Action | Three Waivers (ID, DD, DS) Redesign |
Stage | Proposed |
Comment Period | Ended on 4/5/2019 |
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provision”. Requirement should be eliminated or changed per comments below:
12VAC30-50-490. Support Coordination/case management for individuals with developmental disabilities, including autism.
12VAC30-122-20. Definitions. General:
12VAC30-122-40. Waiver services; when not authorized.
B.3.a.(1) and B.3.b.(1) Delete following employed “at least 8 hours but”. Individuals who work fewer than eight hours per week are unnecessarily disadvantaged by the limitation. Many individuals may work less than 8 hours per week because of medical or other reasons. Without this disregard, there is no incentive for them to work because their income would go to patient pay.
Recommend Spend-down for all Long-Term Care waiver categories. This language is already in the CCC+ waiver. This language should be moved to allcategories.
B.3. Recommend that Patient Pay be considered an Income Related Work Expense (IRWE). IRWEs are already considered when countable earned income is considered. Reasoning - without waiver services, an individual would not be earning at the level they are earning.But, earning at a higher level is forcing them to incur a Patient Pay. This is a disincentive to earn wages at a higherlevel.
Recommend Special Group Category Consideration – SSI/SSDI waiver recipients increasingly have retired, disabled or deceased parents and the waiver recipient’s income increases because their parent’s FICA account is opened and a portion of this account is received by the waiver recipient. This amount (now SSDI) often puts the waiver recipient over the 300% gross income limit. The first thing the individual does is quit work if working. These individuals should be put in a “protected category” which will disregard the amount of the new income (SSDI) that will cause them to become ineligible for waiver services. This protection is considered when looking at continued Medicaid eligibility.(https://secure.ssa.gov/poms.nsf/Inx/0501715015)
Recommend Subsidies and Special Conditions as deduction for wages earned (per SSA definitions). If the individual is not fully earning his or her wages because the work is performed under special conditions (e.g. close and continuous supervision, on the job coaching, etc), then we should deduct that part of his or her wages that are not “earned” by the individual from his/her average gross wages. This is true whether or not the employer or someone else provides the special on-the-job conditions. Most work supports that an individual receives in order to earn income is provided under LTC (i.e. transportation, personal attendant services, job coaching, etc). However, under current Medicaid LTC regulations, if they earn over 300% of federal benefit rate (FBR), they are penalized. Many individuals do not have the out-of-pocket expenses that are needed to bring down countable earned income due to the LTC supports that they are receiving at no cost to them. However, they would not be earning at the level that they are earning without the waiver provided supports. Subsidies and Special Conditions would give value to the supports that are provided to the individual that enables them to work and earn income. https://www.ssa.gov/disabilityresearch/wi/subsidies.htm
Recommend the addition of the following language - “The support coordinator is responsible for determining which Waiver provider will receive the greater Medicaid reimbursement, and will therefore be responsible for collecting the Medicaid co-payment from the individual. The support coordinator will notify all Waiver providers which provider will collect the monthly co-payment and in what amount. Notification will be in writing from the support coordinator to the individual and to all Waiverproviders.”