From Autism Transition Handbook
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Support Services Overview
What are Waivers?
“Waivers” is a shortened term to describe the Medicaid Home and Community Based Waiver Program. This program provides funding for supports and services that help individuals with disabilities live in their homes and communities. Services offered go beyond those provided by Medical Assistance in order to help the individual remain in the community, rather than being admitted to a Long-Term Care Facility. Unlike Medicaid, waivers are not an entitlement program and may have long waiting lists. Most states offer waivers to provide home- and community-based services to people with developmental disabilities (DD), which may cover individuals with autism. For a complete list in your state, you can go directly to the agency within your state that administers the waiver program. Alternatively, you can find a complete listing of waiver programs at the Centers for Medicaid and Medicare services website.
In recent years, many states have added a waiver program specifically for individuals with autism. Currently, there are 11 states with autism waivers, largely for children: Colorado (0-6), Indiana (0 to no max), Kansas (0-5), Maryland (1-21), Massachusetts (birth to 8), Montana (1-4), Nebraska (0-17), North Dakota (birth to 4), Pennsylvania (21 and older), and South Carolina (3-10). These waivers have different requirements, and cover different services such as intensive individual supports, respite, case management, adaptive equipment/environmental mods, OT, PT, speech/language therapy, transportation, individual goods and services, program design & monitoring, adult day, day services, rent and food for unrelated live-in caregiver, residential hab and support, adult foster care, behavioral support services/crisis assistance, community transition, family and caregiver training, music therapy, psychological therapy, recreational therapy, and specialized medical equipment and supplies.
How Do I Know Which Waiver(s) My Child May Be Eligible For and Which One is Best for My Child?
Choosing the right waiver depends upon what your child's specific needs are. Prior to starting the process, it is a good idea to read the eligibility factors for each waiver, and see which one best fits your child's situation and needs. It may be possible that he or she is eligible for more than one waiver; in this case, you may want to apply for more than one waiver. Also, if your child is already covered under one waiver, but you want to apply for a different waiver, you may also do this. Please note, in this case priority for waivers are given to individuals who do not already have a waiver.
Waiver Funded Services to Support Living in the Community
Home and Community Services waivers can help your son or daughter gain, maintain, and improve skills that allow them to live and participate in their local community. The following is a description of waiver services that may be available:
- Habilitation is designed to assist individuals to gain, maintain, and improve skills in the areas of self-care, daily living activities, social skills, and to enable the person’s involvement in community activities. These services help people live in their home; participate in local community activities; use community resources such as parks, pools, movies etc.; and access informal supports such as service clubs, senior programs, and other community opportunities. Services can be provided by a service agency that provides trained individuals to provide assistance or by someone the person and family already knows who is qualified and willing to provide assistance.
- Community Habilitation is delivered in a licensed Adult training facility. Adult training facilities provide services that assist individuals in meeting personal needs and performing basic daily activities. JCAHO Accredited/MA Certified Non-Residential Agencies providing Community Habilitation assist individuals in acquiring, retaining, and improving self-help, socialization, and adaptive skills.
- Transportation services are offered to enable individuals to gain access to their community including both services and informal supports. Transportation covers emergency transportation in certain circumstances.
- Older Adult Day Services support people in meeting their personal care and social needs.
- Home Finding services provide assistance with activities related to self-determined housing. These include education about housing, and home ownership working with landlords, location of housing, and assessment for appropriate physical adaptations to make housing accessible.
- Environmental Accessibility Adaptations: Vehicle Adaptations for improved access and/or safety. Home Adaptations to homes for improved access and/or safety.
- Adaptive Appliances/Equipment The purchase or modification of items for increased functional involvement by individuals in activities of daily living.
- Habilitation Supplies for direct use by individuals and/or caregivers to address health and safety needs. Supplies are limited to those listed in the long definitions document.
- Homemaker Indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. There is no funding cap for this service in the P/FDSW. The consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year.
- Chore indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. Consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year. There is no funding cap for this service in the P/FDSW.
- Residential Home and Community Habilitation - Licensed Homes Direct service and services to meet regulatory requirements and contract conditions provided in licensed community homes to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills
Support Services for Individuals with Autism in Delaware
What Waivers are Available in Delaware and Who is Eligible?
In Delaware there are five available waivers. You may only be in ONE waiver at a time. The waivers are for Acquired brain injury, AIDS/HIV (AHW), Assisted living, Developmental Disabilities (DD), and Elderly and Disabled (E&D). The Developmental Disabilities waiver would be the waiver for which an adult with autism could apply.
How do I know if I qualify for a Delaware waiver?
In order to qualify, you must
- Be a Delaware Resident
- Make a referral to the appropriate office
- Complete a Medicaid application
- Be determined financially eligible
- Qualify for a medical level of care
- Be able to be safely maintained in the community
The level of care is determined by showing deficits in at least two areas of functioning. This can be through testing completed by the school that is then forwarded to DDDS or by DDDS completing the testing.
Qualifying disorders include Aspergers, PDD NOS, Autism, Prader-Willi Syndrome, Brain Injury, etc.
Why is it essential to apply for a waiver immediately after graduation?
In Delaware, funding is provided for young adults who qualify who are completing high school and moving on to the community. This funding is from the Joint Finance Committee and is available through DDDS. Graduating high school seniors who need additional support services in Delaware are eligible for the waiver (approximately 150 graduating seniors each year).
In the case that student applies later on for waiver services, there may be a wait of several months to two years for services. If the person qualifies for “emergency status” they can receive services more quickly. Emergency services are for people who are homeless or about to lose housing.
What is covered under the Delaware waiver?
The Delaware waiver covers housing, day programs, employment services, case management, and respite. The amount of respite varies case by case and depends on the needs of the family and the level of care of the child.
How do I apply for the Developmental Disabilities waiver?
The Developmental Disabilites waiver in Delaware is administered by the Division of Developmental Disabilities (DDDS). Before you can apply for the waiver, the first step is to apply to DDDS. This can be done by calling 1-866-552-5758. They can mail, email, or fax you an application.
If you qualify for DDDS services, you will be connected with a Family Support Specialist (Case Manager) and may be eligible for Respite services based on individual need. The DDDS services are NOT based on income. You may qualify for DDDS services, but not be eligible for a waiver. The Respite and Case Management services are separate from the waiver. DDDS services are available starting at 3 years of age.
If you do qualify for the waiver, you will recieve additional services to help keep you in the community including housing, day programs, and employment services.