Florida Medicaid Waiver For Developmental Disability

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Lawmakers Want State Economists To Examine Costs Need For Medicaid Developmental Disability Programscarlos Guillermo Smith Presses For The Bottom Line Of Legal Costs

Florida Developmental Disability Medical Waiver Q & As | Florida Guardian ad Litem

Opposition to Orange Countys transportation tax brings back Ax the Tax

Floridas top economists could be taking a closer look at the number of people with developmental and intellectual disabilities in Florida who require home- and community-based services.

Those services can help those with disabilities live in the community and outside of institutions. A pair of lawmakers have filed bills that require state economists from the Florida Legislature, the Governors Office and the states Medicaid program to provide lawmakers with information about projected enrollment and costs.

The economists, who meet quarterly at the Social Services Estimating Conference Committee, delve into the minutia impacting Floridas Medicaid program and develop enrollment projections as well as Medicaid cost estimates.

Lawmakers rely on the Medicaid projections as they build state budgets. However, the Social Services Estimating Conference does not provide lawmakers with enrollment and cost projections for the Medicaid iBudget.

Rep. Carlos Guillermo Smith, an Orlando Democrat, told Florida Politics last week the exclusion from the Social Services review is purposeful.

To that end, Guillermo Smith on Tuesday filed HB 1569. In addition to requiring the Social Services Estimating Conference to develop iBudget enrollment and cost projections, the bill also requires conference members to provide projections on the number of people on the waitlist for iBudget services.

Christine Jordan Sexton

Dd Services Provided Varies By State Services Might Include

Service Coordinations:

Support is provided to any child/adult with developmental disabilities review their current situation, identify needs, and make referrals for essential services. These services are reviewed at least annually.

Family Support:

Family support provides assistance to families caring for their children with developmental disabilities at home. The program addresses the unique needs that arise when a child has a developmental disability.

In-Home and Community Supports:

In-home supports are provided to eligible children/adults living in their family home to help them remain in their home and be engaged in the community. A child and their family are assisted to direct a person centered plan and budget and arrange for needed services.

Behavior Support Services:

Behavior is supported through a structured plan that positively addresses the persons behavior as well as his or her quality of life. Positive behavior support is based in the principles of applied behavior analysis and involves understanding factors that impact behavior including antecedents and consequences.

Residential Care:

Residential care consists of group homes in local communities providing 24-hour supports, supervision and training to children with developmental disabilities. Group homes for children have 24-hour awake staffing.

What Are Intellectual And Developmental Disability Services

People with intellectual and developmental disabilities can be challenged with language, mobility, learning and independent living.

Developmental Disability services helps people with intellectual and developmental disabilities such as:

  • Autism spectrum disorders, a group of developmental disabilities that can cause significant social, communication and behavioral challenges.
  • Cerebral palsy, a group of disorders that affect a persons ability to move and to maintain balance and posture.
  • Developmental delay, a delay in reaching key developmental milestones, such as talking, crawling, walking or rolling.
  • Down syndrome, a condition in which a baby is born with an extra chromosome.
  • Other genetic disorders, includes all conditions which cause developmental or intellectual disability.
  • Intellectual disability, a disorder characterized by limits to a persons ability to learn as expected.

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Developmental Disabilities Medicaid Waiver

In Florida, the most significant services for persons with developmental disabilities are provided through the Developmental Disabilities Home and Community-Based Service Medicaid Waiver Operated by the Agency for Persons with Disabilities , this program now has an enrollment of approximately 30,000 people, with another 20,000 determined to be eligible but on a waiting list. Over the last decade, the DD Waiver has been in a continual state of change, with the latest iteration known as iBudget.

How is eligibility determined?

To qualify, an individual must meet all of the following criteria, set forth in §393.063, Florida Statutes:

  • Be over the age of 3
  • Have been diagnosed with one of six different developmental disabilities that occurred before the age of 18: mental retardation , cerebral palsy, autism, spina bifida, Prader-Willi, Phelan-McDermid or Down Syndrome AND
  • Have substantial limitations in at least three life activities: self-care, learning, mobility, self-direction, understanding and use of language, and capacity for independent living.

Like all Medicaid programs, there is also an income and asset limit, although the individual is treated as a household of one when finances are considered.

If the waiting list is so long, whats the point of applying for the DD Waiver?

What services are offered through the DD Waiver Program?

How are services approved?

What is iBudget?

What are my rights under the DD Waiver?

If you have been:

Then you are entitled to:

Statewide Medicaid Managed Care Managed Medical Assistance

Florida

The SMMC MMA program is the delivery of Medicaid State Plan services through a Managed Care Plan that is contracted with AHCA. Florida transitioned most of its Medicaid recipients to the managed care delivery system in 2014. When recipients enroll in a Plan they are considered enrollees or members of that Plan and work with the Plan to access Medicaid services. The Plan must comply with all federal Medicaid regulations as well as AHCAs Coverage Policies and Handbooks.

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How To Apply / Learn More

Long waiting lists to receive services under this waiver should be expected.

This waiver is open to Floridians statewide. Be aware that waiting lists for services are the norm. In 2013, despite assisting over 11,000 persons, there were approximately two applicants for every one slot available. Some limited additional information is available about this waiver on the Department of Elder Affairs website.

To apply, persons under 60 years of age should contact the Florida Department of Children and Families. Persons 60 and older should contact the Department of Elder Affairs.

Months Of Agency Neglect For Vulnerable Children With Disabilities And Their Families

Washington, DC, February 16, 2022

U.S. Representative Charlie Crist led a letter to the Centers for Medicare and Medicaid Services requesting the agency open an investigation into reports that the State of Florida has mismanaged the Medicaid program for children with disabilities. On October 1st, one of the state’s contracted Medicaid managed care providers apparently stopped reimbursing caregivers for children with disabilities. Both the company and the Agency for Health Care Administration , which oversees Florida’s Medicaid program, failed to take action for months. The neglect was such that providers across the state were forced to close their doors and parents were forced to leave their jobs to provide round-the-clock care for their children with disabilities.

This is a pattern of neglect that started with the unemployment fiasco that hung over 1 million Florida workers who lost their job during the pandemic out to dry. Now it’s children with disabilities and their families, along with the small businesses that care for them, who are feeling the pain. Since Governor DeSantis seems more interested in stoking culture wars and playing politics instead of doing his job, I’m calling on the federal Medicaid agency to investigate how this could have happened and how we can keep it from happening again. Florida families who have a child with a disability deserve answers.”

The text of the letter can be found below.

Dear Administrator Brooks-LaSure:

Sincerely,

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Why Is There A Dd Waitlist

Simply stated, the need for services far outpaces the current funding allocated by the Florida Legislature. However, the waitlist has been a longstanding problem. Indeed, many people with DD have been waiting for over ten years or more! 22,759 people on the waitlist until resources become available . The waitlist first reached over 20,000 in May, 2011. Approximately half of the individuals on the waiting list receive Medicaid State plan services.

The waitlist has 7 priority categories based on an evaluation of current circumstances and/or intensity of need.

Individuals on the DD Waitlist by Priority Group

Category

Applying For Services With Apd

What is a Medical Developmental Disability Waiver? | Florida Guardian ad Litem Training

Currently, APD Florida has 21,000 people waiting for services.

To apply for services from the Agency for Persons with Disabilities, which includes waiver participation or placement in an intermediate care facility for the developmentally disabled , submit an application to the APD office that serves your area, either by mail or by hand delivery. Faxed submissions will be returned for an original signature.

Waiver applicants who are in a crisis situation should contact the Agency for Persons with Disabilities regional office serving their county. The local regional office may be able to provide short term services and will review the situation and determine if a crisis application should be completed.

To be eligible for services from the Agency for Persons with Disabilities, you must be a Florida resident and have one of the following seven developmental disabilities: autism, cerebral palsy, intellectual disabilities, Down syndrome, Prader-Willi syndrome, Phelan-McDermid syndrome, spina bifida or children age 3-5 who are at a high risk of a developmental disability.

In order to be eligible for services, an individual must have a developmental disability which occurs prior to age 18.

After applying, and if you have been found eligible to receive services, you will be placed on a waiting list based on your priority category .

If you feel you are Medicaid eligible, please contact the Florida Department of Children and Families at 1-866-762-2237.

Contact Information for APD:

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Apd Offers Waiver Enrollment To Individuals On Waiting List

With the Agency for Persons with Disabilities offering Home and Community-Based Services Medicaid waiver enrollment to individuals on the waiver waiting list, advocates are applauding Governor Ron DeSantis commitment to serving people with disabilities in Florida. Governor Ron DeSantis and the Legislature allocated $95 million for APD to enroll approximately 1,900 people on the waiting list who are in categories 1 through 5.

The state of Florida continues to invest in its citizens including individuals with unique abilities, said Governor Ron DeSantis. Our state is making an historic investment by allocating $95 million to serve people on the waiting list this year. This money helps individuals achieve their goals including the opportunity to find employment, an important step towards independence.

I am so excited to welcome new individuals into the iBudget Florida waiver so they may receive services in their communities, said APD Director Barbara Palmer. We are staggering enrollment of the 1,900 people over the fiscal year to ensure APD is able to meet the needs of customers as they go through the enrollment process. With the continued support of Governor DeSantis and the Florida Legislature, we are making a huge difference in peoples lives.

What Can You Do

Floridians like you can help our fight for Medicaid expansion by sharing your health care story or a loved ones health care experience by emailing . In addition, you can advance our campaign through two simple tasks:

  • Recruiting family, friends and co-workers to sign our petition by visiting www.healthcareforfl.org or texting MEDEX4FL to 52886

  • Contacting your local legislators with one click of the mouse at

References:

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It’s Time To Address Florida’s Medicaid Waitlist

In her mid-50s with debilitating back and hip problems, Alison Holmes continues to provide around-the-clock care for her teenage son JJ, whose disabilities do not allow him to walk, talk, sit or feed himself. Alison is terrified about her own health failing before JJ gets off the Medicaid waitlist for home and community-based services. The Holmes family has been waiting for these services for more than 14 years.

Similar tear-inducing stories are widespread throughout Florida, as there are about 25,000 people with developmental disabilities on the Medicaid waitlist for home and community-based services . Like the Holmes, families can expect to wait 7 or more years before getting waiver services in Florida.

These Floridians with developmental disabilities are waiting to receive Medicaid waiver services, which provide professional, in-home care as a substitute to institutional care. This program offers a combination of human and health services that range from skilled nursing care to pharmaceutical needs and occupational/speech/physical therapy.

The growth of population in Florida and the states shift away from institutional treatment has increased demand for HCBS programs such as the Medicaid waiver waitlist. Still, the Florida legislature has imposed major funding cuts on the Waiver program, including a $43.8 million decrease in funding for the waiver in 2010.

Families Fight To Maintain Care For Loved Ones With Developmental Disabilities

Developmental Disabilities Medicaid Waiver

TAMPA, Fla. Despite a recent increase in funding, many people with developmental disabilities, who already receive money from the state, are fighting for benefits.

Earlier this year, the Florida Legislature made a historic $95 million investment in what’s known as the “iBudget” Florida Medicaid waiver, a program that lets individuals receive care in their own homes and community, rather than an institution.

The move is projected to allow nearly 2,000 people to come off the states years-long, 20,000-person waitlist. But advocates tell the ABC Action News I-Team they worry others who already receive these benefits could be at risk.

A MOTHER’S FIGHT

Jonathan Hughes was born prematurely, and as a result, he has severe cerebral palsy.

The bond between Hughes and his supported living coach, Ernest Bennerman, is one built through trust, comfort, and an understanding that comes with being in each others lives for the last 17 years.

I didnt realize it was 17 years. I knew it was a few years, but not 17 years. But you know, thats because youve got to enjoy this. Youve got to enjoy what you do and I enjoy what I do. Bennerman said, looking at Hughes. I just love this guy, you know he just brings a lot of excitement, definitely to my life.

Bennerman is also Hughes Social Security representative payee and healthcare surrogate.

Im like a brother to him. And hes like a brother to me and were family, Bennerman said.

The appeal was denied.

HIGH TURNOVER

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Floridas Medicaid Program For People With Disabilities Facing Budget Cuts

State health officials recommended limited cuts to a Medicaid program for people with disabilities Monday, after months of deliberating on potential changes that could affect more than 34,500 clients who depend on the program for services.

The recommended cuts were much lower than advocates for clients with developmental disabilities had feared. But the decision will be up to the Legislature, which ordered a redesign of the program and will consider the recommendations in its 2020 session.

The recommendations include some caps on services like companion care, supported employment and adult day training, which could affect about 1,500 Floridians. They also suggest moving some costs to the states main healthcare agency to lower costs for the states Agency for Persons with Disabilities.

Both the Agency for Persons with Disabilities and the Agency for Health Care Administration submitted a report to legislative leaders Monday afternoon with the proposed redesign of the program, also known as iBudget. Lawmakers had ordered the agencies to come up with the redesign earlier this year to curb the programs costs.

Lawmakers had not set a specific dollar figure for the program to meet their standard of budget predictability. But they did direct the two agencies to identify core services as part of the redesign, which some had construed to include eliminating unnecessary ones.

This story has been updated.

Changes Coming For Florida Developmental Disabilities Medicaid Waiver Program

News Service of Florida

The head of the Florida agency that helps people with disabilities told a large crowd of people Wednesday not to worry about an impending redesign of the states Medicaid home and community-based waiver program.

I know that some of you think that doom and gloom is here because of this, but its not, Agency for Persons with Disabilities Director Barbara Palmer said at a public meeting. Its a great opportunity for us to make a difference in the peoples lives.

Palmer said her agency has been working with the state Agency for Health Care administration on the redesign of the program and that the two agencies have held 12 meetings on the issue.

Palmer said that AHCA, which has an expertise in Medicaid waivers, is reviewing other states Medicaid waiver programs to see how they administer services necessary to keep people with developmental disabilities out of institutions and living in the community.

Palmer kept her remarks brief and spent most of the three-hour meeting taking notes. Public testimony centered on three main themes: stakeholder involvement in the redesign, increased funding, and opposition to managed care.

APD has garnered a lot of legislative attention of late, mostly due to budget deficits in the home- and community-based Medicaid waiver program known as the “iBudget.”

Any system, properly funded, can basically work, she said.

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Statewide Medicaid Managed Care Long Term Care Waiver

The SMMC LTC Waiver program is the delivery of Medicaid home and community-based services through a Managed Care Plan that is contracted with AHCA. Once a Medicaid recipient is determined eligible for LTC services, they may enroll with a Plan that manages and coordinates the delivery of those services in the community through a person-centered Plan of Care. The Plan provides a Case Manager to coordinate those services. The Plan must comply with all federal Medicaid regulations as well as AHCAs Coverage Policies and Handbooks.

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