Home > Uncategorized > PROMOTING COMMUNITY INTEGRATION VIA A NEW MEDICAID WAIVER SYSTEM

Original post from the HOOK Law Center:

by Shannon A. Laymon-Pecoraro, Esq.

One of the most important benefits received by individuals who are elderly or have a disability are the waiver services provided by Medicaid. For those unfamiliar with waiver services, they are intended to provide standard medical and non-medical services outside of an institutional setting. The coveted waiver programs in Virginia are those provided by the Home and Community Based Services waiver programs, under which individuals may receive support services necessary to promote independent living in his or her home and the community.

While the waiver programs are undoubtedly beneficial, the unfortunate problem with the waiver system is that the need for services in Virginia has surpassed the available funding for the programs, resulting in a large number of citizens being placed on a waiting list for supports, and essentially denying persons with disabilities the ability to integrate within their own community in violation of the “integration mandate” of the Americans with Disabilities Act. As a result, a lawsuit was brought by the United States Department of Justice against the Commonwealth of Virginia and a settlement was reached that requires the Commonwealth of Virginia to promote community integration. The resulting My Life, My Community waiver redesign initiative intends to simplify the currently complex eligibility system, decrease wait times for services, and provide targeted needs-based services that promote choice.

Effective July 2016, the new Building Independence waiver, Family & Individual Supports waiver, and Community Living waivers will replace the current Day Support and Intellectual Disability and Developmental Disability (I/DD) waivers. In contrast to the old system, the new system appears to focus on supports required by the individual and promote the urgency of such supports. The full transition of the new waiver system will be completed by January 2017.

Some key provisions under the new program include:

  • Both the Family & Individual Supports and the Community Living waivers will allow the recipient to elect an agency-directed (ie: the Community Services Board) or consumer-directed (ie: Moms in Motion or Endependence Center) services, thus promoting choice and improved client service.
  • Whereas current I/DD eligibility essentially pivots on IQ above or below 70, the new waiver eligibility system will focus on required supports. As a result, persons who were previously on the DD waiver and ineligible for sponsored or group home residential options will now have the option to receive such support, if necessary.
  • The new waivers intend to promote more integrative services, which will include employment supports, and additional crisis support services.

Only time will tell how successful the new program will be in accomplishing the intended objectives. In the meantime, the attorneys and staff intend to monitor the developments and assist clients with issues that may present during the initial implementation process.