Now that we’ve covered the Medicaid waiver and what it can do for you, we’ll review the variety of services available. Your options vary based on the type of waiver and whether you are on a traditional waiver or using self-directed services under CDCS. Additionally, your ability to access these services is dependent on your budget, the availability of services in your area, and in some cases, County approval. You may be thinking this is a lot to take in – I’m here to break it down for you! Keep reading to learn about each of the services available.
Service Options Available Under Traditional Waivers
Let’s start with the four different traditional disability waivers.
- Brain Injury (BI)
- Community Alternative Waiver (CAC)
- provides funding for home and community-based services for children and adults who are chronically ill. The CAC Waiver is designed to serve persons with disabilities who would otherwise require the level of care provided in a hospital.
- Developmental Disabilities (DD)
- a program that provides home and community-based services to children and adults with a diagnosis of a developmental disability or a related condition who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD)
- Community Access for Disability Inclusion (CADI)
- is a statewide program that provides financial assistance to eligible individuals to help them with the cost of services that enable them to remain living independently.
Service Options Available Under Self-Direction and Traditional Waivers
- 24-hour Emergency Assistance: On-call counseling and problem solving and/or immediate response for assistance at a person’s home due to a health or personal emergency.
- Adult Day Services: Individualized program of activities designed to meet the assessed health and social needs of a person 18 years or older outside of their residence during the day. Adult day services include the delivery of supervision, care, assistance, training, and activities directed toward achieving specific outcomes, as identified in the person’s support plan.
- Caregiver Living Expenses: Certain expenses incurred by an unrelated caregiver who lives in the same household as a person 18 years or older who receives waiver services when the caregiver also provides an approved service.
- Waiver, AC and ECS Case Management: A service that provides people and their families with access to assessment, person-centered planning, referral, linkage, support plan monitoring, coordination and advocacy related to waiver services, resources and informal supports that are not necessarily funded through the waiver.
- Care coordination: A service for people enrolled in Minnesota Senior Health Options (MSHO) and/or Minnesota Senior Care Plus (MSC+). It provides assessment and coordination of the delivery of all health and long-term care services among different health and social service professionals and across settings of care. Care coordination also includes the waiver case management responsibilities identified above.
- Case Manager/ Care Coordinator: The professional who assists with social, health, educational, vocational, and other supports and services based on the person’s values, strengths, goals, and needs. This professional is responsible to provide the person with the information necessary to make informed choices.
- Chore services: Assistance provided to a person or their primary caregiver to help maintain a clean, sanitary, and safe environment.
- Crisis respite: Short-term care and intervention strategies provided to a person due to:
- Need for relief and support of the caregiver and protection of the person or others living with the person
- Person’s need for behavioral or medical intervention.
Employment exploration services: Services that help a person gain a better understanding of competitive, integrated employment opportunities in his/her community. Exploration activities and experiences strengthen a person’s knowledge, interests, and preferences so he/she can make informed decisions about competitive employment.
Employment exploration includes:
-
- Individualized educational activities
- Learning opportunities
- Work experiences
- Additional related services identified in the person’s coordinated services and support plan (CSSP).
- Competitive, integrated employment: Employment that pays a minimum wage or an industry-standard, customary, or prevailing wage with comparable benefits (e.g., health insurance, leave time, etc.).
- Employment development services: Individualized services designed to help a person achieve competitive, integrated employment, become self-employed, or establish a microenterprise business in his/her community.
- Microenterprise business: A commercial business with five or fewer employees, including the owner(s) of the business.
- Environmental accessibility adaptations (EAA): Physical adaptations to a person’s primary home or primary vehicle to ensure the person’s health and safety or enable them to function with greater independence. For information about what is considered a primary home/vehicle,
- Extended PCA services: Services that follow Medical Assistance (MA) state plan PCA policies but are allowed to exceed the state plan limits on the amount, duration, and frequency based on a person’s assessed need. A person’s dependencies determined in the state plan assessment do not change by adding extended PCA services.
- Family training and counseling: Professional services that provide instruction and guidance to the person and/or family.
- Home-delivered meal: An appropriate, nutritionally balanced meal that is delivered to the person’s home.
- Homemaker: Services that help a person manage general cleaning and household activities. There are three homemaker services:
-
- Homemaker/cleaning
- Homemaker/home management
- Homemaker/assistance with activities of daily living (ADLs).
- Housing access coordination (HAC): A waiver service that helps a person plan for, find, and move to his/her own home. It is a pay-for-performance, person-centered service that pays for staff assistance based on the results achieved. A provider is reimbursed for actual time spent helping a person secure housing.
- In-home family supports: Services provided to a person and his/her family (including extended family members) in the family’s home and/or in the community to enable the person to remain in or return to the home. This includes training of the person and family members to increase their capabilities to care for and maintain the person in the home.
- Night supervision services: Overnight assistance and supervision provided by an awake staff in a person’s own home.
- Personal support: Services provided in the person’s home or community to:
- Achieve his/her full potential
- Increase his/her independence
- Meet community inclusion goals that are important to and important for the person and based on an assessed need.
- Positive support services: Services that consist of developing, implementing, and monitoring a person-centered, individually designed, proactive plan to address challenging behaviors. A waiver positive support professional develops this plan to enhance a person’s quality of life through the process of teaching or increasing positive behavior. When possible, the person leads the process to develop a positive behavior support plan and/or positive support transition plan.
- Respite: Short-term care services provided to a person when the person’s primary caregiver is absent or needs relief.
- In-home respite: Respite provided in the person’s home or place of residence.
- Out-of-home respite: Respite provided outside of the person’s home or place of residence.
- Specialist services: Services provided by an expert or professional designed to promote, support, and augment staff and caregiver competency to meet a person’s needs in eligible areas.
- Transitional services: Items and expenses necessary and reasonable for a person to transition from an eligible setting to their own home.
- Transportation services: Transportation necessary to gain access to waiver and other community services, activities, resources, and employment.
The following services are available only to people on the DD waiver:
- Residential habilitation: Services provided to a person who needs support to live in the community. The services are provided in the person’s own home and community, and they are directed at increasing and maintaining the person’s physical, intellectual, emotional, and social functioning. Residential habilitation includes assistance to develop, maintain, or improve skills related to activities of daily living (ADLs). These services include:
-
- In-home family supports
- Supported living services (SLS) in the person’s own home
- SLS in a provider controlled setting. While this is billed under the waiver as SLS, it is the service provided in what is commonly called Adult or Child Foster Care or “group homes”.
- In-home family supports: Services provided to a person and their family (including extended family members) in the family’s home and/or in the community to enable the person to remain in or return to the home. This includes training of the person and family members to increase their capabilities to care for and maintain the person in the home.
- Supported living services (SLS): Services provided to a person who requires daily staff support for challenging behaviors, medical needs, physical needs, and/or life skills. For people younger than age 18, SLS is provided to children who live outside of the biological or adoptive home.
- Remote support: A real-time, two-way communication between the provider and the person. Remote support:
- Supplements direct in-person service delivery of individualized home supports and supported living services for adults in their own home (SLS)
- Meets the intermittent or unscheduled support needs for a person to live and work in the most integrated setting.
- Real-time, two-way communication: Remote support delivered through one of the following methods:
-
- Telephone
- Secure written electronic messaging (e.g., texting) (Note: this does not include email or fax)
- Secure video conferencing.
- Day training and habilitation (DT&H): Services that develop and maintain life skills for people with developmental disabilities or related conditions so they can fully participate in community life.
- Assistive technology: Devices, equipment, or a combination of both that improve the person’s ability to:
-
- Communicate in the community
- Control or access his/her environment
- Perform activities of daily living.
Services not available under the DD waiver:
- Adult companion services: Non-medical care, supervision, and socialization provided to a person age 18 or older.
- Independent living skills (ILS) training: Services that develop, maintain, and improve the community living skills of a person.
- Individualized home supports: Services providing support and training in community living service categories for people 18 years or older who live in their own homes. Individualized home supports can be provided in the person’s own home or in public community settings and either in person or remotely.
- Support for individualized home supports: A staff member providing direct supervision, cueing, maintenance, guidance, instruction, incidental assistance with activities of daily living, or assistance with coordination of community living activities.
- Training for individualized home supports: Instructional services through which a person receives direct training from a staff member on community living skills identified in a person’s assessment (e.g., MnCHOICES, long-term care consultation ). Training includes skill-building to acquire, retain, and improve the person’s experience living in the community.
- Community living service categories: Broad service categories for providing support and training to help a person to live independently in the community. The community living service categories are:
-
- Community participation
- Health, safety, and wellness
- Household management
- Adaptive skills.
- Remote support: A real-time, two-way communication between the provider and the person.
-
- Supplements direct in-person service delivery of individualized home supports and supported living services for adults in their own home (SLS)
- Meets the intermittent or unscheduled support needs for a person to live and work in the most integrated setting.
- Real-time, two-way communication: When using remote supports, real-time, two-way communication must be used. Support is delivered through one of the following methods:
-
- Telephone
- Secure written electronic messaging (e.g., texting) (Note: this does not include email or fax)
- Secure video conferencing.
- Specialized equipment and supplies (SES): Devices, controls, or medical appliances or supplies specified in the community support plan.
- Adult foster care: Individual waiver services that provide ongoing residential care and supportive services to adults living in a home licensed as family foster care or a community residential setting (CRS). These services are individualized and based on the needs of the adult, as identified in the support plan. Adult foster care can be provided in one of two settings:
- Family foster care setting: A licensed family foster care setting where the license holder resides in the home.
- Community residential setting (CRS): A licensed residential setting that serves adults and where the license holder does not reside. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis). In this type of setting, at least one person receives foster care or supported living services funded by an HCBS waiver program.
- Child foster care: Individual waiver services that provide ongoing residential care and supportive services in a home licensed as family foster care or corporate foster care. Child foster care services are provided to children younger than 18 years old who cannot be cared for in the biological or adoptive home. These services are individualized and based on the needs of the child, as identified in the support plan. Child foster care can be provided in one of two settings:
- Family foster care setting: A licensed family foster care setting where the license holder resides in the home.
- Corporate foster care setting: A licensed corporate foster care setting where the license holder does not reside. This setting typically uses a shift-staff model of support (i.e., paid staff work shifts on a 24-hour basis).
Based on your budget, the above services can be accessed through self-directed services. The options for services increases when using CDCS, although budget amounts may be less.
Stay tuned for an upcoming blog that will focus on self-direction-CDCS!Meet Barb Turner! She’s an expert on Medicaid, has spent over 35 years in the field of disability services, and works closely with the Minnesota State Capital advocating for improvements to services for people with special needs. She is thrilled to share her knowledge with the Joshin community and make Medicaid easier to navigate for all!
Looking to schedule care? Find special needs caregivers near you.