HD47 - A Report on the Methods for and Feasibility of Developing a Waiver for Children with Physical Disabilities That is Separate from Current Department of Medical Assistance Services Waivers

Executive Summary:
House Joint Resolution 182 (Appendix I) directed the Department of Medical Assistance Services (“DMAS”) to “study the methods for and feasibility of developing a waiver for children with physical disabilities that is separate from current Department of Medical Assistance Services waivers.” For purposes of this study, this will be referred to as a study of children’s waiver services. Under HJR 182 it was anticipated that DMAS would develop a waiver that would provide services to children with physical disabilities and provide parents with as much control as possible in the care of their children.

DMAS convened a workgroup for the purpose of evaluating the feasibility of developing a waiver for children with physical disabilities that is separate from current DMAS waivers. The members of the workgroup included: representatives from the Virginia Association for Home Care, Department of Health, Department of Education, Department of Mental Health, Mental Retardation, and Substance Abuse Services, Department of Rehabilitative Services, Consumer Representatives for Children with Physical Disabilities, Centers for Independent Living, Department of Social Services, and DMAS.

There is consensus among the Workgroup and DMAS that Virginia could develop a new home and community-based waiver to offer children with physical disabilities services that would help keep them in their homes and communities. The following recommendations address the feasibility and advisability of offering a home and community-based care waiver for physically disabled children and are in no way intended to fully outline all the details which must be addressed in developing and implementing a waiver for physically disabled children.


• DMAS could develop a new home and community-based care waiver could serve children with severe physical disabilities under 18 years of age and who meet functional and eligibility requirements. Functional requirements include those children who have related conditions as specified in 42 CFR 435.1009. These requirements would be in accordance with the population HJR 182 seeks to maintain in the community, thus avoiding institutionalization.

• There is a possibility that offering a new Medicaid home and community-based care waiver for children with developmental disabilities would encourage entry into the waiver of a population that previously did not participate in a waiver, even though they may have met programmatic and financial eligibility criteria. This also might include some children with related conditions who are on the waiting list to receive services in the Mental Retardation Waiver. To provide DMAS with a better understanding regarding the number of children who may access services under a new waiver, DMAS could develop a model 1915(c) home and community-based care waiver with an initial enrollment limit of 200 children per year during the first three years of operation. After DMAS obtains a better understanding of the number of children who would be eligible for services, the limit could be removed and costs could be adjusted to account for all children who need the service, although this would not be required.

• Services that could be provided in a home and community-based care waiver include personal care, respite care, assistive technology, home modifications and case management.

• The waiver could contain a consumer-directed model of service for parents of children enrolled in the waiver who are under 18 years of age. Under this model, parents could have the ability to hire, train, supervise and fire the personal attendants who provide care. DMAS would need to identify what guidelines would be used to determine if a parent is incapable of independently managing the child’s personal attendant. In addition, parents who are interested in being the employer in the CD-PAS Program could receive consumer training that will assure that the parents understand how to manage the child’s service.

- If this model is chosen, DMAS could mandate additional requirements for personal attendants in the consumer-directed model of service. For example, personal attendants would be screened through the DSS Child Protective Services Registry in addition to completing a criminal history record check with the State Police.

• A new Medicaid home and community-based care waiver that serves 200 disabled children who meet ICF/MR level of care criteria would demonstrate a cost savings to the Commonwealth of $6,536,000 per year to provide services in the home or community versus the ICF/MR institutional setting. The total projected costs for a new waiver to serve approximately 200 physically disabled children per fiscal year would be $6,535,800. Of this amount, approximately $4,403,592 in additional Medicaid funding would be needed to implement the waiver. DMAS would also require additional funding of $99,200 to pay for Medicaid Management Information System development and implementation and staffing to provide waiver oversight.

• The new Medicaid Management Information System (MMIS) system is projected to begin operation in sometime beginning in the year 2001. Since the new system will not be ready for implementation under after January 1, 2001, the existing MMIS system will need to be prepared for Year 2000 Compliance. Preparing the existing MMIS system for Year 2000 Compliance or implementation of the new MMIS system will be given priority over other projects. Therefore, the most realistic proposal to develop and implement a new home and community-based waiver would be January 2001.