Frequently Asked Questions on Transition: Medicaid Waivers and Related Programs
Keywords: Texas Parent to Parent, Medicaid Waiver Program, Medicaid, Consumer Directed Services, Community First Choice
What are Medicaid Waivers?
Medicaid Waivers are long-term supports and services provided by a state/federal partnership for people who need assistance with daily living. The purpose of the Waivers is to keep someone living in the community rather than an institutionalized setting. The same income and resource limits apply as for SSI, but Waivers are the one program based on the assets of the child even under age 18 rather than a family’s.
Why is there such a long waiting list? Are there new programs?
The State of Texas has been slow to fund these programs; however, in the Legislative session of 2013, the state added waiver-type services to STAR+PLUS for people at age 21 who are nursing-home eligible. If your child receives Medicaid, she should receive a letter at age 21 directing her to select a STAR+PLUS MCO (Managed Care Organization) for health services. Another new funding source is Community First Choice (CFC) (June 2015) for people with disabilities of all ages; check with your Local Authority for more information. Additional information on CFC is below.
How do I get my child on the Medicaid Waiver interest (waiting) lists?
There are several different Waivers. Call 877-438-5658 for CLASS and similar programs; contact your Local Authority for HCS and related waivers. You do not have to prove eligibility when you get on the interest list. You must keep your contact information up to date at both sites. (To find your Local Authority, go to https://www.dads.state.tx.us/contact/search.cfm)
What happens when my child’s name comes up on the interest list?
He or she will receive a registered letter from the funding agency. You will be given information about the programs and choices available. You will have to choose a case management provider. If your child proves to be eligible for that waiver, you will create a budget with the assistance of a case manager. Medicaid Waivers give choices to the recipient and family about how to use the program and which services to use from a list of available services.
What is CDS (Consumer Directed Services)?
One of the choices for Waiver services is the CDS model, which empowers the person receiving the service (or someone given that authority) to be the employer of record for attendant care and respite providers. Choosing CDS provides more control over who will work with your child than if you use care providers employed by an agency; you will also be able to pay them at a higher rate. Note that this model requires more effort on your part.
What happens when my child is receiving one waiver service and his name comes up on another waiver?
You can only use one Waiver at a time; you’ll need to do the research to decide which Waiver will best suit your child. It might help to talk to other parents whose children receive Waiver services; call the TXP2P office to connect with community wisdom. See this chart for a comparison of all Waivers: http://www.dads.state.tx.us/providers/waiver_comparisons/index.html
What is Community First Choice?
The following information about CFC is taken from this website: http://www.hhsc.state.tx.us/medicaid/managed-care/community-first-choice/
A federal option, called Community First Choice, allows states to provide home and community-based attendant services and supports to Medicaid recipients with disabilities. This option provides states with a 6 percent increase in federal matching funds for Medicaid for these services. To be eligible for Community First Choice services an individual must:
- Be eligible for Medicaid
- Need help with activities of daily living, such as dressing, bathing and eating
- Need an institutional level of care
Community First Choice services include:
- Activities of daily living (eating, toileting, and grooming), activities related to living independently in the community, and health-related tasks (personal assistance services)
- Acquisition, maintenance, and enhancement of skills necessary for the individuals to care for themselves and to live independently in the community (habilitation); providing a backup system or ways to ensure continuity of services and supports (emergency response services); and
- Training people how to select, manage and dismiss their own attendants (support management).
Texas began the Community First Choice program on June 1, 2015. This means:
- Individuals on a 1915(c) waiver interest list who meet eligibility and coverage requirements may be eligible to get Community First Choice services.
- Individuals already getting services through a 1915(c) waiver will continue to get those services as they do today from their existing providers.
To access CFC, go to your Local Authority for people over 21. (To find your Local Authority, go to https://www.dads.state.tx.us/contact/search.cfm)
For those under 21, go to the Department of State Health Services (call the Texas Medicaid & Healthcare Partnership (TMHP) PCS Client Line toll free at 1-888-276-0702
For more information, go to http://www.dads.state.tx.us/providers/cfc/
General information about CFC
CFC Frequently Asked Questions
For more information, go to http://txp2p.org/parents/pathwaysSevvices.html#ptaServMediWav