Home and Community-Based Services:
Medicaid Research and Demonstration Waivers - 2006
Martin Kitchener, Micky Willmott, Alice Wong & Charlene Harrington.
UCSF National Center for Personal Assistance Services.
Updated November 2006.
|State||Section1||Date submitted2||Date approved3||Date started4||Expiry date5||Name of project||Target group (eligibility)6||No. slots||Services covered||Area covered||Further details|
|AR||1115||May 1996||Oct 1998||Dec 1998||Nov 2006||Independent Choices||Aged/Physically disabled adults||3,500||PAS||Statewide||Independent Choices website: http://www.independentchoices.com
Waiver amended in 2002 to remove the experimental design & expand the program.
|AZ||1115||May 1982||July 1982||Oct 1982||N/A||Arizona LTC System (ALTCS)||Aged, physically disabled, MR/DD adults.||34,000||HCBS (e.g. home health, homemaker, personal care, PAS, meals, transport).||Statewide||Arizona LTC System website:
|CA||1115||May 2004||July 2004||Aug 2004||Jul 2009||California In-Home Supportive Services (IHSS) Plus Demonstration.||Aged, blind & disabled adults and children.||52,000||Personal care, homemaker services, restaurant meal allowances (allows consumer direction).||Statewide||Up to 195 hours of assistance per month allowed (up to 283 for severely impaired people).
3 delivery types:
California Department of Social Services, IHSS:
|COvii*||1115||July 1999||Aug 2001||Dec 2002||Dec 2007||Consumer Directed Attendant Support||Aged/Physically disabled adults.||500||Skilled nursing, personal care, home aide & homemaker services.||Statewide||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:
|FLviii*||1115||May 1996||Oct 1998||Mar 2000||Feb 2008||Consumer Directed Care Plusix||Aged/Physically disabled adultsx, MR/DD adults, children with DD||6,000||HCBS waiver services and any others approved by the consumer's state program office (e.g. yard work).||Statewide (children with DD). Selected counties (other groups).||FL participated in RWJF ‘Self-Determination’ project.
Approved under IP.
Florida Consumer-Directed Care Plus Waiver Operational Protocol (Dec 2003)
Foster, L., Phillips, B. & Schore J.
Consumer and Consultant Experiences in the Florida Consumer Directed Care Program (June 2005):
|LAxi*||1915c||Oct 2002||Apr 2003||Apr 2003||Apr 2006||New Opportunities Waiver (NOW)||MR/DD||4,776xii||18 services including respite, adaptations, skilled nursing & family support.||N/A||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):
NOW contact information:
|MD||1915c||N/A||N/A||Nov 2004||N/A||New Directions||N/A||100||Personal care, PAS, adaptations & equipment.||N/A||News Release (11.8.04) HHS Approves Maryland Plan To Allow Individuals With Disabilities To Direct Own Care
Independence Plus: A Demonstration Program for Family or Individual Directed Community Services Waiver (Oct 2004):
|MN||1115||June 2000||Pending||N/A||N/A||Consumer-Directed Home Care||Adults & children||1,500||Personal care, duty nursing, home health.||Statewide||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:
Community Alternatives for Disabled Individuals (CADI) Waiver for persons with disabilities who require the level of care provided in a nursing facility:
|NC||1915c||May 2003||Jan 2004||Date unknown, but program has started||N/A||CAP Choice||Aged/Disabled adults (not MR/DD).||600xix||In-home respite, PAS, home mobility aids, good & services.||Pilot in a limited no. of counties.||NC Community Alternatives Program website:http://www.ncdhhs.gov/dma/medicaid/ltc.htm
Application under IP
Independence Plus: A Program for Family or Individual Directed Community Services Waiver (May 2003):
|ND||1915c||Oct 2003||Pending||N/A||N/A||North Dakota Self Directed Supports||MR/DD Adults & Children.||N/A||Any services not included in the state plan||Statewide||Application under IP
Independence Plus: A Demonstration Program for Family or Individual Directed Community Services Waiver (October 2003):
|NH||1915c||July 2002||Dec 2002||Jan 2003||Jan 2006||Home Support Waiver for Children with DD||Children with MR/DD||200xx||Family support & care co-ordination, personal care, respite, modifications.||Statewide||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):
|NJxxi||1115||May 1996||Oct 1998||May 2000||Apr 2005||Personal Preference||Aged/Physically disabled adults, MR/DD adults.||3,500||PAS||Statewide||http://www.state.nj.us/humanservices/dds/projects/ppp/
Individuals are ineligible for the program if they need less than 180 days support/year.
|OR||1115||July 1998||Nov 2000||Dec 2001||Nov 2006||Independent Choices||Aged/Physically disabled adults, MR/DD adults, other.||300||PAS, homemaker & chore services, transport, adult companion services, in-home services.||3 regions||Oregon Department of Health Services, Seniors & People with Physical Disabilities
Brochure on Independent Choices
Oregon intends to replicate this statewide if successful. OR received funding from the RWJF ‘Self-Determination’ project.
|SC||1915c||Dec 2002||July 2003||May 2003||Jun 2006||South Carolina Choice||Aged/Physically disabled adults.||900xxii||Personal care, PAS, care advice, adult day health, respite.||3 selected counties.||Approved under IP|
|VT||1115||Oct 2003||Jun 2005||N/A||Sept 2010||The Vermont Choices for Care Long-Term Care Plan,||Aged/Physically disabled adults.||3,250||HCBS||Statewide||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)
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.
|VT||1115||Apr 2005||Sept 2005||Oct 2005||Sept 2010||Global Commitment Waiver||For a complete list of populations served:
|4,000||For a complete list of services:
|Statewide||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
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).
Notes and sources
• The table includes all programs reported by CMS as being 1115 ‘research and demonstration’ programs and all 1915(c) IP waiver programs. Unless otherwise stated, information is from CMS ‘A Map of State Waiver Programs and Demonstrations’. At: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html (Accessed 11/17/06).
• States marked * received IP Systems Change Grants from CMS in 2003.
• N/A denotes where the information was not available. RWJF is the Robert Wood Johnson Foundation.
i This refers to the section of the Social Security Act under which the waiver has authority.
ii The date the first application was submitted regardless of whether amendments have been made to the original waiver design
iii The date the application was first approved by CMS regardless of whether amendments have been made to the original waiver design.
iv This is the date that the waiver was first implemented, regardless of any subsequent amendments to the program design.
vThe expiry date is the most recent approved expiration date for the waiver.
vi The target group categories are those used by the CMS to categorize different population groups covered by waivers.
vii Another 1115 waiver program ‘Colorado Alternatives in Medicaid Home Care’ was approved Oct 1997. It would permit greater flexibility in defining where Medicaid home health visits can occur, so that visits can be made in schools, work sites or day treatment centers and would allow delegation of some skilled nursing functions to allow people flexibility in selecting home health aides of their choice. The limit would be 200 slots but it is not expected to be implemented. There are two other proposed 1115 waiver programs, Children's HCBS Program with Premium and Children's Extensive Support Program with Premium, these would replace existing 1915(c) programs for children with disabilities and would provide self-directed or family-directed in-home support services (http://www.chcpf.state.co.us/HCPF/MedicaidEligibility/mefcc.asp).
viii Florida received approval to convert it's ‘Cash and Counseling’ 1115 Demonstration waiver to an IP waiver (Dec 2003). From 2004 the program no longer has an experimental design (http://cdcplus.org/).
ix Formerly known as Consumer Directed Care.
x This includes adults with TBI/SCI who are eligible for the Florida TBI/SCI waiver at the time they seek to enroll.
xi Louisiana has a 1915(c) HCBS waiver serving people with lost sensory or motor function that was amended in 2000 to allow consumer directed PAS. It is not an IP program.
xii This figure is for year 3 of the program. The number of approved slots available in year 1 are 4,251 and year 2 are 4,576.
xiii This refers to the section of the Social Security Act under which the waiver has authority.
xiv The date the first application was submitted regardless of whether amendments have been made to the original waiver design.
xv The date the application was first approved by CMS regardless of whether amendments have been made to the original waiver design.
xvi This is the date that the waiver was first implemented, regardless of any subsequent amendments to the program design.
>xvii The expiry date is the most recent approved expiration date for the waiver.
xviii The target group categories are those used by the CMS to categorize different population groups covered by waivers.
xix Information direct from the state website, state officials state that the waiver will begin early in 2005.
xx Figure is the proposed number of slots in the 3rd (final) year of the waiver. In year 1, the proposed number of slots is 200, In year 2 the proposed number of slots is 400. North Carolina's application for the IP 1915(c) waiver, Appendix - Financial Documentation, p.50. Available at: http://www.bc.edu/schools/gssw/nrcpds/cash_and_counseling.html/resources/20060118-130916/northcarolina.doc
xxi Number of slots in the final year of the program. In year 1 the number of approved slots is 180, in year 2 the number of slots is 190.
xxii New Jersey is converting the Cash & Counseling 1115 Demonstration waiver to an IP 1115 waiver as the program no longer has an experimental design. In the meantime, the state still has 1115 demonstration authority until April 2005. CMS Approval Letter - Revised implementation Date. http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/MWDL/itemdetail.asp?filterType=data&filterValue=New%20Jersey&filterByDID=2&sortByDID=2&sortOrder=ascending&itemID=CMS048009.
xxiii Number of slots in the final year of the program. In year 1, the number of approved slots is 300, in year 2 the number of slots is 600