The Virginia Autism Project submits the following comments Virginia’s Amendment Applications for its §1915(c) Medicaid Waivers.

1. Combining the annual service limits for Assistive Technology and Electronic Home-Based Services into one annual $10,000 limit to be shared between the two services. (BI, CL, FIS)

   1. The Virginia Autism Project agrees with this plan amendment.  Home and Community-Based Services (HCBS), were developed as types of person-centered care delivered in the home and community to address the needs of people with functional limitations who need assistance with everyday activities.  In today’s world, that assistance can be Assistive Technology (AT) to allow someone to be more independent in their home without someone always having to be physically present.  For example, requiring a caregiver to be present for someone who could function with just a daily “check-in” burdens a system which already has workforce shortages.  Providing support through Assistive Technology helps relieve the demands of finding warm bodies to perform those supports which can be performed remotely.  However, the $5,000 cost allowance is not realistic.  Combining these amounts to $10,000 gives people who want independence more purchasing power to ensure their safety and independence in the home and community.  VAP learned that Maryland provides $34,000 for the cost of AT.  The combination of the amounts already authorized to $10,000 is not a heavy lift for Virginia to ensure its Medicaid Waiver Recipients have access to AT.

2. Permit the allowance for individuals offered a Developmental Disabilities Waiver slot to delay enrollment into the waiver for up to 1 year. (BI, CL, FIS)

   1. The Virginia Autism Project agrees with this plan amendment.  As everyone in this system knows, there is a workforce shortage.  With the influx of waiver recipients, there is an increased demand for providers.  Giving recipients more time to find a provider helps relieve the anxiety about losing their slot through no fault of their own.

3. Disregard Social Security Disability Insurance (SSDI) benefits above the maximum Social Security Insurance (SSI) benefit limit as determined by the Social Security Administration for purposes of pre-eligibility treatment of income. (BI, CL, FIS)

   1. The Virginia Autism Project agrees with this plan amendment.  Under the current Virginia regulations, disabled adults and children who have a Medicaid-funded Waiver are required by the Social Security Administration (SSA) to transition from personal SSI disability benefits to SSDI benefits on their parent’s work record when a parent retires or dies. This removes SSI payments from the General US Treasury and takes it “off-the-books” since SSDI is paid for by SSA with dollars previously funded by a parent’s lifetime of work. Given that SSDI benefits can often more than quadruple the amount of SSI, this required migration of benefits creates life-altering penalties for a portion of the 16,000 disabled individuals in Virginia who utilize Medicaid-funded Waiver services. For some, the new SSDI payment amount, in combination with the Cost of Living increases, moves them over the income limit for Medicaid eligibility in Virginia.   They lose all their Medicaid-funded Waiver benefits, including group homes, life-critical support services, and healthcare. For others, their monthly SSDI payment is just below the Medicaid income cap which prevents them from having a simple, meaningful-life job.  CMS provided the answer to this problem and Virginia finally woke up to this fact.  

In a memorandum dated, December 7, 2021, State Flexibilities to Determine Financial Eligibility for Individuals in Need of Home and CommunityBased Services, CMS states: “This new option permits states to adopt higher effective income and resource eligibility standards for people who need HCBS (Home and Community-Based Services), either for all such individuals or for a particular cohort of such individuals. The option affords states with broad discretion in selecting the cohorts of individuals needing HCBS for whom the state will apply higher effective income or resource standards.”  These individuals will still be obligated to pay the state a patient pay amount that is based on their new SSDI rate.  There is no downside to the state for this change and in fact, it is not an exaggeration to say it will save lives.

4. Amend the rules for when a Legally Responsible Individual (spouse or parent of a minor) is a paid aide/attendant for personal care/personal assistance. (CL, FIS, CCC+)

   1. The Virginia Autism Project supports this amendment. However, we are disappointed that families who are Legally Responsible Individuals (LRI) providing care for their disabled child still have to justify the fact they will be the paid caregiver through Consumer Directed Services. We support the spirit of the amendment but protest the attitude towards families that it carries in its stipulations. Requiring a copy of an “advertisement” and “interview notes” is a ridiculous documentation requirement.  Demanding a copy of the job description for employment (with no benefits) in a caregiver role for often intense care needs is to put it simply — absurd.  This requirement perfectly illustrates DMAS’ superior attitude toward family members.  Further, DMAS states that “a family member as a paid support person”…  [must be] aware that there is a different relationship once he/she is paid to support the individual.”   The Virginia Autism Project would argue that no, there is not a different relationship. That person is still the parent.  There is no difference in relationship to the child.  They are just being paid to provide care because appropriately skilled caregivers are unavailable at current rates. Unnecessary DMAS documentation requirements continue to plague an already paperwork-burdened system.  If the intent is to save taxpayer dollars, such unnecessary documentation requirements and their resulting administrative costs waste scarce taxpayer dollars.  

Respectfully Submitted by 

Teresa L. Champion on behalf of the Virginia Autism Project