Community Services and Support for Individuals with

1
Community Services and Support for Individuals
with Disabilities in Texas

• Medicaid Waivers
• April 2006

2
Home and Community Based Services 1915 (c)
Waivers

• Medicaid home and community-based service waivers
  afford States the flexibility to develop and
  implement creative alternatives to placing
  Medicaid-eligible individuals in hospitals,
  nursing facilities, or intermediate care
  facilities for persons with mental retardation or
  related conditions.

3
Home and Community Based Services 1915 (c) Waivers

• Flexible
• Wide range of services and supports possible
• Family and consumer driven
• States may decide number of people to serve,
  ages, disabilities, etc.
• Waiver eligibility is based on the persons
  income and not the familys.

4
Texas HCBS 1915 (c) Waivers

• MDCP Medically Dependent Children Program
• CLASS Community Living Assistance and Support
  Services
• DB-MD Deaf/Blind and Multiple Disabilities
• CBA Community Based Alternatives
• CWP Consolidated Waiver Program
• HCS Home and Community Services
• TxHmL Texas Home Living Waiver

5
MDCP DADS

• Alternative to nursing facility
• Serves children under age 21 who require licensed
  nursing services
• Cost cap is dependent on the childs level of
  support needs, but is no higher than about
  25,000 per year.

6
MDCP Services

• Respite
• Home Modifications
• Adaptive Aids
• Additional financial support to help keep your
  child in day care, also known as Adjunct
  Supports.
• Transition Assistance Services

7
MDCP 1,022 served8,604 waiting
(11/30/04)1,347 new children (9/05 8/07)

• Important Facts and Issues
• Children who receive services from MDCP
  automatically transition into the CBA waiver once
  they turn 21
• Money Follows the Person from Nursing Facility
• Consumer Directed Services is coming soon

8
CLASS - DADS

• Alternative to ICF/RC institutionalization
• Children and adults with developmental
  disabilities that occurred before the age of 22
  and have a Level of Care 8
• Primary disability must be a related condition
  (other than mental retardation)
• Demonstrated need for habilitation and case
  management

9
CLASS Services

• Habilitation
• Supported Employment
• Home/Vehicle Modifications
• Adaptive Aids/Supplies
• Therapy ST, OT, PT
• Specialized Therapies
• Consumer Directed Services
• Nursing

• Psychological/Behavioral
• Respite including camps
• Case Management
• Prevocational Services
• Habilitative transportation
• Support Family Services
• Transition Assistance Services

10
CLASS 1,81213,453 waiting (3/4 children)1,645
new individuals (9/05 8/07)

• Important Facts and Issues
• Available in 175 counties, but expanding to
  statewide coverage in future.
• Money Follows the Person from Nursing Facility
• Small provider base
• Support Family Services limited to children under
  18 years and low reimbursement rate.

11
CLASS Coverage Areas and Counties April 2006

• Houston Harris, Brazoria, Fort Bend, Galveston,
  Montgomery, Matagorda, Waller, Walker, Wharton,
  Austin, Colorado
• Beaumont Jefferson, Orange, Chambers, Hardin,
  Liberty, Orange, Newton, Polk, Tyler
• Lubbock Lubbock, Crosby, Floyd, Hale, Hockley,
  Lamb, Terry, Lynn, Garza, Motley, Swisher, Castro

12
CLASS Coverage Areas and Counties April 2006

• Corpus Christi Nueces, Jim Wells, Kleberg, San
  Patricio, Bee, Refugio, Live Oak, Aransas,
  Calhoun, Victoria, Calhoun
• Longview Smith, Gregg, Rusk, Upshur, Wood, Van
  Zandt, Henderson, Harrison, Anderson, Cherokee,
  Morris, Bowie, Cass, Marion, Angelina, Trinity,
  Delta, Hopkins, Houston, Lamar, Nacogdoches,
  Panola, Rains, Shelby
• Dallas Collin, Cooke, Dallas, Denton, Ellis,
  Fannin, Grayson, Hunt, Kaufman, Rockwall, Navarro

13
CLASS Coverage Areas and Counties April 2006

• Amarillo Armstrong, Carson, Potter, Randall,
  Deaf Smith, Gray, Hutchinson, Moore, Donley,
  Dallam, Hansford
• San Angelo Coke, Nolan, Taylor, Tom Green,
  Runnels, Scurry, Mitchell, Sterling, Callahan,
  Jones, Coleman, Eastland, Brown, Stephens,
  Schleicher, Sutton, Val Verde
• Fort Worth Tarrant, Hood, Johnson, Parker,
  Wise, Jack, Clay, Wichita

14
CLASS Coverage Areas and Counties April 2006

• Valley Brooks, Cameron, Duval, Hidalgo, Jim
  Hogg, Kenedy, Starr, Webb, Willacy, Zapata
• Austin Travis, Hays, Bastrop, Williamson,
  Blanco, Caldwell, Burnet, Llano, San Saba,
  Washington, Brazos, Burleson, Fayette, Grimes
• San Antonio Atascosa, Bandera, Bexar, Comal,
  Frio, Guadalupe, Kendall, Kerr, Medina, Wilson,
  Gillespie, Gonzales, Kinney, Zavala, Maverick

15
CLASS Coverage Areas and Counties April 2006

• Midland/Odessa Ector, Midland, Martin, Andrews,
  Winkler, Gaines, Dawson, Howard, Regan, Upton,
  Ward, Reeves
• Waco/Temple Bell, Bosque, McLennan, Coryell,
  Hill, Milam, Robertson
• El Paso El Paso

16
CBA - DADS

• Alternative to nursing homes
• Adults age 21 or over
• Cost cap based on level of support services
  needed. The state refers to this as Texas Index
  of Level of Effort (TILE)

17
CBA Services

• Adaptive Aids/Supplies
• Adult Foster Care
• Assisted Living
• Nursing
• Home Modifications
• Therapies OT, PT, ST
• Consumer Directed Services

• Personal Assistance Services
• Respite Care
• Emergency Response Services
• Home delivered meals
• Transition Services

18
CBA 27,664 served66,787 waiting3,068 new
individuals (9/05 8/07)

• Important Facts and Issues
• Money Follows the Person from Nursing Home.
• Automatic admission for children aging out of
  MDCP waiver or Medicaid Private Duty Nursing
• Limited financial cap
• No case management

19
Deaf-Blind with Multiple Disabilities DADS

• Alternative to ICF-MR/RC
• Adults over the age of 18 who are deaf/blind and
  have a third disability

20
Deaf-Blind with Multiple Disabilities - Services

• Case Management
• Assisted Living
• Habilitation
• Nursing
• Respite
• Orientation and Mobility
• Therapies OT, PT, ST

• Adaptive Aids/Supplies
• Environmental Accessibility
• Intervenor
• Behavior Communication Services
• Chore Provider
• Transition Services

21
DB-MD 143 served18 waiting18 new individuals
(9/05 8/07)

• Important Facts and Issues
• Currently children are not eligible for the
  waiver. There have been discussions about
  broadening the eligibility to include children
• Small eligible population
• Money Follows the Person from Nursing Facility
• Consumer Directed Services

22
HCS DADS

• Alternative to ICF/MR
• Children and Adults with primary diagnosis of
  mental retardation or another disability with an
  IQ below 75
• Cost Cap based on Level of Need

23
HCS - Services

• Residential Assistance (Foster/Companion Care,
  Residential Support, Supervised Home Living)
• Day Habilitation
• Counseling and Therapies
• Audiology
• Dietician

• Adaptive Aids
• Home Modifications
• Nursing
• Respite
• Supported Employment
• Case Management
• Dental

24
HCS 8,860 served26,698 waiting2,815 new
individuals (9/05 8/07)

• Important Facts and Issues
• Statewide
• Foster/Companion Care
• Rich service array and high dollar cap
• Provider is case manager, no independent case
  management
• No Consumer Directed Services

25
Texas Home Living - DADS

• Alternative to ICF/MR
• Adults and children with mental retardation who
  are already Medicaid eligible
• Service coordination by MRA

26
TxHmL - Services

• Adaptive Aids
• Home Modifications
• Community Supports
• Dental
• Supported Employment
• Employment Assistance
• Nursing

• Pathology, Audiology and Dietician
• Therapy OT, PT, ST
• Respite
• Day Habilitation
• Behavioral Support

27
TxHmL

• Important Facts and Issues
• 10,000 Cap - 8,000 for Community Supports and
  2,000 for Professional and Technical Supports
• New admissions to the waiver get taken from the
  HCS waiting list.
• If you accept the waiver, your name still remains
  on the HCS list until that waiver is available.

28
Other Important Information

• Make sure to put your name on the waiting lists
  for all of the waivers that you think you might
  be eligible for.
• Ask for the person who is taking your name to
  send you a letter showing the date that you asked
  to be put on the list.
• The waiting lists all move at different paces.
  The CLASS and HCS waiver waiting lists seem to
  take the longest time.

29
Waiting List Phone Numbers

• MDCP 1-877-438-5658
• CLASS 1-877-438-5658
• DB/MD 1-877-438-5658
• HCS local MHMRA
• www.dads.state.tx.us/contract/mra/index.cfm
• CBA local DADS office
• TxHome Living local MHMRA