Medical waiver to be redesigned for disabled in VA

Medical waiver to be redesigned for disabled in VA

RICHMOND, VA (WWBT) - Thousands of people with disabilities and families of the disabled have applied for "medical (Medicaid) waivers" over the last decade.

Those waivers combine federal and state money to provide long-term support for individuals who are elderly or have disabilities. That includes medical and non-medical services without the requirement that a person lives in an institution in order to receive the services. The waiver program is being redesigned and is expected to be implemented on July 1.

The redesign comes after a Department of Justice investigation in 2012 that found Virginia not to be in compliant with the Americans with Disability Act. The DOJ's reasoning ranged from a waiting list of almost 11,000 people along with some inadequate reimbursement rates and a lack of providers who are able to offer services to the disabled. Some people are on the waiting list for a medical waiver for years, even decades.

The Commonwealth complied, thus a redesign was born.

Tammy Burns, the mother of a 17-year-old boy with autism, said she had to wait seven years after applying for a waiver when her son was just 6 years old. She is thankful for the re-design, but says there is still a long way to go.

"It was very heartbreaking as a family because you knew there were these services that would really benefit him and your family and yet you're waiting," Burns said about her experience.

The redesign and medical waivers are overseen by the Department of Behavioral Health and Development Services, a state-run organization.

Previously, individuals with disabilities could apply and obtain waivers under the name: Intellectual Disability waiver (ID), Day Support waiver and Individual and Family Developmental Disabilities Support waiver (DD.)

There are also two separate waiting lists for people with intellectual and developmental disabilities, more than one access point to sign up and the current waivers are very disability specific.

Those will change to the Community Living waiver (CL,) Building Independence waiver (18 years old and older) (BI), and the Family and Individual Supports waiver (FIS).

The current Day Support waiver will become the Building Independence waiver and is intended to support adults 18 and older to be able to live independently in the community. Individuals will typically own, lease or control their own living environment. The supports available will be periodic or provided based on need.

The Developmental Disabilities waiver will become the Family and Individual Supports waiver and provide supports for people living with their families friends or in their own homes. It's available to children and adults.

The Intellectual Disability waiver will become the Community Living waiver and provide up to 24/7 residential services and additional supports for adults and some children with major medical and behavioral support needs.

The Department of Behavioral Health and Developmental Services says the new waivers are more individualized and will help address specific needs of the disabled.

There will also be a single entrance point to apply. The single access point is now the Community Services Board (CSB), regardless of disability category. The waiver redesign is also supposed to provide individuals with the ability to move between waivers depending on their needs and abilities.

Heather Norton, the director of community support services for the Department of Behavior Health and Developmental Services, said the redesign will have a positive impact moving forward.

"We'll have one statewide waiting list which will change to prioritization category so we'll have a priority one category for individuals who need services within the next year, prioritization two for individuals who need services between two  and five years and priority three for people who need services five years or more," Norton said. "As we start to shift the way we're providing services based on support needs we're likely going to be able to serve more individuals with similar amounts of money."

The new waivers are also supposed to be less costly than the old waivers.

Norton says there will be more service options to assist individuals to be better connected and involved in their communities.

Norton also says the waiting list is being split into prioritization categories depending on if someone needs services immediately of if a person can wait.

Norton recommends if you are on the waiting list, make sure your information is up to date with your case manager, that will determine where you will fall on the waiting list.

For individuals who have waivers, the transition should be seamless. However,  what will change are some processes. For example, individuals with the DD waiver will now be assessed using the SIS Assessment instrument.

Individuals seeking DD and FIS waiver services will go through the CSB rather than the Department of Health Child Development clinics for eligibility screening because there is now a single point of entry at CSB.

The new waivers must still be approved by the Center for Medicaid Services. It is anticipated that will occur by July 1, but could happen later.

Additional slots have been requested of the General Assembly for each of the new waivers to hopefully serve more people and get individuals off the waiting list.

Copyright 2016 WWBT NBC12. All rights reserved