After wading through a swamp of information about Medicaid waivers for people with developmental disabilities, I have come up with the following summary. I am no expert on this and any additional information, corrections, or comments are welcome.
The CMS (Centers for Medicare and Medicaid Services) is asking for comments on proposed changes to Home and Community Based Services waivers. States apply for waivers of specific parts of Medicaid law so that they can use Medicaid funding for targeted groups of people with disabilities, who "but for the provision of such services" would require the level of care provided in a hospital, a nursing facility, or an intermediate care facility for the mentally retarded. These services are considered to be "medical assistance" and must be provided to eligible individuals in accordance with a written plan of care. The costs for such services must not exceed the estimated cost of providing services in an institution (a hospital, nursing facility, or ICF/MR).These waivers to the states are called 1915(c) waivers because they are described in Sec. 1915(c) of the Social Security Act.
Michigan has several waivers and demonstration projects funded by Medicaid. The HCBS waiver for people with developmental disabilities is called the Habilitation Supports Waiver (HSW). Waiver funds go to Community Mental Health agencies to provide an array of services for eligible adults with developmental disabilities. Michigan has a specific number of HSW slots approved by the CMS per fiscal year. The assignment of slots is managed by the Michigan Department of Community Health. Each PIHP (that's the Washtenaw Community Health Organization for Washtenaw, Livingston, Lenawee, and Monroe Counties) has an annual allocation of active enrollments that cannot be exceeded. The need for waiver services must be written into the persons plan of service developed through the person-centered planning process.
If you google "Michigan HSW overview", one of the top items that comes up is a 2010 Powerpoint presentation by the Michigan DCH that includes detailed information on the 1915(c) Habilitation Supports Waiver and the services available.
Many families of even the most severely developmentally disabled adults do not know that the waivers exist. When they are informed, they often struggle with mental health agencies to get even the most basic needs of their loved-ones met. So the waiver is no panacea, but to begin applying for waiver services, contact your local community mental health agency. If you have an adult developmentally disabled family member, it is possible that he or she is already covered by the waiver. You may have been asked to sign a form to voluntarily waive the right to services in an ICF/MR (Intermediate Care Facility for the Mentally Retarded) in exchange for community-based services under the waiver. Community Mental Health agencies can be stingy about revealing much information about the waiver because you might actually want and need those services!
Now that you have some information on how waivers are supposed to work, you can try to figure out what the federal CMS is proposing to change and how it will affect you and your family member.
I will have future blogposts at the The DD News Blog on the specific changes that are proposed. You have until June 14th to submit comments to CMS.
Here is a link to information on Michigan's specialty services waivers that list services available under each waiver and who to contact for more information.
For a complete list and explanation of waiver services go to the Michigan Medicaid Provider Manual and scroll down to Section 15 - Habilitation Supports Waiver for Persons with Developmental Disabilities