Michigan: 2019 Annual Home and Community Based Waiver Conference

Ian the Handsome

Home and community based Medicaid waivers are available for people with developmental disabilities who live in community settings but need an institutional level of care. Michigan's DD waiver is call the Habilitation Supports Waiver (HSW). 

The Children's Waiver Program allows minor children who live at home to qualify for Medicaid  services, regardless of the family's income. Services include an array of "medically necessary" social services and supports for both the child and the family that allow the child to continue to live at home. The CWP is also covered at this conference.

It never surprises me when parents of children and adults with intellectual and developmental disabilities know next to nothing about these waivers and the services that they theoretically make available. This applies even to people whose children are currently covered by Medicaid Waivers. Unbeknownst to them, that paper that someone slid over the table to them at a recent person-centered planning meeting and asked them to sign, was giving permission to "waive" services ordinarily provided in an Intermediate Care Facility for people with intellectual disabilities, for home and community based services. 

Community Mental Health agencies are reluctant to provide parents with a comprehensive list of possible services (as long as they are "medically necessary") under Medicaid waivers for fear that an astute family member may find something that could fill a critical need for the disabled individual and therefore compel CMH to actually provide the service. You will notice that I did the best that I could to at least find a list of services included in Michigan's Medicaid Provider Manual, but it is hard to read and understand without knowing how these services are defined and who provides them.

I go to the Medicaid Waiver conference almost every year, partly to find out what the  Michigan Department of Health and Human Services is cooking up for my kids and whether it is something I need to applaud or stop in its tracks. [I am looking at this in terms of the effect on my sons; I do not make judgments for others.] I never know if I am going to be pleasantly surprised or appalled by the inspirational keynote speakers. In 2016, the keynote speaker appeared in a mermaid costume (I was prepared to find her talk appalling), but she was hilariously funny and if she did not make her living as a Rheumatology Nurse Practitioner in Lansing, she might have made it as a professional comedian.

Consider taking a chance on this two-day conference (it's only $20 for family members), including a buffet breakfast and lunch. I'll see you there.

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The 2019 Annual Home and Community Based Waiver Conference

Tuesday, November 19, 2019 and 

Wednesday, November 20, 2019

Kellogg Hotel & Conference Center at Michigan State University
219 S Harrison Rd, East Lansing, MI 48824
View Google Map

Registration is open!

This conference will provide technical assistance and training on the implementation and maintenance of the Children’s Waiver Program (CWP) and the Habilitation Supports Waiver (HSW), clinical issues, and administrative functions relevant to these waivers. Additionally, this conference will provide training in ASD, evidence-based services, highlight programs across the state, and provide technical assistance on implementation of the Medicaid/MIChild Autism Benefit.

Overnight Accommodations:

The Kellogg Hotel & Conference Center is located in East Lansing adjacent to Michigan State University. The discounted room block of $85 per night plus tax has been filled. Other upgraded rooms choices are available for $145 group rate. For Room Reservations: Call 517-432-4000 and provide the discount code of 1911DCH&MA. The deadline for room discounts is October 10, 2019.

Rooms are available at other area hotels with special rates for the conference.

Documents
Save the Date Flyer Waiver Conference
Agenda C-Waiver Conf 2019

Who Should Attend

This conference contains content appropriate for case managers, supports coordinators, clinicians, behavior analysts, CMH administrative or clinical staff, providers, HCBS or waiver coordinators, individuals receiving services and family members and social workers at all levels of practice (beginning, intermediate and/or advanced).

EVENT DETAILS

Closure of Vocational Centers: A Threat Against the Significantly Disabled

Matt at work

This is by the father of Matt. Matt has intellectual and developmental disabilities. He loves his job in a vocational center, sometimes known as a sheltered workshop. Why do some people want to take his job away from him?

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An Existential Threat against the Significantly Disabled:
Phase-Out of Vocational Centers (Sheltered Workshops)

By: Harris Capps, November 2019

I am a Parent and Guardian for my son Matthew, who has moderate to severe Intellectual and Developmental Disabilities (IDD), to include autism and cerebral palsy that precludes speaking. He also has behavioral episodes that may range from tantrums to severe meltdowns that could result in injury to himself or others. Just explaining that to you is painful, because his dignity is important to us. He resides in an Intermediate Care Facility (ICF) which provides 24-hour care. He is largely unable to understand how to reason or make decisions. He knows that a dollar will help him go to MacDonald’s, but he has no concept of how many dollars and cents may be required. 

The very existence of Sheltered Workshops for those with Intellectual and Developmental Disabilities (IDD) has been attacked for the first time since the law was enacted in 1938 as a part of the new Social Security Program. Why do higher functioning disabled persons and their lobbying organizations want to deny lower functioning persons, the right to work? If a higher functioning individual can get a job that provides a mandated minimum wage, surely, they already have the minimum wage law in effect to protect them. So, let me tell you a bit more about Matt. 

Matthew loves to go to work at “PERCO”, a vocational Center in Perry County, Ohio. If we call him on Sunday evening and remind him that he gets to go to work the next day, he quite literally jumps up and down and makes sounds of anticipatory delight.

According to his job coaches, Matt is very proud that he accomplishes work and earns a paycheck. Matthew is unable to differentiate the amount of his check… he just revels in the fact that he has earned something of value which allows him to pay for things. If a picture is worth a thousand words, do you think this photo of Matt working conveys dissatisfaction or sadness? 

The following episode tells you the importance of his work. On a Saturday in February 2019, Fran and I got a call from nursing at Matt’s ICF. Matt had made the sign (crossed arms) for “work”. In other words, he wanted to go to work. But his Work Center is not open on the weekends. The direct care worker tried to explain to Matt that the Center was closed. Matt quickly went from a somewhat manageable tantrum to what we call a “meltdown” typically evidenced by his inability to control his emotions, yelling, crying, and in this case, he bit his direct care worker on the arm. The worker had to go to the hospital for treatment.

Supporters of “14 (c) Work Centers know many Myths for phasing-out the Sub-minimum Wage including self-determination. For example, it is simply untrue that “employers across the country are using this waiver to acquire cheap labor”. And, the false assertion that my son is somehow a victim of discrimination, and exploitation. Matt voluntarily attends a sheltered workshop because it fits his capabilities. People with IDD like Matt would never be able to work in “competitive employment” because his measured productivity (monitored by the Department of Labor) is too low, and for what he does achieve, he requires job coaches to teach, encourage and know how to deal with his disabilities.

An article written by David Ordan ["Eliminating subminimum wage waivers will harm hundreds of thousands of people with disabilities" 8/10/18 in thehill.com] said, 

“In 2014, 75 percent of individuals with I/DD receiving day or employment services through a state I/DD system were attending a sheltered or facility-based environment.

This means that efforts to remove 14 (c) subminimum wage certificates are essentially targeting one group, and one group alone: people with disabilities who choose to attend sheltered workshops”. 

He further explains that follow-up studies have shown the failure of closing Work Centers, like in Maine where, over a seven-year period displaced persons not able to obtain employment increased “Day Program” enrollment from 550 in 2008 to 3,178 in 2015.

Mis-informed logic ignores important subjective standards such as empathy, compassion and personal values resulting in treatment of folks like Matt as an individual. In 1938 persons who had just suffered through the Great Depression used not only logic but their values to say that Matthew Matters.

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See more on sub-minimum wage and sheltered workshops from The DD News Blog