AIM Independent Living Centers: AIM Training Department

Under Section 1915(c) of the Social Security Act, Medicaid law authorizes the Secretary of the U.S. Department of Health and Human Services to waive certain Medicaid statutory requirements. These waivers enable States to cover a broad array of home and community-based services (HCBS) for targeted populations as an alternative to institutionalization. Waiver services may be optional State Plan services that either are not covered by a particular State or that enhance the State’s coverage. Waivers may also include services not covered through the State Plan such as respite care, environmental modifications, or family training.

To be a waiver participant, an individual must be medically and/or age qualified, certified for the waiver's institutional level of care, choose to enroll in the waiver as an alternative to institutionalization, cost Medicaid no more in the community under the waiver than he or she would have cost Medicaid in an institution, and be financially eligible for Medicaid that supports Long Term Care services.

The New York State Traumatic Brain Injury Waiver

For individuals with Traumatic Brain Injury (HCBS/TBI)
One component of a comprehensive strategy developed by the NYS Department of Health to prevent unnecessary entrances into nursing homes and to help individuals leave nursing homes to live in the community
Provides 11 Medicaid-funded services needed to assist participants to live in community-based settings and achieve maximum independence; services are used in combination with existing Medicaid and Non-Medicaid services
Participants may be eligible for rent subsidies and housing supports and limited one-time payment for furniture and household supplies.
Each recipient must be given the choice of living in the community or in a nursing facility, and - if choosing the community - a living arrangement that can meet his or her needs.

Who is Eligible?

An individual who is:

diagnosed with TBI or a related condition,
eligible for nursing facility level of care,
recipient of Medicaid coverage that supports community based long term care services, and
be between 18 and 64 years of age upon application of waiver.

A Regional Resource Development Specialist (RRDS) educates the individual about the waiver program, helps the applicant select a service coordinator, and approves all service plans. A service coordinator compiles all documentation needed to establish eligibility, and in conjunction with the individual develops a Service Plan which describes his/her interests, strengths, and goals.

Providers of TBI Waiver services must demonstrate to the RRDS that they meet program qualifications, which include assessments of character, competence, and ability to deliver services according to the Waiver's standards. Each waiver participant has an individualized service plan which the RRDS reviews every six months to ensure the health and welfare of the participant and to ensure that all necessary services are provided. The NYS Department of Health oversees the program.

New York State Medicaid Waiver for Nursing Home Transition and Diversion

The Home and Community-Based Services (HCBS) Medicaid Waiver for Nursing Home Transition and Diversion (NHTD) is one of the options available to New Yorkers with disabilities and seniors so they may receive services in the most appropriate, least restrictive setting. This summary provides a general overview of the NHTD waiver.

Philosophy

The NHTD Medicaid waiver was developed based on the philosophy that individuals with disabilities and/or seniors have the same rights as others to:

Be in control of their lives.
Encounter and manage risks and learn from their experiences.

What is an HCBS Medicaid Waiver?

Is an opportunity for comprehensive services to be available in the community rather than in an institution.
Allows states to assemble a package of carefully tailored services to meet the needs of a targeted group in a community-based setting.
Maintains the waiver participant's health and welfare through an individualized service plan.
Assures the overall cost of serving waiver participants in the community is less than the cost of serving a similar group in an institution.

Why did New York State Develop the NHTD Medicaid Waiver?

State legislation authorized a new HCBS Medicaid waiver to provide a cost-effective community-based alternative to nursing facility care, reflecting the State's commitment to serve all persons in the least restrictive setting, appropriate to their needs.

Individuals with disabilities and seniors, their families and other interested persons advocated for additional options for community-based services and supports.

Otherwise existing Medicaid services and other supports may not be sufficient or most efficient to meet the needs of some individuals with disabilities and seniors to transition into or remain in the community.

What are the Expected Outcomes?

Participants will have an additional community-based choice.
Participants will have opportunities to live meaningful and productive lives in their communities.
Families and other informal caregivers will have access to additional supports to assist them in their caregiver roles.

To be Eligible for the NHTD Medicaid Waiver an Individual Must:

Be capable of living in the community with needed assistance from available informal supports, non-Medicaid supports and/or Medicaid State Plan services and be in need of one or more waiver service;

Be eligible for nursing home level of care;
Be authorized to receive Medicaid Community Based Long Term Care;
Be between 18 and 64 with a physical disability, or age 65 and older upon application to the waiver;
Be considered part of an aggregate group that can be cared for at less cost in the community than a similar group in a nursing home;
Choose to live in the community as a participant in this waiver rather than in a nursing home; and
Not participate in another HCBS waiver.

Regional Resource Development Centers (RRDC)

The NHTD waiver is administered through a network of Regional Resource Development Centers (RRDC), each covering specific counties throughout the State. The contact person at the RRDC is the Regional Resource Development Specialist (RRDS). Additionally, the RRDC employs a Nurse Evaluator (NE).

Responsibilities of the RRDS include:

Interviewing potential waiver participants;
Assisting participants to access approved providers for Service Coordination;
Reviewing Service Plans for approval;
Determining whether an applicant participant meets all non-financial eligibility requirements for the waiver;
Maintaining regional budgets for waiver services; and
Issuing Notice of Decision forms to applicants to approve or deny waiver participation and to participants as necessary for ongoing participation.

Responsibilities of the Nurse Evaluator include:

Utilizing clinical expertise to review medically complex Service Plans;
Providing technical assistance to the RRDS and waiver service providers; and
Resolving issues associated with level of care determinations.

AIM and MEDICAID WAIVER

The following represents AIM’s participation in the New York State Waiver programs:

Waiver Services for the Traumatically Brain Injured

Counties Served

Allegany, Chemung, Schuyler, Steuben, Tioga, Tompkins

Services Provided

Service Coordination
Independent Living Skills Training

Waiver Services for Nursing Home Transition and Diversion

Counties Served

Allegany, Chemung, Schuyler, Steuben, Tioga,

Services Provided

Service Coordination
Independent Living Skills Training

For information regarding Medicaid Waiver programming at AIM, please contact Rhona Johnson, at 1.888.962.8244 x228 or rjohnson@aimcil.com