OVERVIEW OF DDS ACS HCBS MEDICAID

WAIVER

Medicaid• Regular state plan

Medicaid pays for doctor appointments, hospital expenses, medicine, therapy and some adaptive equipment  

• Waiver allows Medicaid to be used to pay for additional services 

• If person is waiver eligible, they can obtain regular state plan Medicaid services as well as waiver services

Medicaid Waiver Facts• Implemented September 1, 1989• Alternative to institutionalization• Not an entitlement program• Voluntary program• Services and supports to live and work in the

community• Administrative authority and responsibility

for waiver including application by DMS• Approval of application by CMS• Day to day operation by DDS with oversight

by DMS

Application

• Contact DDS Intake and Referral staff (Adults) or DDS Children’s Services (Child)

• Informed choice of ACS Waiver and/or ICF (HDC)

• Complete application packet

• DDS review of application packet for eligibility

• Notification of placement on waiting list or ineligibility for waiver

Eligibility Requirements

• Developmentally Disabled (onset prior to age 22)

• ICF Level of Care limitations in 3 of 6 major life activities (self care, language, learning, mobility, self direction or independent living)

• Medicaid Eligible - $1911 (3 x SSI) monthly income limit, $2,000 resource limit and meet disability criteria

Case Management• Locating, coordinating

and monitoring of waiver services, state plan services, publicly funded services and informal community supports

• Development and timely submission of MAPS

• Assistance with Medicaid income eligibility and ICF level of care documents

Supportive Living Array• Individually tailored

services and supports that assist individual in acquiring, retaining and improving targeted skills necessary to reside in the community

• Direct care staff person works with person in waiver recipient’s home and community on identified goals and objectives

Supportive Living Array (cont)• Community Experience - activities in a

natural setting such as shopping at a grocery store

• Respite

• Non – Medical Transportation

Levels of Support• Pervasive – constant

support 24 hours a day, 7 days a week

• Extensive – schedule of daily or weekly supports less than 24 hours a day, 7 days a week

• Limited – intermittent in nature

Supported Employment

• Competitive employment

• Minimum wage

• Integrated work site

• On-going support

Adaptive Equipment

• Purchase, lease or repair of equipment required to enable individual to perform daily tasks

• Personal emergency response system

Environmental Modifications

• Adaptations to waiver participant’s place of residence

• Necessary to ensure health, welfare and safety

Specialized Medical Supplies

• Disposable undergarments

• Ostomy and colostomy supplies

• Nutritional supplements

• Non – prescription medications

• Drug and alcohol screening

Supplemental Supports• Emergency medical costs

including prescription co-pay

• Transitional expenses for moving from ICF/SNF

• Ancillary support to assure health and safety in crisis situation

• Fees for activities to reinforce specific habilitation needs (like Camps)

Consultation• Psychological or adaptive

behavior testing• Screening, assessing,

developing therapeutic treatment plans

• Training of direct care staff or family members

• Development of behavior management plan

• Determining appropriateness of equipment

Crisis Center/Intervention• Short term out of home placement for

intervention of crisis situation• In-home or community services provided

by mobile team during crisis situation to assist and/or train in dealing with behavior

Multi-Agency Plan of Service• Individualized• Services provided in least

restrictive environment• Monitored and adjusted

based on needs• Safeguards individuals

rights• Assures individuals health

and safety• Approved by physician• Prior approval by DDS

Waiver Assurances• Level of Care (LOC) for all

applicants and annually for persons on waiver using processes and instruments described in the waiver

• Person centered planning where individual has choice of waiver, waiver services and providers, plan is updated annually/as needed and addresses all assessed needs (including health and safety risk factors) and personal goals and services are delivered based on plan

Waiver Assurances, continued• Qualified Providers who meet

certification standards including provider training

• Health and Welfare is monitored continuously with remediation when appropriate

• Administrative Authority with Medicaid agency retaining authority and responsibility for waiver

• Financial Accountability billing for authorized services delivered by qualified providers in accordance with approved waiver

Contacts for Application

For CHILDREN (those up to age 21 and still in school):

501-682-2277

For ADULTS:

501-682-8678 or 501-683-5687