Residential Services & Medicaid Home and Community Based Waivers

1. Residential Services & MedicaidHome and Community Based Waivers April 18, 2005

2. Residential Services • Residential services: group-home, foster care, in-home supports, semi-independent living, respite. • Residential Waiting List: emergencies, budget, placement process, referrals, and providers. • In an emergency residential situations, contact your SSA immediately, and they will help you through the respite/placement process. In emergency situations, residential services are provided through local dollars. • Family Support Service dollars are available: up to $1750.00 per individual to help with respite, adaptive equipment. • A vast majority of individuals receiving residential services in Summit County are funded through the Medicaid Home and Community Based Waiver Program.

3. Medicaid Waivers • MRDD Waiver programs offer an alternative health care package for persons who would otherwise be institutionalized in an ICFMR under Medicaid • Waivers must ensure an individual’s Health and Safety, and services provided must be medically necessary • Administered by the Center for Medicare and Medicaid Services, and the Ohio Department of Job and Family Services, who have contracted with ODMR/DD and County Boards of MR/DD • 60 % funding allocated by CMS, with the remaining match provided by ODMR/DD and/or County Boards of MR/DD

4. What is waived? • The Medicaid tenets of statewideness, comparability and may be “waived” for a 1915(c) Home and Community Based Waiver. • The individual’s right to live in an ICFMR • The family income requirement

5. MRDD Waivers • Currently the waivers available to individuals with mental retardation and/or a developmental disability are: • Individual Options Waiver (IO) • Level One Waiver (L1)

6. IO Waiver Benefit Package • Homemaker Personal Care • Respite • Transportation • Environmental Modifications & Adaptations • Specialized Medical Equipment & Supplies • Supported Employment • Social Work Services • Nutritional / Interpreter Services • Home Delivered Meals

7. Level I Benefit Package • Homemaker Personal Care • Respite – Institutional and Informal • Transportation • Environmental Modifications & Adaptations • Specialized Medical Equipment & Supplies • Personal Emergency Response System • Emergency Assistance

8. Who is eligible? Individuals... • Who have mental retardation or a developmental disability • Who have an ICF/MR Level of Care • Whose health, safety and welfare needs can be assured by formal supports, informal supports and home and community based services

9. ICF/MR Level of Care An ICF-MR Level of Care requires 3 substantial limitations in 6 or 7 of the following life areas (depending on age): • Personal Care • Learning • Communication • Mobility • Self direction • Capacity for independent living • Economic Self Sufficiency ( Over 16)

10. Financial Requirements • The individual must be financially eligible for Medicaid under a special income level. Income of parents or spouse is not considered available to a waiver participant. • Individuals must meet the above criteria, and have less than 1500.00$ accessible resources, and make less than approximately $1064.00 per month in income to be waiver eligible. (300% of the SSI Standard). • If an individual makes more than a specified amount per month, he or she will have a patient liability. (They will be liable for some of the costs).

11. Prohibitions • Individuals cannot receive waiver services when living in the hospital or a nursing home. • Nursing Services and professional services such as OT and PT, and Hospice are not covered under the waiver programs. • Waivers do not currently cover the costs of day services. Most adults who have a waiver, however, do attend day programming. • Services provided, must be deemed necessary to ensure the individual’s health and safety

12. Waiver Providers Waiver programs are client driven, all individuals have the freedom to choose their own provider, from a pool of certified providers. Providers will provide services according to the individual’s service plan, and: • Be at least 18 and pass background check • CPR Certification • Training in MUI’s and Rights • Are prohibited from providing services to his/her minor child or his/her spouse • Comply with behavior Support and medication administration requirements

13. How do I apply? • Contact your Service Coordinator (SSA) at CSBMR/DD • Contact the Service Utilization Department (330-634-8016) • Contact Summit County Job and Family Services • Indicate your desire to be placed on either or both the Individual Options and Level One Waiting List • Complete the 2399 Application form • Waivers are limited: Priority Status vs. Waiting List