and Advocacy

2. Coweta County SchoolsWorkshop Series - #2 Medicaid Waivers, SSI,Estate Planning and Advocacy • Judy Floyd Parent Mentor, Coweta County School System 770-254-2810 x219 Judy.floyd@cowetaschools.net • Linda Wilson Partners in Policymaking Graduate Coweta Supporters 770-463-1658 lpwilson@numail.org

3. Medicaid eligibility • As a result of receiving SSI • Family income for children under age 18 • Based on individual’s income at age 18 • Medicaid Deeming Waiver (also known as the Katie Beckett Waiver)

4. Deeming Waiver • Not based on family income • Eligible if child requires • Skilled nursing care • Hospitalization • Intermediate care facility – active treatment with a deficit in 3 self help areas • Apply through DFACS

5. Deeming Waivers • Many denials for new and renewals • Be sure that your paper work is complete • Appeal decision • Be specific about things that need supervision – safety issues, health issues, detailed level of care and support • Being addressed by GAO (Georgia Advocacy Office) and GCDD (Governor’s Council on Developmental Disabilities)

6. SSI • Supplemental Security Income • Eligible when child becomes adult according to law at age 18 • Parent income no longer considered • Less than $2000 in the bank • Can own home and auto • Income limits apply

7. SSI • Needs based program • Maximum of $579/month in 2005 • Will increase to $603 in 2006 • Automatically receive Medicaid for medical, therapies, and waivers • Can earn up to $22,192 per year and still retain Medicaid although payments maybe reduced

8. SSIHow to Apply • Contact SSA (Social Security Administration) at 1-800-772-1213 • Set up an appointment (phone or in person in LaGrange) • Provide requested information • Parent can be designated the payee • Yearly report on how funds are spent

9. SSIBenefits Navigator • Benefits Navigator Project – work with individuals who are eligible for Social Security based on a disability • Will assist you in making informed decisions when you work and have Social Security benefits • If an individual is still in school, he may qualify for a Student Earned Income Exclusion

10. SSIBenefits Navigator • Contact Division of Rehabilitation Services (GROUP) at 866-489-0001 • Help with transition from school to work • Will attend IEP meetings • Help DD population become informed consumers • No cost

11. SSDI • Social Security Disability Insurance • Entitlement program • Medicare included • May jeopardize SSI benefits

12. SSDI • Based on child’s or parent’s work record • For a child to receive benefits on a parent’s work record • Disability must have started prior to age 22 • Must meet definition of disability for adults • Parent must become disabled, retired, or die • If received SSI and Medicaid, may be able to retain Medicaid

13. Trusts • Setup to prevent assets from disqualifying child for SSI • Legal arrangement regulated by state law in which one party holds property for the benefit of another • Often called “special needs” trusts • Better than relying on others to use funds appropriately

14. Trusts • Funds must be paid by someone to provide you with items other than food and shelter • Supplemental discretionary trust – specifies that funds are not to be used for items covered by Medicaid or SSI • Discretionary trust – more freedom to use funds. Must be careful to not provide goods or services (shelter or food) which are covered by Medicaid or SSI

15. Trusts • Setting up a trust • Testamentary – sets up in a will • Inter vivos (or Living) – sets up a trust before dying • Funding the trust • Family’s assets • Assistance and inheritance from friends and family • Life insurance

16. Wills • Legal document that is a statement of what you want to have happen after your death • A Will can provide • Property distribution • Naming a guardian • Creating a trust

17. Wills • If you do not have a Will, your property is distributed to your heirs according to the laws of the state • It is important that a child with developmental disabilities not receive funds as they may jeopardize their government benefits

18. Wills • Should indicate that a family member has a disability • Relatives should consider making arrangements to not leave property to an individual with developmental disabilities. This includes life insurance.

19. Guardianship • Court-approved legal relationship between a competent adult and a minor or adult with a disability • Limits a person’s independence and rights • At age 18, individuals are considered to be adults. Personal, medical and financial decisions should be made by the individual

20. Guardianship • Parents are legal guardians of a minor child • Only the court can make one person the guardian of an adult • Need for guardianship varies for each individual with disabilities • Handled by the Probate Court

21. Guardianship • Types • Person – personal issues including living arrangements, medical treatment, signing for services • Property – money or property • Full or Plenary - person’s personal and property

22. Guardianship • Annual report required • If receiving SSI, consider Person only since will be doing a financial report for SSA • Alternatives • Representative Payee • Joint accounts • Durable power of attorney for health care, property or advocacy

23. Medicaid Waivers • MHDDAD – Division of Mental Health, Developmental Disabilities, and Addictive Diseases – part of DHR (Department of Human Resources) • Regions have been reduced from 7 to 5 • Coweta County is in Region 1

24. Medicaid Waivers • To contact Region 1 Charles Fetner, Regional Coordinator 1305 Redmond Circle, Building 401 Rome, GA 30165 Phone 706-802-5272 Fax 706-802-5280 Toll Free 1-800-646-7721

25. Medicaid Waivers • To Apply for Waiver Services Columbus Community Services Phone 706-494-5929 Toll Free 1-800-579-7609

26. Medicaid WaiversTypes • ICWP – Independent Care Waiver – physical disability or traumatic brain injury • Deeming Waiver – Katie Beckett – chonic medical condition, under age 18 • CHSS – Community Habilitation Support Services – moving individuals out of institutions • MRWP – Mental Retardation Waiver Program – developmental disabilities

27. Medicaid WaiversTypes • CCSP – Community Care Services Program – elderly and DD who need nursing home level care • SOURCE – Service Options Using Resources in a Community – care management – not available in Coweta • GAPP – Georgia Pediatric Program – medically fragile under age 21 • Autism Family Support

28. Medicaid WaiversMRWP • 7079 being served • 3200 on short term waiting list • 3126 on long term waiting list • 700 age out of the school system annually

29. Medicaid WaiversMRWP • Residential Options • Residential Training and Supervision • Group home/personal care home • 24x7 • Training tailored for individual – self care, independent living skills, communication skills, leisure skills • Personal Support • Similar to Residential Training • Occurs in family’s or individual’s home

30. Medicaid WaiversMRWP • Day Services Options • Day Habilitation • Offered in a facility or community, non-work, training in areas of communication, social, leisure, and self help skills • Supported Employment • Opportunity for individuals to work a minimum of 80 hours per month, provides job development, coaching and follow-up • Day Support Services • Provides for facility day habilitation, prevocational, and supported employment

31. Medicaid WaiversMRWP • Specialized Medical Supplies • Specialized Medical Equipment • Personal Emergency Response Systems • Environmental Modifications • Vehicle Adaptation • Respite Care • Home Based Services • Natural Support Enhancements • Natural Support Therapies • Consumer Directed Natural Support Enhancements

32. New Medicaid Waivers • Proposed by Dr. Stephen Hall, Director of the Department of Developmental Disabilities, DHR • Recognize that parents are the primary service providers – always! • Current waivers established in 1987 • Medicaid is a states program that is federally funded • Will take advantage of the flexible Federal Medicaid Rules Template • Will send to federal govt in Dec, 2005 • Plan to implement starting July, 2006

33. New Medicaid Waivers • Bring fairness, choice, accountability and self-determination to the system • Assessment process will be the same statewide using SIS (Supports Intensity Scale) – www.aamr.org • More flexibility on what services are obtained by individual’s funding • Will not provide more funding • Will provide more choice • Money will follow the individual

34. New Medicaid Waivers • Reduce current waivers to two waivers • Supports Waiver • Live in own home or family’s home • Participate in community life • Comprehensive Waiver • More intense, urgent and extensive out of home residential services • Funding will be based on level of support that is needed

35. New Medicaid Waivers • Individualized budgeting– can spend dollars where you want • Community Connection/Community Guide/Brokerage Services – help connect to community activities • Dental services will be available • Transportation services • Behavioral Support Services

36. New Medicaid Waivers • Participant Direction – same as Consumer-Directed Natural Supports Enhancements Services. • Choose and direct services to extent desired • Can be employer of record and pay providers • Support Coordination – monitoring of supports and services as necessary • Extenuating Circumstances Payment • Payment to family member for services when providers not available and is cost effective

37. New Medicaid WaiversProviders • Group Providers – same as today • Individual Providers – expedited process to establish small providers that support 1-3 individuals • Specific Providers – a particular specialty such a dental, health, behavior • Will result in increased number of providers

38. New Medicaid Waivers • Gradual move to new services – must be selected by the family • Current waiver will be converted on individual’s birthday • Process • Determine eligibility • Assess needs • Choice of services

39. New Medicaid Waivers • Will use Utilization Management • Ensure efficient and effective use of funds • Outcomes that lessen dependence on funding • Shifts from program funding to individualized budgeting that controls costs

40. Unlock the Waiting Lists! • We must reduce the number of individuals on the waiting lists for services • Georgia’s annual budget determines how many additional people receive services • We need to tell our elected officials and state officials how important this issue is!

41. Unlock the Waiting Lists!Budget Process • DHR and DCH submit proposed budget to the Governor in September • Governor develops budget and submits to the legislature in January • Legislators debate, modify, and approve budget • Returns to the Governor for approval

42. Unlock the Waiting Lists! • Previously (2004-2005) budget – 10 waivers funded • Last year (2005-2006) budget – 925 additional waivers were funded • This year (2006-2007) budget – DHR is asking for 1500 additional waivers

43. Unlock the Waiting Lists!Goals • Funding, with new money, for at least 1,500 services for people who want and need alternatives to institutions and nursing homes. • Funding, with new money, an increase for provider rates that ensures direct service professionals for disability supports are given fair and livable wages, provided training and assure quality services • Implementation of a multi-year funding plan for home and community-based services

44. Unlock the Waiting Lists • Go to www.unlockthewaitinglists.com for more information • Write/call/visit the Governor and your Legislators • Attend Disability Day at the Capitol – February 23, 2006