The Virginia Medicaid population in fiscal year 2008* was comprised of:

• 487,929 children,
• 142,180 parents or caretakers of children and pregnant women,
• 81,541 elderly persons,
• 182,636 persons who are blind or who have disabilities

Children and parents/caretakers of children make up about 70 percent of the Medicaid beneficiaries, but they account for less than a third of Medicaid spending. Persons who are elderly or who have disabilities account for the majority of Medicaid spending because of their intensive use of acute and long-term care services.

Termination of Virginia Medicaid Healthy ReturnsSM Disease Management Program.

Date: 10-6-09

Since January 2006, the Department of Medical Assistance Services (DMAS) has offered the Virginia Medicaid Healthy Returns SM Disease Management Program. This program was designed to help Medicaid and FAMIS Fee-for-Service recipients with asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease, and/or congestive heart failure better understand and manage their health condition(s). Health Management Corporation (HMC) has administered the Healthy Returns SM program.

However, due to the ongoing state budget shortfall, Governor Kaine recently announced cost saving actions to reduce spending in Fiscal Year 2010. As part of his plan, the Healthy Returns SM contract, which was up for renewal in November 2009, will not be renewed. Therefore, the Healthy Returns SM disease management program will be eliminated and the program will no longer be available, effective October 31, 2009. DMAS will communicate program changes to enrolled disease management members prior to October 31, 2009.

If you need information or have questions regarding your patients currently participating in the disease management program prior to October 31, 2009, please call 1-866-836-4008 seven (7) days a week to speak with one of Healthy Returns’SM nurse consultants or pharmacists.

Discontinuation of Environmental Modification Service and Assistive Technology Service in the Elderly or Disabled with Consumer-Direction Waiver and the HIV/AIDS Waiver.

Date: 6-1-09

The purpose of this memorandum is to notify providers of the discontinuation of Environmental Modifications (EM) and Assistive Technology (AT) services in the Elderly or Disabled with Consumer-Direction (EDCD) and HIV/AIDS Waivers, effective July 1, 2009.

On July 1, 2008, individuals enrolled in the HIV/AIDS and EDCD Waivers were provided access to AT and EM services as a part of the State’s efforts to rebalance its long-term supports system through the Money Follows the Person (MFP) demonstration project. However, the broad extension of these two waiver services to all EDCD and HIV/AIDS Waiver participants led to costs in excess of the cost-savings generated by the MFP program. Therefore, as required by the FY2010 budget reduction directive, DMAS is limiting access to these two services in the HIV/AIDS and EDCD Waivers to MFP demonstration participants only.

Waivers are funded per “slot.” A slot is an opening of waiver services available to a single individual. For both the MR/ID and the DD (IFDDS) Waivers, there are long waiting lists of persons who have already applied. During the 2007 General Assembly, 330 new MR/ID waiver slots and 100 new DD (IFDDS) waiver slots were included in the final budget. Even so, there are thousands of persons who have been assessed as eligible and are still waiting to a receive waiver slot. It is important to put an individual on the waiting list even if no slots are currently available. Waiting lists clearly support the unmet need for services, and this is something that the members of the General Assembly need to know when making decisions on funding priorities.

Receiving a waiver slot does not guarantee that a person will be able to access services included in the waiver. Services can be provided only by approved agencies in each locality. There may be a limited number of approved persons or agencies in a particular area to provide services such as respite care or home modifications. Reimbursement rates may make it challenging to attract and retain skillful providers, so, just as in the health care profession in general, there is often a high turnover rate in service providers. If you have a case manager, it is important to keep him or her informed if you are having difficulty in accessing services, because if services are not used it is possible that waiver funds may be terminated.

Medicaid waivers vary from state to state. If an individual receives waiver services in Virginia and then moves to another state, he or she will lose the Virginia waiver funding. The person must reapply for waiver services in their new home state. (Exceptions to this policy are made only in the case of individuals placed out of state by the Virginia services network). It is important to consider the alternatives when making a decision to move to another state. Your case manager can give you information to assist you with this decision.

Some individuals with disabilities and their families consider Medicaid-funded hospitals, nursing homes, and intermediate-care facilities the most appropriate placement for the individual, while others see institutions as a “last resort” placement. Most individuals in institutions have a low probability of accessing waiver services and returning to their home communities.

It is important for all families to plan ahead for the long-term financial and care needs of their loved ones by carefully managing their own financial and care resources, exploring community and faith-based options, and learning about government programs such as Social Security Disability Income (SSDI) and Supplemental Security Income (SSI). For information on these programs, see the Social Security Administration.

Important note: Waiver funding is limited. It is important to balance advocating for oneself or one’s own family member with recognizing the very real needs of other people with disabilities across the state. Individuals and families must honor the system and use it responsibly. Individuals and families must exercise the same integrity as consumers that they demand from the services system.

Waiver funding is limited. It is important to balance advocating for oneself or one’s own family member with recognizing the very real needs of other people with disabilities across the state. Individuals and families must honor the system and use it responsibly. Individuals and families must exercise the same integrity as consumers that they demand from the services system.

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Senior citizens and the disabled person are slapped upside the head by the government again. Why is it that big business and banks that are still giving themselves these ridicules bonuses are the ones that are receiving the stimulus from our government, but the people that actually can and do stimulate the economy are always the punching bag for our congress?

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Again the elderly of these here United States are getting bent over by the people that they put into office. No increase in Social Security for 2010 but an increase of 15% in Medicare premiums. This must be the new math that they are teaching the kids in school, because it just doesn’t seem to make sense to me.

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• Adult Day Health Care
• Agency and Consumer-Directed Personal Care
• Personal Emergency Response System (PERS)
• Agency and Consumer-Directed Respite Care
• Medication Monitoring
• Transition Services
• Transition Coordination
• For individuals participating in the Money Follows the Person project, environmental modifications and assistive technology for 12 months following a move to the community from a hospital or nursing home.
 
If you answer yes to any/all of the following questions, you may be eligible for the EDCD Waiver.

• Are you 65 years or older or do you have a disability?
• Do you need assistance with bathing, dressing, eating, getting out of bed, walking or using the bathroom?
• Do you have a medical or nursing need?
• Do you need help remembering things or forget how to do things?
• Do you sometimes wander away from home?
• Do you forget who you are or where you are?
• Do you need help remembering to take your medications or need assistance in taking your medications?
 
Your Next Steps

If you think that you might qualify for the EDCD Waiver, contact your local health department and request a long term screening for the EDCD waiver. To find information on-line, visit the VirginiaNavigator website, select “Health Department,” and put in your zip code. After you contact the department, a nurse and a social worker will schedule a meeting with you to assess your needs.  If you are in the hospital, a discharge planner may also do this.  To view the assessment instrument that will be used (the Uniform Assessment Instrument or “UAI”), look on-line at the Department of Medical Assistance Services.

Waiting list status: There is currently no waiting list for this waiver. The EDCD Waiver is administered by DMAS

Medicaid Home and Community-Based Waivers were established by the U.S. Congress to slow the growth of Medicaid spending for nursing home care and institutional placement as the only means for individuals with disabilities to receive support for their needs such as personal care and training.

In 1981, Congress amended the Medicaid program to allow for Home and Community-Based Waivers. States were given the option to develop Waiver programs as alternative services for people who were eligible for institutional placement.

Medicaid Home and Community-Based Waivers enable individuals with disabilities to receive the supports and services necessary for them to live independently in their home and communities and reduces inappropriate institutional placement. Virginia has seven (7) Home and Community-Based Waivers.
 
Elderly and Disabled with Consumer Direction Waiver (EDCD Waiver).
Alzheimer’s Assisted Living (AAL) Waiver managed by the Care Coordination Services Unit.
AIDS Waiver.
Individual and Family Developmental Disabilities Support Waiver (IFDD Waiver).
Mental Retardation Waiver (MR Waiver).
Day Support.
Technology Assisted (Tech).

Five waiver programs are managed by the Department of Medical Assistance Services. DMAS Waiver Services staff are responsible for the development, oversight, and quality management review of these waivers. Staff responds to requests for policy interpretation, prior authorization services, and technical assistance to providers.