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New Medicaid Waiver Rules Set To Take Effect

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In a long-awaited move, federal officials are clarifying what counts as home and community-based services for people with disabilities.

Under a final rule expected to be published in the Federal Register next week, housing for those with disabilities will not only be judged by its location or physical characteristics but will also have to meet specific “outcome-oriented” criteria in order to qualify under Medicaid home and community-based services waivers.

“Home and community-based settings do not include a nursing facility, institution for mental diseases or an intermediate care facility for individuals with intellectual disabilities,” the rule states. What’s more, homes “must exhibit specific qualities to be eligible sites for delivery of home and community-based services” under the new federal requirements.

Specifically, the settings must be integrated in and provide full access to the community and be places where individuals choose to live, Medicaid officials said. Additionally, homes must offer personal rights to privacy and dignity and allow individuals to independently make choices about daily activities, their physical environment and who they interact with.

The new rule also states that individuals with disabilities receiving Medicaid home and community-based services do so through a person-centered planning process.

“People with disabilities and older adults have a right to live, work and participate in the greater community,” said Secretary of Health and Human Services Kathleen Sebelius. “Today’s announcement will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

States offering existing Medicaid waivers for home and community-based services must establish transition plans to meet the new requirements as soon as possible under the rule.

Medicaid officials previously said that they were prompted to issue the new rules — which have been in the works for years — after hearing reports of homes built on the sites of former institutions that were being labeled as community-based.

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Comments (15 Responses)

  1. Dadvocate says:

    Friday afternoon news dump? Wow! HHS must not be too keen on media scrutiny post the Obamacare website debacle. This highly contentious, years in the making rulemaking will certainly get detailed study and comment inspite of the timing of the announcement.

  2. sarachaya says:

    My son has met all the criteria for home and community based service – including the one in our state which says he must have his OWWN HOME – thus huis name is on the lease of the town home he rents. To be truley in the community, some of these rules – along with SSI rules need to be amaended so that he is permitted to SAVE towards down payment to buy his very own home.

  3. Brian Bishoff says:

    About time. Every state/region can do it. We’ve managed without institutions where I live and work (New Hampshire) since the late 80’s, though there are a few group homes.

  4. Cathy says:

    In KS, the state from which Sebelius is coming, there is a 5 year waiting list to be offered residential. If you turn down residential at the end of the 5 year wait, you go to the bottom of the list. Programs in KS are terrible. We pulled our son out of 3 different day programs and finally gave up. The only difference for people like my son who aren’t high functioning between an institution and day services/ residential is a bus ride to and fro. All these is good PR but amounts to nothing in the “field”! And, yes, everyone in the state is aware of my feelings and the specifics.

  5. Sandy says:

    I totally agree with sarachaya says. If SSI would raise the limit of income allowed maybe several of us that can and do work as much as physically possible could save enough to benefit the community as a whole.

  6. Rosella A Alm says:

    Nothing is perfect for everyone. It is up to each of us to do our best to make as good a life as possible for our loved one with a disability. My son has multiple disabilities, and is unable to communicate orally. He has autism, epilepsy and many gastrointestinal problems, yet he lives in his own home with twenty-four hour support staff. The house he lives in is owned by a special needs trust. Both he and his support staff pay rent to the trust.

    In our state, CA the twenty-one Regional Centers do assist people with disabilities to achieve these goals.

  7. LW says:

    I am in Texas, My son is on the program, But he gets nothing, We have been trying to get him Discharged for 6 months, and the Local will not do it , It is suppose to take 10 days. my son brings a lot of money in due to his high LOC, and when they shut down instatutions, they build more group homes, this is not right for many they could serve if they would let people out that do not want their services.

  8. Kellie says:

    I agree that we (disabled people) must be allowed to save money. However, there are some state and federal programs that allow it. For example, in Iowa, some of the Waiver programs allow an individual to have savings of $12,000 and a couple $13,000. This has been very helpful for my husband and myself, as we are both on the Waiver.

  9. patm says:

    Does this new ruling mean that Misericordia in Chicago, which is built on the site of a former institution and does as good a job or better than any of the other agencies serving the disabled population, will not qualify as being community based? If this ruling challenges that, it is off base. What matters NOT is the physicality, what matters is the programming that supports the individual, no matter where it is done.

  10. Judith Greenbaum says:

    Community based homes should be judged by their program discriptions and outcomes rather than by how many people live there and where the homes are situated. If an individual with ID goes bowling once a week, eats out once a week, goes to the movies once every other week, exercises at an athletic club twice a week, visits family every other week, and works every day at a church but lives with 7 other people with ID in an apartment on grounds that that contain other apartments for people with ID, is that indivodual integrated into the community?

  11. LW says:

    To Judith’s question,
    THE IN HOME COMMUNITY BASED SERVISE PROGRAM WAS Designed for the home as in Family based an Family orientated , where the family member could stay with the ones they loved, the ones that raised them, until this program they had no choice but to suffer and be separated from there family. There is a BIG difference in the program and the one you speak of. A group home should have NEVER been allowed to collect this money, Many Loved ones were just taken to day hab and basically kidnapped by the providers, because the got triple money for the person with IDD and the family’s lost all they had. I know some who lost their homes, cars , and became homeless. THIS IS NOT RIGHT FOR NO PROVIDER TO BE THIS GREEDY. There is a lot to say on the matter but this is clear to me . It’s clearly about FAMILY.

  12. Dan says:

    Anybody can write a regulation or make an assertion of rights. To support people effectively with the resources available, that’s the work. More than anything else, institutions are the compromises made to some concept of financial reality of the time. In 1976 I worked in a 22 bed group home where everyone shared a room. It was not what its creators had hoped it would be the day it opened, but for the people who came there from a state institution where they lived 50 to 100 people in a room, it was a better life. Advocacy to me, is not about creating a perfect world but about reaching for that better life.

  13. maggie dee says:

    If these person-centered “homes” are state controlled/run then these waivers will NOT be places people will choose to live. Apartment units, each with its own kitchen, bathroom(s), bedroom(s…depending on size of family) and individually rented with varying rent based on income is still marginalizing and medicalizing housing. The only truly “accessible’ are those units or single family dwellings are those found under Housing Vouchers (similar to Sect. 8). When people have a common dining room, living room the “person-centered” is still a facility. This is bunching people with disabilities in an area rather than a mix of households. Maggie Dee Dowling, KUSF in Exile

  14. Cathy Enfield says:

    This is a very complex issue. Many decisions in these rules need to be broken down for real life.

    I have many questions to ask and many remedies to receive about these new rules. There is just not enough definition.

  15. holly says:

    Its still about these non-profits with their own care coordinators and owning their own group homes. Lots of money to be made. I would say the majority of care coordinators/community mental health do not know the laws. they just do what they are told. A lawyer versed in disability law/Medicaid/ trust funds is about the only option people have. Comes down to money you have to pay a lawyer. Or have the money to own your house or build a house on your property for you loved one to live in or if your loved one is self sufficient enough live in a state that will actually let them live in a apartment with support. Trying to enforce laws and getting a lawyer to do their job is all about money. Its also about opposition from those very people/organizations that are supposed to advacate. sincerely, mom of a very disabled daughter in west michigan

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