Developmental Disabilities Administration Waiver Services A Pathway to
Developmental Disabilities Administration Waiver Services: A Pathway to Independence and Supports for your Child with Developmental Disabilities Casey Shea Disability Rights Maryland Interim Co-Managing Attorney Developmental Disabilities, Health Care, Victims of Crime Act (VOCA) Team caseys@disabilityrightsmd. org
Disability Rights Maryland: Maryland’s Protection & Advocacy System for People with Disabilities Federally mandated agency charged with advancing the civil rights of people with disabilities. We provide free legal services to Marylanders of any age with all types of disabilities (developmental, intellectual, psychiatric, physical, sensory, learning, traumatic brain injury), who live in facilities, in the community, or who are homeless. DRM envisions a world where people with disabilities are fully included in the workplace, neighborhoods and all aspects of community life. DRM’s Advocacy Services Plan outlines the issues that take priority considering DRM’s limited resources. The annual plan is a product of community input and DRM’s expertise in providing legal services to Marylanders with disabilities. DRM maximizes resources by using many advocacy strategies, including: Information and referral, outreach and education, monitoring and investigations, training and technical assistance, coalition and policy work, individual representation, impact litigation and support for self-advocacy.
Note This presentation provides basic information for Maryland residents; it does not contain legal advice.
Presentation Agenda Medicaid Basics Planning Steps for People with Developmental Disabilities (DD) Supports and Services for people with DD: Developmental Disabilities Administration (DDA) Services Other Services Planning Steps for people with significant disabilities Other Services
Medicaid Basics Link here for information about applying for Medicaid (also called Medical Assistance): https: //dhs. maryland. gov/weathering-toughtimes/medical-assistance/ Poverty population or disability Children in foster care* One route to Medicaid eligibility in Maryland is linked with Social Security Income (SSI) eligibility (there is also a Medicaid “buy-in” program) Appeals of SSI denials can take ~two years Person Centered Planning Except for the Mental Health system, most of the Medicaid Waiver and Community First Choice (CFC) services described here must adhere to federal requirements for person centered planning. In General: the person themselves with a team of their choosing define the goals for their own life and decides what services they want and where they want to live. The case management entities are required to inform the person about what is available and help them make informed choices. * Children who receive federal foster care maintenance payments or for whom an adoption assistance agreement is in place must be covered by Medicaid. 42 U. S. C. § 1396 a(a)(10)(A)(i)(I); 42 C. F. R. § 435. 115(e)(1), (2).
Medicaid Basics (Continued) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) – federal entitlement under Medicaid for eligible youth under 21 Youth will lose some services when they transition to adulthood, e. g. , dental care and other supports that are not delivered through the adult Medicaid system. Nursing has different eligibility requirements for adults. Many of the adult service delivery systems require Medicaid eligibility Medicaid state plan vs. Medicaid “Waivers” State plan: all people on Medicaid who meet certain requirements have an entitlement to the services Waivers: Service Delivery system created as home and community based alternatives to institutionalization. They may waive certain requirements People who are enrolled in Medicaid waivers are entitled to: (1) all of the state plan Medicaid services that are medically necessary; and (2) all of the waiver services they have an assessed need for. Maryland has several waivers, including: DDA (Community Pathways, Community Supports, & Family Supports), Autism (only through school years), TBI (small), Model, Community Options for adults with physical disabilities. DDA Community Pathways Waiver has the largest service array including residential supports.
I. Planning for Young People with Developmental Disabilities
What is a Developmental Disability (DD)? A severe, chronic disability that is not solely mental illness and is likely to be permanent. There are many types of developmental disability: common factor is an inability to live independently without support. Based on functional skills, not just one diagnosis.
Some of the Services & Supports Available for Young Adults with DD Natural supports – friends, family, neighbors, etc. Medicaid – Nursing Services, Community First Choice Developmental Disabilities Administration (DDA) - Community Pathways, Community Supports, or Family Supports Waivers Autism Waiver – for young adults under 21 before transition to adulthood. Mental health system – Core Service Agency DORS – Employment Support Services
Developmental Disabilities Administration (DDA) Services DDA Medicaid “Waivers”: Community Pathways Waiver Community Supports Waiver (No Residential Services) Family Supports Waiver (Children Only, no residential) All 3 waivers have same eligibility definition. But a person can only be placed in one waiver at a time Work with Coordinator of Community Services to determine appropriate Waiver based on the person’s needs.
DDA Services (continued) DDA has most comprehensive service delivery system. DDA Waiver services include: Coordination of Community Services (CCS) A wide array of supports to help people with DD get jobs, stay employed, and learn skills Staff support to help people with DD live in their own homes Residential services (in Community Pathways Waiver) Assistive technology, home modifications, behavior supports, and more No limits on the budget in Community Pathways Waiver Community Supports and Family Supports Waivers currently have cost limits, don’t include residential services Integrated community settings Choice of provider agency Can receive all services needed Protections against discharge Notice and opportunity for a hearing
How to Apply for DDA Waiver Eligibility Apply for Medicaid Waiver Services through the Developmental Disabilities Administration (DDA): DDA Eligibility Application is available on DDA website here: https: //dda. health. maryland. gov/Pages/Apply%20 for%20 Services. aspx Start DDA application preparation early It can take some months to obtain relevant testing or other documentation such as a neuropsychological assessment and report, 90 days to get a decision from DDA, and two months or more to appeal a denial. Are you unsure if a DDA eligibility application was submitted or decided on? Call DDA Regional Offices to ask for status, and request DDA file to information they have about the applicant. See DDA Website for Regional Office Contact Information here: https: //dda. health. maryland. gov/Pages/Regional%20 Offices. aspx
TIP: Ensure Strong Disability Evaluation Submitted to DDA • To support DDA application, obtain strong relevant • • disability evaluation • Psychological Evaluation, or other evaluation relevant to disability Obtain further assessment, such as a Neuropsychological Testing, if diagnosis or eligibility is in doubt. For Psychological or Neuropsychological Testing, ensure Adaptive Functioning testing is included. Ensure Disability code in special education system reflects person’s Developmental Disability (e. g. , Autism Spectrum Disorder, Intellectual Disability, etc. ). Contact Disability Rights Maryland with questions.
Maryland DDA Eligibility Criteria “Developmental disability” means a severe, chronic disability of an individual that: (1) Is attributable to a physical or mental impairment other than the sole diagnosis of mental illness, or to a combination of mental and physical impairments; (2) Is manifested before the individual becomes 22 years old; (3) Is likely to continue indefinitely; (4) Results in an inability to live independently without external support or continuing and regular assistance; and (5) Reflects the need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are individually planned and coordinated for the individual. Cite: Md. Code, Health General Art. § 7 -101(f)
DDA Eligibility Criteria – Key Definitions "External support" means: (1) Periodic monitoring of the circumstances of an individual with respect to: (i) Personal management; (ii) Household management; and (iii) The use of community resources; and (2) Rendering appropriate advice or assistance that may be needed. Cite: Md. Code, Health General Art. § 7 -101(g)
DDA Eligibility Criteria – Definition of “Live Independently” "Live independently" means: (1) For adults: (i) Managing personal care, such as clothing and medication; (ii) Managing a household, such as menu planning, food preparation and shopping, essential care of the premises, and budgeting; and (iii) Using community resources, such as commercial establishments, transportation, and services of public agencies; or (2) For minors, functioning in normal settings without the need for supervision or assistance other than supervision or assistance that is age appropriate. Cite: Md. Code, Health General Art. § 7 -101(l)
Common Errors in Applying to DDA for people with DD Saying a person is independent in activities of daily living when the person needs prompting or assistance to complete adaptive functioning tasks Submitting documentation that only shows a mental health diagnosis when the person also has a developmental disability Lack of or inadequate evaluations of a person’s developmental disability
Note about DDA Eligibility Process • Two consultants have found DDA eligibility system to be • subjective • DRM and Coalition partners have advocated for more objective process, DDA may be working on changes Important to put forward strong evaluation and documentation of person’s developmental disability
DDA Eligibility Determination Letter • IMPORTANT: DDA Waiver eligibility is separate from accessing Waiver services. To access Waiver services, DDA must agree to let you into the Waiver because they have funding for you. • Review DDA eligibility letter: Ensure person with DD is determined “Developmentally Disabled” (DD) and not “Individual Support Services (ISS)-Only” Eligible. If found not DD eligible or found “ISS eligible only, ” person can request reconsideration or an administrative appeal. Call Disability Rights Maryland for information or technical assistance. DDA will assign a Priority Category in each Eligibility Determination Letter: Future Needs, Current Request, Crisis Prevention, Crisis Resolution. • If found “DD eligible” prior to age 22, person is considered “Transitioning Youth” (“TY”). • Much more difficult to get into a DDA Waiver if a person with DD is found eligible after 22 • Typically, a person must get to top of Waiting List by qualifying for “Crisis Resolution” criteria.
Why Should Planning Begin Early? There is a long history of full funding for transitioning youth (TY) priority category, although not guaranteed. Important that young people with developmental disabilities are known to DDA during the transition years, if not sooner. Don’t want to miss the possibility of accessing TY funds. After a person with DD is found DD eligible, they still need to create a proposed Person Centered Plan and conduct a service provider search or create a self directed services budget.
What Happens if Someone with DD is Found Not Eligible? A person with DD who is found not DD eligible: • May seek reconsideration of an old DDA eligibility determination by submitting new supporting documentation and/or evaluation. • May appeal an eligibility denial in a Medicaid Fair Hearing • Not required but DRM recommends getting legal representation, and an expert familiar with person • Generally must file appeal within 90 days of date on determination letter (check timeframe on letter to confirm) • Can consult with Disability Rights Maryland about requesting reconsideration or appealing.
What Happens if Someone is Eligible? • A person found DD eligible should: - Be assigned a Coordinator of Community Services (CCS), typically at ~18 years old (or earlier) - If CCS not assigned, you can try to request a CCS from DDA. - Include CCS at IEP meetings. - Work with CCS & chosen team for DDA services well ahead of transition to: - Determine Service Needs [and figure out what state agencies (e. g. , Medicaid, DDA, DORS) will provide each service] - Create a “Person Centered Plan” with individually driven goals and outcomes. Person’s outcomes should drive DDA services. - Start early! • REMINDER: Eligibility is separate from accessing services.
How do I access services after eligibility? • A person found DD eligible should: With Coordinator of Community Services’ (CCS) help, search for and be accepted by DDA provider agency(s) or develop self directed services plan. CCS’s role it is to assist the person as needed to pursue their goals. Work with CCS and providers or team to develop a Service Funding Plan(s) (SFP) and ensure it describes the needed services. Ideally, get an approval of a SFP for the person’s needed Waiver Service(s) from DDA several months before he/she turns 21 or transitions from the school system.
II. Accessing Supports for People with Significant Disabilities Planning Steps
Who? Recommendations in this section also apply to those who likely cannot live independently and support themselves at age 21 due to a developmental disability or a mental health condition.
Transition Planning Steps Start early – at least two years, preferably many more, before transition age. Social Security Income (SSI) and Medical Assistance application. If relevant, file a SSI application as soon as the disability is identified. Delays in processing or appeals are common and can cause problems later. Adults who are not on SSI might not qualify for Medical Assistance unless they qualify for the Employed Individuals with Disabilities Program (Medicaid “buy-in”)
Transition Planning Steps Attend IEP Meetings: Children with significant disabilities usually receive special education services. Federal education law requires transition planning as part of the Individual Education Plan (IEP) process beginning at age 14. A transition plan must be developed by the age of 16. To accomplish this: For more information about Special Education rights, access Disability Rights Maryland’s Special Education Rights Handbook and other resources at https: //disabilityrightsmd. org/resources/.
What if Nursing Services are Needed? Some individuals with significant disabilities may also be eligible for the Rare and Expensive Case Management (REM) program – for those who qualify, this service can provide nursing, delegated nursing, among other services.
II. Other Services for People with Disabilities
Other Services to Consider: • For People seeking Mental Health Services • • Young person can be referred to local Core Services Agency (CSA) / Behavioral Health Authority • To access mental health services through Medical Assistance, you can contact Optum Maryland for intake and referral at 1 -800 -888 -1965. • Click here to access Optum Maryland’s website: https: //maryland. optum. com/ The local Behavioral Health Authority plans, develops, and manages a full range of treatment and rehabilitation services for persons with serious mental illness. When contacting the CSA, a young adult can request services they need including: limited case management, day program, or a residential rehabilitation program (RRP). • Plan early to apply for RRP programs, ~2 years before transition • In addition to RRP, youth with disability can consider other housing options The service system for persons with mental illness is more limited than for persons with DD and not as individualized. Young Adults in need of support for mental health related issues should also be referred to Own Our Own, a statewide mental health consumer education and advocacy group, and its local affiliates. On Our Own has wellness and recovery centers throughout the state and a peer support program specifically for Transition Age Youth: • Link here to access On Our Own Maryland’s website: https: //onourownmd. org/projects/transitional-age-youth-outreach-project/
Other Services to Consider: • Community First Choice (CFC) Program under Maryland Medical Assistance Provides In-Home Support and other Services Separate application process from Medicaid and DDA Contact Maryland Access Point at 1 -844 -627 -5465 Separate service delivery process from DDA Services People enrolled in a DDA Waiver should try to exhaust services under the Medicaid State Plan, including CFC before requesting DDA Waiver Services that may overlap. Link here to access CFC Program Informational Resource from Maryland Legal Aid Bureau: https: //www. mdlab. org/wp-content/uploads/MLA_Your. Rights-under. Community-First_v 3_WEB. pdf
Housing Other Types of Services to Consider: A young person can apply for public housing and section 8 housing if possible in their county of residence. Applications can also be placed with housing units federally subsidized by Housing and Urban Development (HUD) – no residency preferences, if a person with a physical disability needs accessible unit, apply even if says only openings for Seniors. Weinberg Housing Units: The Maryland Department of Housing and Community Development has a small rental housing program for individuals with disabilities who require permanent supportive housing to live independently in the community. Learn more on the Department of Disabilities website here: maryland. gov/housing/Pages/MPAH. aspx#: ~: text=Weinbergfunded%20 units%20 commonly%20 referred, income%20 for%20 rent Maryland’s Section 811 Program – Apply through Case Worker, Contact Maryland Department of Disabilities with questions, 410. 767. 3660 Public Benefits Counseling, Work Incentive Information Resource: Maryland Work Incentive Network, 1 -888 -838 -1776, www. md-win. org Information for people receiving disability benefits who are interested in working SSI, Employed Individuals with Disabilities Program, 1619(b), etc. Service from the Division of Rehabilitation Services (DORS) If you have concerns about DORS, contact Maryland’s Client Assistance Program (CAP) at: Voice: 410 -554 -9361, Toll-free: 1 -800 -638 -6243 Fax: 410 -554 -9362, TTY: 410 -554 -9360 E-mail: cap. dors@maryland. gov https: //dors. maryland. gov/Brochures/CAP. pdf Link to DORS’ website here for more information about their services: https: //dors. maryland. gov/consumers/Pages/appropriate. aspx
Disability Rights Maryland Intake Line: Phone: 410 -727 -6352 ext. 0 Toll free: 1 -800 -233 -7201 TTY: 410 -235 -5387 Casey Shea, Esq. 1500 Union Ave. , Suite 2000 Baltimore, MD 21211 -1982 caseys@disabilityrightsmd. org Thank you!
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