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Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social Security Act, the federal government grants waivers of requirements that are otherwise applicable to Medicaid “state plan” services. Congress enacted section 1915(c) of the Social Security Act in the Omnibus Reconciliation Act (OBRA) of 1981. Until then, comprehensive long-term care services through Medicaid were available only in institutional settings. Although mandatory home health services and optional personal care services were available as Medicaid benefits before OBRA 1981, states had largely restricted their use and limited the amount of services - New York being an exception with its personal care program and the Lombardi or Long Term Home Health Care Program (LTHHCP), which was established by Chapter 895 of the New York Laws of 1977. In fact, Congress reportedly modeled 1915(c) waivers in part on New York’s experience with the Lombardi program. In waiver programs, CMS waives key requirements that apply to Medicaid “state plan” services – those provided to all Medicaid recipients in the state. State plan services are either “mandatory” or “optional,” meaning that a State may elect to include them in the state plan. Once elected by a state, an optional service must still comply with all of the federal requirements. For a waiver, however, waivers of the “statewideness” or “comparability” requirements of federal Medicaid law allow states to create waiver programs that target only a particular population -- limited by age, diagnosis, or geographic area of the state, or that limit the number of waiver slots available. Waiver of the financial eligibility requirements allow states to include individuals who would normally not meet Medicaid’s income/resource guidelines. Waivers have grown nationally with the momentum to “rebalance” long term care services from institutional care to care in the communities. However, they are not the only Medicaid home care services -- Medicaid programs offer “state plan” services which are part of the state’s statewide Medicaid plan, offered to all people of all ages and diagnoses in the state, if eligible. Unlike waiver services, state plan services may not have a waiting list. New York State has long led the nation in these two state plan services: personal care (also known as home attendant services in NYC) and certified home health care program (CHHA) services. This training outline by Selfhelp Community Services provides background, with statutory and regulatory references, about the various Home and Community Based Waiver Programs in New York State. A Table of Contents is set forth below. Related Links and Documents on Waivers in New YorkBackground on Waivers - Federal Law Requirements and Trends - See Cynthia Shirk, Rebalancing Long Term Care: The Role of the Medicaid HCBS Waiver Program, Georgetown University National Health Policy Forum, 2006 GIS 07 MA/018 (elimination of transfer penalty in all waiver programs) 1. Long Term Home Health Care Program (Lombardi/ LTHHCP)
2. Traumatic Brain Injury (TBI) Waiver
3. New York State Transition & Diversion Waiver (NHTDW)
4. NYS Office of People with Developmental Disabilities (formerly OMRDD)
5. Care at Home for Children with Physical Disabilities - Levels I & II
6. OMH Waiver for Children and Adolescents with Serious Emotional Disturbance
7. Bridges to Health (B2H) Waiver
8. New Federal Options for Waivers and Community-Based Long Term Care
================================================================================================= Training Outline on Waivers in New York State by Selfhelp Community Services Provides background, with statutory and regulatory references, about the various Home and Community Based Waiver Programs in New York State. 1. HCBS Waivers: Federal Landscape.............................................................................................................4
2. Introduction – 1915(c) Waivers.......................................................................... .......................................... 4
3. Medicaid HCBS Waiver Programs in NYS (adults) ...................................... ............................................. 7
5. New Options under Federal Law – PPACA................................................................................................. 35
This article was authored by the Evelyn Frank Legal Resources Program of Selfhelp Community Services, Inc.
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