A Home and Community Based (HCBS) Waiver is a way for the District to receive partial reimbursement from the federal government for providing needed community based programs and supports designed to enable individuals to leave institutional settings or to prevent their placement into institutional settings in the first place.
The federal government reimburses the District 70 percent of the cost of services and supports for people enrolled in a HCBS Waiver. This reimbursement helps the District to fund programs that might otherwise not be affordable. The reimbursement is received through the Medicaid program, therefore, a person must be enrolled in Medicaid to participate. DDS currently has one HCBS Waiver. It is the Mental Retardation Developmental Disabilities (MRDD) vocational, and family supports services for people who live in their own or family home or in licensed settings, where vocational and in-home services are needed for people who require a more intensive level of support to remain in their community.
What services are provided through the waivers?
MRDD Waiver services are used in combination with other Medicaid and generic services to provide a level of support that enables you to remain in the community and to meet your health and safety needs. The waiver offers a wide variety of services to do so.
Why enroll in the waiver?
Enrolling in a waiver is how you will be able to obtain services and supports from DDS such as day and vocation services and residential supports. People already in service also have to enroll so that District can receive all the federal matching funds for which it is eligible.
When needs increase over time, those enrolled in the waiver will be eligible for an increased level of services and supports in a timely fashion. By enrolling in a waiver, individuals can earn a monthly income and still retain their Medicaid health benefits.
How does a person enroll?
DDS notifies people who are on the MRDD Waiting List when there is an available opening on a waiver through the Resource Planning Allocation Unit. If you are eligible for the waiver program at that time, you and your team will start the Individual Plan process and complete the waiver application, and if necessary a Medicaid application. If you already are receiving services, your Support Coordinator can help you determine if you are waiver eligible and help complete the application process. To be eligible:
- The person must have Medicaid or be Medicaid eligible.
- The person must need an ICF/MR level of care. That is, the person must have a level of need which would necessitate the level of services provided in an institution.
- The person must say that they want to live in a community setting.
- The person must demonstrate a need for one or more of the services provided by a HCBS Waiver.
The person's income and assets must be within the limits specified for the waiver. That is:
- Assets less than $4,000, if receiving income from sources other than SSI.
- SSI benefits require assets less than $2,000.
- Income and entitlements less than $1,800 per month.
- If you work, you may be eligible as long as your assets and income meet the required thresholds.
What happens if you do not or cannot enroll?
DDS will work with you and your family to determine if you need to enroll in the waiver to obtain or keep services from DDS. If you do but choose not to enroll at that time, DDS will not offer you most services, such as day and vocational services and residential supports. If a family believes that their son or daughter is ineligible due to assets, staff from the department's Service Coordination Division will review particular financial circumstances to assist in a resolution.
If you are willing to enroll in a waiver, but cannot because you have excess assets, DDS will help you to arrange to spend down those assets to become eligible, or you would privately pay for your service(s) until you become waiver eligible.
What if you are found ineligible or denied services?
If a person applies for the waiver and is found ineligible, or, does not agree with service limits, requests additional services but is denied or is told that services will be reduced, they will be notified in writing by DDS and may appeal the decision to the Department of Health Care Finance, Office of Disability & Aging.