Introduction to Medicaid Long-Term Care Home and Community Based Services

Virginia Department of Medical Assistance Services
600 E. Broad St, Suite 1300
Richmond, VA 23219
(804) 786-7933
dmasinfo@dmas.virginia.gov

Virginia has seven Medicaid programs that provide individuals with long-term care services in their home and community. These programs, called Medicaid waivers, provide a variety of services to the elderly and individuals with disabilities who meet the criteria for institutional care but choose to receive services at home and in the community. While assistance with the cost of room and board is not available through Medicaid waivers, waivers provide supports that help individuals to live as independently as possible in the community.

Long-Term Care Medicaid Waivers

• Elderly or Disabled with Consumer Direction Waiver (EDCD Waiver)
• Mental Retardation Waiver (MR Waiver)
• Individual and Family Developmental Disabilities Support Waiver (DD Waiver)
• Day Support Waiver for Individuals with Mental Retardation (Day Support Waiver)
• Alzheimer's Assisted Living Waiver (AAL Waiver)
• Technology Assisted Waiver (Tech Waiver)
• AIDS Waiver

Who Qualifies for Services?

• In general, the waivers provide services to the elderly (65 and older) and individuals with physical disabilities, mental retardation, developmental disabilities, and medical conditions requiring ongoing nursing care. Each waiver has a specific target population and eligibility criteria.
• To qualify for a waiver, an individual must meet the criteria to be institutionalized in a nursing facility, hospital, or an Intermediate Care Facility for Individuals with Mental Retardation (ICF/MR). Individuals receiving waiver services choose to receive services at home rather than in an institution.
• Individuals receiving waiver services must also meet the Medicaid eligibility criteria as determined by the local department of social services.
• Individuals found eligible to receive waiver services and who have a waiver slot are eligible to apply for Medicaid using special rules that apply to individuals meeting institutional criteria. For example, parents income and resources are not considered when applying for Medicaid for a child who qualifies for waiver services and has a waiver slot.

Who can help initiate services?

Initiation of services varies according to the waiver. Specific information is available in each of the brochures, or by contacting your local department of social services.

Will there be a fee?

There is no cost to be screened for a waiver.

There may be a monthly patient pay for services. The local DSS eligibility worker will determine if an individual has a patient pay.

Is there a waiting list?

Currently there is no waiting list for the EDCD, Tech, and AIDS Waivers.

There is a waiting list for the DD, MR, Day Support, and AAL Waivers.

Individuals may receive services on one waiver while on the waiting list for another waiver as long as the individual meets the eligibility criteria for both waivers.

If someone doesn't qualify for services, is there an appeal process?

Yes, individuals denied eligibility may appeal within 30 days to:

Recipient Appeals Unit
DMAS, Suite 1300
600 E. Broad St.
Richmond, VA 23219

More information on the appeal process may be found at http://www.dmas.virginia.gov/app-home.htm.

What type of services are available?

Each waiver has a set of available services based on an individual's needs.

EDCD Waiver: personal care, adult day health care, respite and personal emergency response systems (PERS).

MR and DD Waivers: personal assistance, training services, PERS, companion care, environmental modifications, skilled nursing, respite, and assistive technology devises.

Day Support Waiver: day support and prevocational services.

AAL Waiver: adult residential services in an assisted living facility.

Tech Waiver: private duty nursing, personal care, respite, environmental modifications, and assistive technology devices.

AIDS Waiver: personal care, respite, nursing services, case management and nutritional supplements.

Information on Choice

• Eligible individuals have the right to choose between institutional care or receiving waiver services at home and in the community.
• Services that are provided are supports that are needed, that the individual chooses, and that the individual agrees are needed.
• Individuals have the right to choose from among waiver service providers and change providers as needed.
• Individuals have the right to participate in service planning and choose others to assist in service planning if needed.

Who can be called for more information?

Information on services available and waiver eligibility may be found at www.dmas.virginia.gov/ltc-home.htm by clicking on the Description of Home and Community-Based Waivers link.

The local department of social services may provide more information on available long-term care programs. A listing of local DSS agencies may be found at www.dss.state.va.us/localagency/index.html.

If in a hospital or institution, contact the social worker or discharge planner for more information.

 

This document was developed under Grant No. 91599/3 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. However, the contents herein do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not infer endorsement by the Federal government. Please include this disclaimer whenever copying or using all or any part of this document in dissemination activities.