RD414 - Auxiliary Grant Portability a Plan to Restructure Auxiliary Grants for Certain CSB Case Management Consumers - December 3, 2008


Executive Summary:
Item 282 D of the 2008 Appropriation Act directs the Secretary of Health and Human Resources and State Board of Social Services to develop a plan for the portability of Auxiliary Grants (AG) to pay for housing of consumers who receive case management services from a community services board (CSB) or behavioral health authority and who are eligible for AG. Specifically, the plan must target Assisted Living Facility (ALF) residents. This plan is in response to a 2007 Virginia Acts of Assembly directive that the Secretary of Health and Human Resources submit a report to the General Assembly on the feasibility of restructuring the A, which concluded that such restructuring is feasible.

Under the proposed restructuring plan, eligible participants would be limited to those ALF residents who:

• Meet the Residential Assisted Living level of care criteria;
• Are receiving an AG and have been an ALF resident for at least the last six months;
• Are receiving Medicaid funded Case Management services from a CSB; and
• Meet the Department of Medical Assistance Services (DMAS) eligibility criteria for Mental Health Support or Intensive Community Treatment services.
Priority would be given to those meeting all of the above who reside in facilities that have given notice of closure or of discontinuing acceptance of AG recipients.

Individualized services would be provided as defined in the Medicaid State Plan Option services of Mental Health Case Management, and Mental Health Support or Intensive Community Treatment. The array of services would be based on an individual assessment and service plan. Housing would be in natural residential settings in the community, such as a one bedroom apartment or studio apartment.

In State Fiscal Year 2007, there were approximately 1,500 ALF residents who met the Residential Assisted Living level of care criteria and who received an AG and Medicaid funded Case Management services from a CSB. Approximately 300 of those also received Mental Health Support Services at some point during the year. The number of consumers to be served in a portable AG program, therefore, is estimated to be approximately 300 the first year and 500 the second year.

The restructured, portable AG would be financed in the same manner as regular AG, with the Department of Social Services (DSS) paying 80% and the locality paying 20% in local match. Program monitoring and quality assurance would be provided by the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) through its licensing of Case Management, Supportive In-Home Services, Intensive Community Treatment, and Programs of Assertive Community Treatment services.

Involved state agencies, local departments of social services and CSBs would have specified roles and responsibilities for successful operation of the restructured portable AG. The DSS and Department of Medical Assistance Services would provide administrative oversight and technical assistance. The DMHMRSAS would monitor and evaluate the impact of the program, and local departments of social services and community services boards would provide the direct program components.

Should the General Assembly authorize implementation of a restructured portable AG, a number of operational changes would need to be defined by the State Board of Social Services through regulation. In addition, implementation mechanics at the local level would need to be addressed.