Coweta County SchoolsWorkshop Series - #2

Medicaid Waivers, SSI,Estate Planning and Advocacy

Coweta County SchoolsWorkshop Series - #2

Medicaid Waivers, SSI,Estate Planning and Advocacy

• Judy FloydParent Mentor, Coweta County School System

770-254-2810 x219

Judy.floyd@cowetaschools.net

• Linda WilsonPartners in Policymaking Graduate

Coweta Supporters

770-463-1658

lpwilson@numail.org

Medicaid eligibility

• As a result of receiving SSI– Family income for children under age 18– Based on individual’s income at age 18

• Medicaid Deeming Waiver (also known as the Katie Beckett Waiver)

Deeming Waiver

• Not based on family income

• Eligible if child requires– Skilled nursing care– Hospitalization– Intermediate care facility – active treatment

with a deficit in 3 self help areas

• Apply through DFACS

Deeming Waivers

• Many denials for new and renewals• Be sure that your paper work is complete• Appeal decision• Be specific about things that need supervision –

safety issues, health issues, detailed level of care and support

• Being addressed by GAO (Georgia Advocacy Office) and GCDD (Governor’s Council on Developmental Disabilities)

SSI

• Supplemental Security Income

• Eligible when child becomes adult according to law at age 18

• Parent income no longer considered

• Less than $2000 in the bank

• Can own home and auto

• Income limits apply

SSI

• Needs based program• Maximum of $579/month in 2005 • Will increase to $603 in 2006• Automatically receive Medicaid for

medical, therapies, and waivers• Can earn up to $22,192 per year and still

retain Medicaid although payments maybe reduced

SSIHow to Apply

• Contact SSA (Social Security Administration) at 1-800-772-1213

• Set up an appointment (phone or in person in LaGrange)

• Provide requested information

• Parent can be designated the payee

• Yearly report on how funds are spent

SSIBenefits Navigator

• Benefits Navigator Project – work with individuals who are eligible for Social Security based on a disability

• Will assist you in making informed decisions when you work and have Social Security benefits

• If an individual is still in school, he may qualify for a Student Earned Income Exclusion

SSIBenefits Navigator

• Contact Division of Rehabilitation Services (GROUP) at 866-489-0001

• Help with transition from school to work

• Will attend IEP meetings

• Help DD population become informed consumers

• No cost

SSDI

• Social Security Disability Insurance

• Entitlement program

• Medicare included

• May jeopardize SSI benefits

SSDI

• Based on child’s or parent’s work record• For a child to receive benefits on a parent’s

work record– Disability must have started prior to age 22– Must meet definition of disability for adults– Parent must become disabled, retired, or die

• If received SSI and Medicaid, may be able to retain Medicaid

Trusts

• Setup to prevent assets from disqualifying child for SSI

• Legal arrangement regulated by state law in which one party holds property for the benefit of another

• Often called “special needs” trusts• Better than relying on others to use funds

appropriately

Trusts

• Funds must be paid by someone to provide you with items other than food and shelter

• Supplemental discretionary trust – specifies that funds are not to be used for items covered by Medicaid or SSI

• Discretionary trust – more freedom to use funds. Must be careful to not provide goods or services (shelter or food) which are covered by Medicaid or SSI

Trusts

• Setting up a trust– Testamentary – sets up in a will

– Inter vivos (or Living) – sets up a trust before dying

• Funding the trust– Family’s assets

– Assistance and inheritance from friends and family

– Life insurance

Wills

• Legal document that is a statement of what you want to have happen after your death

• A Will can provide– Property distribution– Naming a guardian– Creating a trust

Wills

• If you do not have a Will, your property is distributed to your heirs according to the laws of the state

• It is important that a child with developmental disabilities not receive funds as they may jeopardize their government benefits

Wills

• Should indicate that a family member has a disability

• Relatives should consider making arrangements to not leave property to an individual with developmental disabilities. This includes life insurance.

Guardianship

• Court-approved legal relationship between a competent adult and a minor or adult with a disability

• Limits a person’s independence and rights

• At age 18, individuals are considered to be adults. Personal, medical and financial decisions should be made by the individual

Guardianship

• Parents are legal guardians of a minor child

• Only the court can make one person the guardian of an adult

• Need for guardianship varies for each individual with disabilities

• Handled by the Probate Court

Guardianship

• Types– Person – personal issues including living

arrangements, medical treatment, signing for services

– Property – money or property– Full or Plenary - person’s personal and

property

Guardianship

• Annual report required • If receiving SSI, consider Person only since

will be doing a financial report for SSA• Alternatives

– Representative Payee– Joint accounts– Durable power of attorney for health care,

property or advocacy

Medicaid Waivers

• MHDDAD – Division of Mental Health, Developmental Disabilities, and Addictive Diseases – part of DHR (Department of Human Resources)

• Regions have been reduced from 7 to 5

• Coweta County is in Region 1

Medicaid Waivers

• To contact Region 1Charles Fetner, Regional Coordinator

1305 Redmond Circle, Building 401

Rome, GA 30165

Phone 706-802-5272

Fax 706-802-5280

Toll Free 1-800-646-7721

Medicaid Waivers

• To Apply for Waiver ServicesColumbus Community Services

Phone 706-494-5929

Toll Free 1-800-579-7609

Medicaid WaiversTypes

• ICWP – Independent Care Waiver – physical disability or traumatic brain injury

• Deeming Waiver – Katie Beckett – chonic medical condition, under age 18

• CHSS – Community Habilitation Support Services – moving individuals out of institutions

• MRWP – Mental Retardation Waiver Program – developmental disabilities

Medicaid WaiversTypes

• CCSP – Community Care Services Program – elderly and DD who need nursing home level care

• SOURCE – Service Options Using Resources in a Community – care management – not available in Coweta

• GAPP – Georgia Pediatric Program – medically fragile under age 21

• Autism Family Support

Medicaid WaiversMRWP

• 7079 being served

• 3200 on short term waiting list

• 3126 on long term waiting list

• 700 age out of the school system annually

Medicaid WaiversMRWP

• Residential Options– Residential Training and Supervision

• Group home/personal care home

• 24x7

• Training tailored for individual – self care, independent living skills, communication skills, leisure skills

– Personal Support• Similar to Residential Training

• Occurs in family’s or individual’s home

Medicaid WaiversMRWP

• Day Services Options– Day Habilitation

• Offered in a facility or community, non-work, training in areas of communication, social, leisure, and self help skills

– Supported Employment• Opportunity for individuals to work a minimum of 80 hours

per month, provides job development, coaching and follow-up

– Day Support Services• Provides for facility day habilitation, prevocational, and

supported employment

Medicaid WaiversMRWP

• Specialized Medical Supplies• Specialized Medical Equipment• Personal Emergency Response Systems• Environmental Modifications• Vehicle Adaptation• Respite Care• Home Based Services• Natural Support Enhancements• Natural Support Therapies• Consumer Directed Natural Support Enhancements

New Medicaid Waivers

• Proposed by Dr. Stephen Hall, Director of the Department of Developmental Disabilities, DHR

• Recognize that parents are the primary service providers – always!

• Current waivers established in 1987• Medicaid is a states program that is federally funded• Will take advantage of the flexible Federal Medicaid Rules

Template• Will send to federal govt in Dec, 2005 • Plan to implement starting July, 2006

New Medicaid Waivers

• Bring fairness, choice, accountability and self-determination to the system

• Assessment process will be the same statewide using SIS (Supports Intensity Scale) – www.aamr.org

• More flexibility on what services are obtained by individual’s funding

• Will not provide more funding• Will provide more choice• Money will follow the individual

New Medicaid Waivers

• Reduce current waivers to two waivers– Supports Waiver

• Live in own home or family’s home• Participate in community life

– Comprehensive Waiver• More intense, urgent and extensive out of home

residential services

• Funding will be based on level of support that is needed

New Medicaid Waivers

• Individualized budgeting– can spend dollars where you want

• Community Connection/Community Guide/Brokerage Services – help connect to community activities

• Dental services will be available• Transportation services• Behavioral Support Services

New Medicaid Waivers

• Participant Direction – same as Consumer-Directed Natural Supports Enhancements Services. – Choose and direct services to extent desired– Can be employer of record and pay providers

• Support Coordination – monitoring of supports and services as necessary

• Extenuating Circumstances Payment – Payment to family member for services when providers

not available and is cost effective

New Medicaid WaiversProviders

• Group Providers – same as today

• Individual Providers – expedited process to establish small providers that support 1-3 individuals

• Specific Providers – a particular specialty such a dental, health, behavior

• Will result in increased number of providers

New Medicaid Waivers

• Gradual move to new services – must be selected by the family

• Current waiver will be converted on individual’s birthday

• Process– Determine eligibility– Assess needs– Choice of services

New Medicaid Waivers

• Will use Utilization Management– Ensure efficient and effective use of funds– Outcomes that lessen dependence on funding– Shifts from program funding to individualized

budgeting that controls costs

Unlock the Waiting Lists!

• We must reduce the number of individuals on the waiting lists for services

• Georgia’s annual budget determines how many additional people receive services

• We need to tell our elected officials and state officials how important this issue is!

Unlock the Waiting Lists!Budget Process

• DHR and DCH submit proposed budget to the Governor in September

• Governor develops budget and submits to the legislature in January

• Legislators debate, modify, and approve budget

• Returns to the Governor for approval

Unlock the Waiting Lists!

• Previously (2004-2005) budget – 10 waivers funded

• Last year (2005-2006) budget – 925 additional waivers were funded

• This year (2006-2007) budget – DHR is asking for 1500 additional waivers

Unlock the Waiting Lists!Goals

• Funding, with new money, for at least 1,500 services for people who want and need alternatives to institutions and nursing homes.

• Funding, with new money, an increase for provider rates that ensures direct service professionals for disability supports are given fair and livable wages, provided training and assure quality services

• Implementation of a multi-year funding plan for home and community-based services

Unlock the Waiting Lists

• Go to www.unlockthewaitinglists.com for more information

• Write/call/visit the Governor and your Legislators

• Attend Disability Day at the Capitol – February 23, 2006