In 2013, the Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS) began an effort to redesign the systems of supports for Virginians with intellectual and other developmental disabilities (DD). The goals of this initiative, which came to be known as “My Life, My Community," include:

• Supporting the Commonwealth’s efforts to comply with the terms of the settlement agreement with the U.S. Department of Justice to ensure that persons with DD receive services in the most integrated setting appropriate to their needs;

• Better aligning the supports that individuals receive with their needs;

• Encouraging the provision of services in small community homes, community-based day programs, and other more integrated services;

• Expanding the range of options available to support individuals in settings other than congregate residential programs, such as state training centers;

• Developing and implementing an electronic system for managing the statewide waiting list for waiver slots, slot assignment, and service authorization for all three waivers; and

• Increasing the capacity of the waivers to serve more individuals.

Years of work by DBHDS, DMAS, and system stakeholders on the My Life, My Community initiative culminated in federal approval of significant amendments to Virginia’s three 1915(c) waiver programs for persons with DD, effective September 1, 2016. As of January 2018, there were 13,150 people enrolled among the waivers and 12,320 additional people on the waiting list to receive a DD waiver slot. The three amended waivers and the number of individuals enrolled in each as of January 2018 is shown in Figure 1 on page 2.

Thus far, many of the goals of the redesign have been achieved:

• The three redesigned waivers, with new services and revamped rate structures for most services, are in place.

• The electronic waiver management system (WaMS) has been operational since September 1, 2016. As with any information technology system, the implementation was not without its challenges. Yet, through January 1, 2018, 22,249 service authorizations have occurred via WaMS, additional functionality has gradually come on-line (such as the individual support plan), and future changes and additions are being discussed.

• A waiver amendment was approved by CMS effective June 1, 2017 to implement a customized rate process by which those few individuals whose needs exceed the existing tier reimbursement system can be fully met by their providers. To date, 82 individuals have been approved for a customized rate.

• CMS is currently considering waiver amendments for two of the three remaining new waiver services (for which state funding was delayed beyond that of the other new services): Community Guide/Peer Mentoring and Employment and Community Transportation. Further rate methodology development was required for the third service (Benefits Planning) and that is currently underway. These services are expected to increase community integration in activities and settings that will decrease or prevent an increase in the need for ongoing paid staff to support the individual.

This report focuses on changes in per member per month costs comparing individuals who began receiving waivers services in Fiscal Year (FY) 2017 and those enrolled between one and four-and-a-half years ago, as well as changes in total waiver expenses over the past five years.