Medicaid Waiver Programs: Adding Value to the Social Workers Tool Box
by Chava White, LMSW-AP-CCM
There are five Medicaid waiver programs in Texas. Clearly, these programs are valuable tools for social workers and are designed to assist all age groups. These programs are cost effective alternatives to institutional placement. They are considered waivers because the usual eligibility requirements—including household income—are waived. They are often applicable to cases involving a dependent child or adult child with life long disabilities. It is important to note that in the case of children, parental income does not disqualify them from eligibility for these waiver programs as long as the child has a disabling developmental, cognitive or medically complex condition and does not have savings in excess of $2000. Those who qualify for these Medicaid waiver programs automatically will have traditional Medicaid benefits*. While all of the Medicaid waiver programs have limited funding, restricted enrollment and waiting lists**, they still have an important value and can still serve as an important tool for the benefit of many of the families that we encounter in our work settings.
There has always been a perception that one has to be poor to qualify for state benefits. But many middle income individuals do qualify. There are also many social workers, especially those who have always worked with an adult population, who have no idea about most of these available programs. But in reality, anyone who meets disability, functional, cognitive and medical complexity criteria can usually qualify financially due to their life long disabilities.
Yes, the waiting list for these benefits is long. But that should not stop referrals for those individuals and families who would qualify for these waiver programs. This is particularly true for an adult with a disability. These programs can offer important program access which becomes even more important when loved ones can no longer care for them. It may be wise, in fact, to place individuals with disabilities stemming from childhood years on a waiting list as part of their long term care plan. For the parent of an adult child with a disability, such a plan would be comforting and extremely helpful.
No one gets to the top of the list if they don’t get on the list!!!!
Some people can qualify for more than one program, so they can be placed on more than one list.
Also, if institutional placement is essential, the knowledge of the availability of these waiver programs can be a real life saver because anyone in an institutional setting is eligible for immediate placement in an appropriate waiver program, traditional Medicaid benefits are also provided to those who are on these waiver programs!
The Five Home and Community Based waiver programs currently operational in Texas are:
1. Medically Dependent Children’s program (MDCP)
This program provides Medicaid and community based services for children under 21 who meet medical necessity criteria for nursing home care. Parental income is not an issue for those children who meet the medical necessity criteria and do not have more than $2000 in savings for the child.
Services included are respite care, minor home modifications, adaptive aides, supports to participate in child care, and assistance with independent living. Additional medical needs are covered by the traditional state Medicaid program inclusive of the Texas Health steps program.
To be placed on the wait list, call 1-877-438-5658 or in Houston 713-967-7597
NOTE: Any child residing in a state funded facility can ask to be placed on the MDCP program.
2. Community-Based Alternative (CBA)
This program is for adults who are over 21 and who qualify for nursing facility care. Those aging out of the Medically Dependent Children’s Program are automatically enrolled in this program. It is also a benefit for anyone who meets the nursing facility care who is enrolled in a managed care plan in Harris County.
Covered services include: respite care, adult foster care, nursing services, speech, physical and occupational therapy, adaptive aides and medical supplies, minor home modifications, personal assistance services, emergency response services, assisted living, home delivered meals, and consumer directed services.
In Harris County, where many of the Medicaid services are under a managed care provider, CBA is a benefit for any plan member who meets the nursing facility level of care criteria.
For more information go to: www.dads.state.tx.us/services
In Houston call: 713-692-1635
NOTE: Anyone residing in a nursing home setting can request to be placed on the CBA program.
3. Community Living Assistance and Support Services (CLASS)
This program provides Medicaid and community based services to individuals of any age who are developmentally disabled as an alternative to institutional placement. The onset of disability must be before age 22. Additionally, the individual must have a “related condition” that impairs daily functioning. The disability must be one other than mental retardation (but not in exclusion of mental retardation) and this disability affects the individual’s ability to manage activities of daily living. The individual must be either receiving SSI or be eligible under Medicaid nursing home criteria. Parental income is not an issue for qualifying.
Covered services include: case management, adaptive aides, habilitation, respite care, limited nursing services, psychological services, speech physical and occupational therapy, supplies, minor home modifications, supportive employment, specialized therapies, consumer and directed services.
To be placed on the wait list, call the state office @ 1-877-438-5658
For more information go to: www.dads.state.tx.us/services
NOTE: Anyone residing in a state funded facility meeting the above criteria can ask to be on CLASS.
4. Home and Community Based services (HCS)
This is a Medicaid waiver program for individuals with a primary diagnosis of mental retardation and is offered as an alternative to ICF-MR placement. It is available to anyone who is eligible for SSI, NH Medicaid and for those who are under 18; parental income does not disqualify the individual as long as they do not have assets greater than $2000.
Available services are either provided to individuals living with their family members, in a foster home (this includes parents assuming role of foster parents), or in a personal care home with no more than four others receiving same services. Benefits of this program include: case management, adaptive aides, residential assistance, day habilitation, respite, limited nursing care, minor home modification, counseling and therapies, dental treatment and supported employment.
Telephone numbers: Harris county: for waiting list: 713-970-7799
For information: 713-970-7649
This program is under contract to MHMRA
For more information go to: www.dads.state.tx.us/services
NOTE: Anyone residing in a state funded facility meeting the above criteria can ask to be on HCS
5. Deaf-Blind Multiple Disabilities (DBMD) Program
This program is available to those 18 years old or older who are deaf and blind and who have at least one additional disability. Individual must be on SSI or meet the Medicaid nursing home criteria.
Services provided include: case management, habilitation service, Case management, assisted living, day habilitation, speech, physical and occupational therapies, respite care, limited nursing services, adaptive aides, supplies, chore provider, environmental accessibility, orientation and mobility, behavior communication services, consumer directed services.
For enrollment, contact DADS at-1-877-438-5658 to obtain a DBMD Medicaid Waiver Interest Form which is faxed to 512-438-3549.
More information is available at: www.dads.state.tx.us/services
NOTE: Anyone residing in a state funded facility can ask to be on a community based program.
The writer hopes that social work colleagues will remember that there are waiver programs available for people with life long developmental, cognitive and medical complexity. Don’t forget to include these valuable waiver programs in your social work tool box.
Chava White, LMSW-AP-CCM
Advanced Practice Social Worker
St. Luke's Episcopal Hospital
Houston, Texas
*except for the CBA program which in many cases currently required recipients to chose one of the Medicaid managed care plans.
**The waiting lists have been challenged by the Advocacy, Inc on behalf of The ARC of Texas and state is now required to expedite enrollment by 5-20%
