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Overview of Presentation

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?.

jennelle-hebert
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Overview of Presentation

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

  2. 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

  3. 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

  4. 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

  5. …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

  6. …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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. How Waiting List Will Work The Arc of New Jersey & NJDHS-DDD

  16. 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

  17. 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

  18. 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

  19. Questions The Arc of New Jersey & NJDHS-DDD

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Waiver 101 • Eligibility • State specific • Income • Resources • Level of care • Service need The Arc of New Jersey & NJDHS-DDD

  26. CMS Oversight • Level of Care • Services • Plan • Qualified Providers • Financial Accountability • Administrative Oversight by Medicaid Agency The Arc of New Jersey & NJDHS-DDD

  27. 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

  28. 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

  29. 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

  30. Revisions to CCW • Philosophical Changes • Changed Services • New Services • Deleted Services The Arc of New Jersey & NJDHS-DDD

  31. Revisions to CCW • Services where you live • With family • Apartment • Supportive living • Group home The Arc of New Jersey & NJDHS-DDD

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. 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

  41. 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

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