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

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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

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Welcome Introductions

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Presenters

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

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Todays Presentation

• Overview the SEDW
• Eligibility requirements
• Services
• Currently participating sites
• Wraparound
• Funding

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History of 1915 (c) Waivers

• Legislation
• Enacted under the Reagan administration
• Title XIX of the Social Security Act
• Michigan DCHs (c) and (b)(c) Waivers
• Waiver for children with a serious emotional
  disturbance
• Childrens Waiver Program
• Habilitation Supports Waiver

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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

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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

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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

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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 childs community

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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 childs 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
• Meet CMHSP contract criteria for and is at risk
  of inpatient hospitalization in the state
  psychiatric hospital

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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.

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Eligibility Criteriacontinued

• 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

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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.

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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.

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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

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Other Covered 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

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Community Living Services (CLS)

• Staff assistance, support and/or training with
• socialization skills,
• interactions, and
• internal controls

• Skill development activities of daily living
  Skills, such as
• Personal hygiene
• Household chores
• School attendance

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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

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Family Support Training (FST)

• FST, 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.

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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.

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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.

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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

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Therapeutic Overnight Camp

• A group recreational and skill building service
  in a camp setting aimed at meeting goals detailed
  in the childs plan of service. A session can be
  one or more days and nights of camp.

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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.

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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

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Currently participating
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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

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Ages Of Children Served By SEDW
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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

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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

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Systems Outcomes Maximizing Fiscal Efficiencies

• Reduce impediments to improve local collaboration
  by
• Implementing a system of care
• Streamline service opportunities
• Use of braided funding

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Falling Through the Cracks
DHS
EDUC
SA
CMH
COURT
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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

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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

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Funding

• Federal match funds to support collaborative
  service delivery in a childs community
• Billed fee for service by the responsible CMHSP

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Projected Annual Waiver Costs vs.
Hospitalization Costs
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Local Funding

• Mental Health/CMHSP General local funds
• Child Care Fund (DHS/Court)

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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

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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?

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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?

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The Child Care Fund
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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

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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)

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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

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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

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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

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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

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Building a Collaborative Community budget, No
Its My Money
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Sources of FundingUsing CCF and SEDW
1 from County/CMH/UW
1 from State
2 CCF
2 Federal Share
2 CMH State Share
4 Total SEDW Effort
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Child Care Fund and Medicaid
CMH 2,000
430
County 430 Commissioners
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Finance Planning

• Discussion about current funding and how it works
  (Medicaid, Child Care Fund)
• Finance matrix
• Finance strategies identified (maximize Medicaid,
  redirect out of home care, reallocate existing
  revenue, new funding)
• Interagency agreements developed
• Target population more specific (juvenile justice
  child care fund involved only, foster care-not
  abuse or neglect, SED at risk of hospitalization
  only)

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Readiness Checklist

• Systems Planning
• CMHSP Infrastructure
• Wraparound Experience

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System of Care Planning

• Common interagency vision, mission, values about
  your system of care
• Interagency goals
• Interagency planning structure
• Preliminary target population identified
  juvenile justice, child welfare, seriously
  emotionally disturbed

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questions?
Questions?
Questions?
questions?
Questions?
Questions?
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Contact Information

• Connie Conklin, MDCH
• 517.241.5765, Conklinc_at_michigan.gov
• Joan Deschamps, MDCH
• 517.241.5754, Deschampsj_at_michigan.gov
• Deb Milhouse, MDCH
• 517.241.5757, Milhouse_at_michigan.gov
• Andy Thalhammer, MDHS
• 517.335.4256, ThalhammerA_at_Michigan.gov