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Demo Waiver entries for US.

State: AR
Sectionⁱ: 1115
Date submittedⁱⁱ: May 1996
Date approvedⁱⁱⁱ: Oct 1998
Date started^iv: Dec 1998
Expiry date^v: Nov 2006
Name of project: Independent Choices
Target group (eligibility)^vi: Aged/Physically disabled adults
No. slots: 3,500
Services covered: PAS
Area covered: Statewide
Further details: Independent Choices website: http://www.independentchoices.com/ICHome.htm Waiver amended in 2002 to remove the experimental design & expand the program.
Independent Choices brochure:
http://www.independentchoices.com/ICBrochure2K.pdf

State: AZ
Sectionⁱ: 1115
Date submittedⁱⁱ: May 1982
Date approvedⁱⁱⁱ: July 1982
Date started^iv: Oct 1982
Expiry date^v: N/A
Name of project: Arizona LTC System (ALTCS)
Target group (eligibility)^vi: Aged, physically disabled, MR/DD adults.
No. slots: 34,000
Services covered: HCBS (e.g. home health, homemaker, personal care, PAS, meals, transport).
Area covered: Statewide
Further details: Arizona LTC System website:
http://www.ahcccs.state.az.us/Services/Programs/ALTCS.asp

State: CA
Sectionⁱ: 1115
Date submittedⁱⁱ: May 2004
Date approvedⁱⁱⁱ: July 2004
Date started^iv: Aug 2004
Expiry date^v: Jul 2009
Name of project: California In-Home Supportive Services (IHSS) Plus Demonstration.
Target group (eligibility)^vi: Aged, blind & disabled adults and children.
No. slots: 52,000
Services covered: Personal care, homemaker services, restaurant meal allowances (allows consumer direction).
Area covered: Statewide
Further details: Up to 195 hours of assistance per month allowed (up to 283 for severely impaired people). 3 delivery types: (1) individual provider (2) contract & (3) homemaker.
California Department of Social Services, IHSS:
http://www.dss.cahwnet.gov/cdssweb/In-HomeSup_173.htm

State: CO^vii*
Sectionⁱ: 1115
Date submittedⁱⁱ: July 1999
Date approvedⁱⁱⁱ: Aug 2001
Date started^iv: Dec 2002
Expiry date^v: Dec 2007
Name of project: Consumer Directed Attendant Support
Target group (eligibility)^vi: Aged/Physically disabled adults.
No. slots: 500
Services covered: Skilled nursing, personal care, home aide & homemaker services.
Area covered: Statewide
Further details: Approved before IP was introduced.
In 2003 the state legislature increased the cap of the waiver to 500.

Consumer Directed Attendant Support (CDAS) Demonstration Project website:
http://www.chcpf.state.co.us/HCPF/Syschange/cdas/cdasindex.asp

State: FL^viii*
Sectionⁱ: 1115
Date submittedⁱⁱ: May 1996
Date approvedⁱⁱⁱ: Oct 1998
Date started^iv: Mar 2000
Expiry date^v: Feb 2008
Name of project: Consumer Directed Care Plus^ix
Target group (eligibility)^vi: Aged/Physically disabled adults^x, MR/DD adults, children with DD
No. slots: 6,000
Services covered: HCBS waiver services and any others approved by the consumer's state program office (e.g. yard work).
Area covered: Statewide (children with DD). Selected counties (other groups).
Further details: FL participated in RWJF ‘Self-Determination’ project.
Approved under IP.

Florida Consumer-Directed Care Plus Waiver Operational Protocol (Dec 2003)
http://www.cashandcounseling.org/resources/20060118-095701/FLOptrtnlProtocol.pdf

Foster, L., Phillips, B. & Schore J.
Consumer and Consultant Experiences in the Florida Consumer Directed Care Program (June 2005):
http://aspe.hhs.gov/daltcp/reports/FLcdcp.htm

State: LA^xi*
Sectionⁱ: 1915c
Date submittedⁱⁱ: Oct 2002
Date approvedⁱⁱⁱ: Apr 2003
Date started^iv: Apr 2003
Expiry date^v: Apr 2006
Name of project: New Opportunities Waiver (NOW)
Target group (eligibility)^vi: MR/DD
No. slots: 4,776^xii
Services covered: 18 services including respite, adaptations, skilled nursing & family support.
Area covered: N/A
Further details: Approved under IP, this replaces a previous waiver & provides a self-direction option.

Louisiana Department of Health and Hospitals, Waiver Services, New Opportunities Waiver (NOW):
http://www.dhh.louisiana.gov/offices/page.asp?ID=92&Detail=4124

NOW contact information:
http://www.dhh.louisiana.gov/offices/miscdocs/docs-92/NOW_waiver_contacts.pdf

State: MD
Sectionⁱ: 1915c
Date submittedⁱⁱ: N/A
Date approvedⁱⁱⁱ: N/A
Date started^iv: Nov 2004
Expiry date^v: N/A
Name of project: New Directions
Target group (eligibility)^vi: N/A
No. slots: 100
Services covered: Personal care, PAS, adaptations & equipment.
Area covered: N/A
Further details: News Release (11.8.04) HHS Approves Maryland Plan To Allow Individuals With Disabilities To Direct Own Care
http://www.hhs.gov/news/press/2004pres/20041108.html

Independence Plus: A Demonstration Program for Family or Individual Directed Community Services Waiver (Oct 2004):

http://www.dhmh.state.md.us/dda/Developments/NewDirections.pdf

State: MN
Sectionⁱ: 1115
Date submittedⁱⁱ: June 2000
Date approvedⁱⁱⁱ: Pending
Date started^iv: N/A
Expiry date^v: N/A
Name of project: Consumer-Directed Home Care
Target group (eligibility)^vi: Adults & children
No. slots: 1,500
Services covered: Personal care, duty nursing, home health.
Area covered: Statewide
Further details: Minnesota received funding from the RWJF ‘Self-Determination’ project & the waiver builds on that project.

Community Alternative Care (CAC) Waiver for chronically ill and medically fragile persons who need the level of care provided in a hospital

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_003902

Community Alternatives for Disabled Individuals (CADI) Waiver for persons with disabilities who require the level of care provided in a nursing facility

http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod;=LatestReleased&dDocName;=id_003905

State: NC
Sectionⁱ: 1915c
Date submittedⁱⁱ: May 2003
Date approvedⁱⁱⁱ: Jan 2004
Date started^iv: Date unknown, but program has started
Expiry date^v: N/A
Name of project: CAP Choice
Target group (eligibility)^vi: Aged/Disabled adults (not MR/DD).
No. slots: 600^xix
Services covered: In-home respite, PAS, home mobility aids, good & services.
Area covered: Pilot in a limited no. of counties.
Further details: NC Community Alternatives Program website: http://www.dhhs.state.nc.us/dma/commaltprog.htm

Application under IP

Independence Plus: A Program for Family or Individual Directed Community Services Waiver (May 2003):

http://www.cashandcounseling.org/resources/20060118-130916/northcarolina.doc

State: ND
Sectionⁱ: 1915c
Date submittedⁱⁱ: Oct 2003
Date approvedⁱⁱⁱ: Pending
Date started^iv: N/A
Expiry date^v: N/A
Name of project: North Dakota Self Directed Supports
Target group (eligibility)^vi: MR/DD Adults & Children.
No. slots: N/A
Services covered: Any services not included in the state plan
Area covered: Statewide
Further details: Application under IP

Independence Plus: A Demonstration Program for Family or Individual Directed Community Services Waiver (October 2003):
http://www.cashandcounseling.org/resources/20060118-131915/ND.pdf

State: NH
Sectionⁱ: 1915c
Date submittedⁱⁱ: July 2002
Date approvedⁱⁱⁱ: Dec 2002
Date started^iv: Jan 2003
Expiry date^v: Jan 2006
Name of project: Home Support Waiver for Children with DD
Target group (eligibility)^vi: Children with MR/DD
No. slots: 200^xx
Services covered: Family support & care co-ordination, personal care, respite, modifications.
Area covered: Statewide
Further details: New Hampshire received funding from the RWJF ‘Self-Determination’ project. Approved under IP.

Independence Plus: A Demonstration Program for Family or Individual Directed Community Services Waiver (October 2002):
http://www.cashandcounseling.org/resources/20060118-120326/NH.pdf

State: NJ^xxi
Sectionⁱ: 1115
Date submittedⁱⁱ: May 1996
Date approvedⁱⁱⁱ: Oct 1998
Date started^iv: May 2000
Expiry date^v: Apr 2005
Name of project: Personal Preference
Target group (eligibility)^vi: Aged/Physically disabled adults, MR/DD adults.
No. slots: 3,500
Services covered: PAS
Area covered: Statewide
Further details: http://www.state.nj.us/humanservices/dds/personal.html Individuals are ineligible for the program if they need less than 180 days support/year.

State: OR
Sectionⁱ: 1115
Date submittedⁱⁱ: July 1998
Date approvedⁱⁱⁱ: Nov 2000
Date started^iv: Dec 2001
Expiry date^v: Nov 2006
Name of project: Independent Choices
Target group (eligibility)^vi: Aged/Physically disabled adults, MR/DD adults, other.
No. slots: 300
Services covered: PAS, homemaker & chore services, transport, adult companion services, in-home services.
Area covered: 3 regions
Further details: Oregon Department of Health Services, Seniors & People with Physical Disabilities
http://www.oregon.gov/DHS/spwpd/ltc/inhome.shtml#ic

Brochure on Independent Choices
http://dhsforms.hr.state.or.us/Forms/Served/SE9057.pdf

Oregon intends to replicate this statewide if successful. OR received funding from the RWJF ‘Self-Determination’ project.

State: SC
Sectionⁱ: 1915c
Date submittedⁱⁱ: Dec 2002
Date approvedⁱⁱⁱ: July 2003
Date started^iv: May 2003
Expiry date^v: Jun 2006
Name of project: South Carolina Choice
Target group (eligibility)^vi: Aged/Physically disabled adults.
No. slots: 900^xxii
Services covered: Personal care, PAS, care advice, adult day health, respite.
Area covered: 3 selected counties.
Further details: Approved under IP

State: VT
Sectionⁱ: 1115
Date submittedⁱⁱ: Oct 2003
Date approvedⁱⁱⁱ: Jun 2005
Date started^iv: N/A
Expiry date^v: Sept 2010
Name of project: The Vermont Choices for Care Long-Term Care Plan,
Target group (eligibility)^vi: Aged/Physically disabled adults.
No. slots: 3,250
Services covered: HCBS
Area covered: Statewide
Further details: http://www.dad.state.vt.us/1115waiver/1115default.htm

The Vermont Long-Term Care Plan: A Demonstration Waiver Proposal to the Centers for Medicare and Medicaid Services (October 2003)
http://www.cashandcounseling.org/resources/20060118-100712/VT.pdf

For more information on how the Global Commitment Waiver (see below) will affect the Vermont Choices for Care Long-Term Care Plan: The Vermont Choices for Care Long Term Care Plan: Key Program Changes and Questions, Kaiser Commission on Medicaid and the Uninsured Issue Paper, July 2006.
http://www.kff.org/medicaid/upload/7540.pdf

State: VT
Sectionⁱ: 1115
Date submittedⁱⁱ: Apr 2005
Date approvedⁱⁱⁱ: Sept 2005
Date started^iv: Oct 2005
Expiry date^v: Sept 2010
Name of project: Global Commitment Waiver
Target group (eligibility)^vi: For a complete list of populations served:
http://www.ncsl.org/print/health/waiver.pdf
No. slots: 4,000
Services covered: For a complete list of services:
http://www.ncsl.org/print/health/waiver.pdf
Area covered: Statewide
Further details: The Global Commitment Waiver is a 1115 Medicaid waiver that the CMS approved for the State of Vermont in September 2005. This waiver is unique, allowing Vermont to deviate from traditional federal Medicaid law and regulations in 4 key ways: 1) imposes a global cap on federal funds, 2) establishes the state as a managed care organization, 3) allows the state to use federal Medicaid funds for state fiscal relief and non-Medicaid health programs, 4) new flexibility to cut back on coverage (p. 6 Kaiser Issue Paper). For more information: Guyer, J. (2006). Vermont's Global Commitment Waiver: Implications for the Medicaid Program, Kaiser Commission on Medicaid and the Uninsured Issue Paper
http://www.kff.org/medicaid/7493.cfm

The Office of Vermont Health Access will enter into interagency agreements with the various state agencies (such as the Department of Disabilities, Aging, and Independent Living) that currently administer Medicaid programs being subsumed into the new demonstration program, including the state's pharmacy program for low-income persons. "Expenditures from these agencies will be reported in the aggregate under the demonstration."

Vermont also received federal approval in June 2005 for a long-term care plan, Choices for Care (see above), that provides an entitlement to either nursing home care or home and community-based services (HCBS) for Medicaid-eligible persons, consistent with their needs and choices. "This program will operate, in effect, through a "global" budget because Medicaid funds will not allocated in separate "silos" for nursing homes or HCBS but can be spent on whichever service is most appropriate for persons found to be eligible for long-term care (from "Vermont Global Commitment to Health," National Conference of State Legislatures).
http://www.ncsl.org/programs/health/vthealth.htm

Information derived from the Center for PAS report:
Kitchener, M., Willmott, M., Wong, A. & Harrington, C. (11/2006). Home and Community-Based Services: Federal Funding to States.

Click here to view the full report.

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