APD > APD Questions and Answers on the Medicaid Waiver

What services did the Legislature eliminate?

Chore, Non-residential Support Services, and Homemaker Services will be eliminated. However, the definition of In-Home Support Services will be expanded to include activities previously provided in the eliminated services.
Massage Therapy and IQ Testing (Psychological Assessments) will be eliminated. These service changes require federal government approval. They will take effect 30 days after receiving approval.

What services will be limited?

The services the Legislature limited by law are listed below. These changes take effect on July 1, 2007. The Agency is developing procedures for implementing these limits that will be available on the Agency's web site. With the exception of Residential Habilitation services, the change in service limits will be phased in for all affected individuals either on August 1 or October 1, 2007. All those affected by a change will be notified prior to it occurring. There may be additional service modifications made according to the agency's waiver plan.

Supported Living Coaching will be limited to no more than 20 hours a month for persons who also receive in-home support services.
Support Coordination to all persons under the age of 18 who live in the family home will be limited to Limited Support Coordination only.
Personal Care Attendants shall be limited to 180 per month. Additional hours may be authorized only if there is a substantial change in circumstances.
Residential Habilitation Services will be limited to no more than 8 hours a day. Additional hours may be authorized for persons who have intensive medical, adaptive, or behavioral needs. (In effect until 4 tier system implemented.) This limit will not be implemented until the latter part of August 2007.

Will the 180 limit for Personal Care Attendants affect people under 21?

APD and the Agency for Health Care Administration have reached an agreement which allows for people under the age of 21 to receive more than 180 hours of Personal Care Assistance if medically necessary. The Medicaid State plan will cover the cost of the additional hours.

Why is the agency making these changes?

The Florida Legislature required these changes in a law it passed this year. For many years the waiver has offered a wide array of services to people with developmental disabilities. The Agency for Persons with Disabilities is experiencing a budget deficit due to the variety and increasing costs of providing all the services. As a result, it has become necessary to reduce the number of services and limit the use of the remaining waiver services in order for the agency to remain within its budget. Failure for a state agency to remain within its budget is against the law. The legislature selected services for elimination and modification in the budget passed this year and in the law, Chapter 2007-64

Explain the proposed 4-tiered waiver system?

In addition to the changes listed above, the Agency for Health Care Administration, in consultation with the Agency for Persons with Disabilities, is required to seek federal approval for two additional waivers and implement a four-tiered waiver system. The new waiver system calls for waiver clients to be assigned to one of four "tiers", based on an assessment of their needs, according to the following criteria:

Tier 1 - current DD waiver: Limited to individuals with intensive medical, behavioral and adaptive needs that cannot be met in other tiers.
Tier 2 - Capped at $55,000: Limited to clients whose service needs include a licensed residential facility and greater than 5 hours a day of Residential Habilitation as well as clients in supported living who receive more than 6 hours of in-home support services
Tier 3 - Capped at $35,000: Will include all individuals who do not fall into tier 1 or tier 2.
Tier 4 - Current FSL waiver with a cap of nearly $15,000: Additional services may be added to this tier after July 1, 2008.

Will I lose my waitlist number on July 1?

The agency will be reviewing the waitlist to eliminate people who have moved out of state, are not Medicaid eligible, or no longer want agency services. The date a person is determined eligible for services is what the agency uses to enroll people into a waiver. The agency is considering no longer issuing waitlist numbers since they are not an accurate predictor of when someone will receive services. Instead APD will issue and track a date of eligibility. The date of eligibility is the determining factor in who is enrolled when enrollment is opened again in the future. The legislature has given priority to dependent children and people in crisis on the waiting list.

When will these changes go into effect?

Some of the changes will require federal approval which will take several months to receive. Some changes will require a revision to current rule. These changes will take effect as early as July 1, 2007. Please refer to the procedures for implementing the service limits and service limitations for more precise information. The procedures are posted on the agency web site: www.apd.myflorida.com.

When will I (my family member) be notified?

You will be notified promptly of changes that affect you when either the agency or the federal government has made a decision.

Do I have appeal rights?

The client or guardian will have the right to request a hearing on any limitation or elimination of services, and if moved from 1 waiver to another. The limitations and elimination of services will be required by a "change in law". This means a request for hearing may be denied if it challenges the "change in the law" and may limit the success of any hearing that is held.

What if I (my family member) need more services than the cap allows?

Individuals and families are encouraged to work with their waiver support coordinator and APD Area office to locate generic and community resources that may supplement waiver services. Natural supports should also be used to fullest extent possible.

The new law makes some exceptions for individuals who have intense behavioral, medical and/or adaptive needs. If you feel that you or your family member meet this criteria, consult with your waiver support coordinator. You may request that your services be reviewed.

The law allows for a "consumer-directed" option in each of the waiver tiers. What does that mean in terms of services?

Consumer direction is a concept that allows more participation and control by the individuals over their paid service plan and natural and community supports. Examples of consumer direction built into the current waiver include individual choice of providers and receipt of a service at the time and place convenient to the individual receiving services. Other considerations for future waivers may be the individual's ability to move services around as needed as long as total funding of their plan is not exceeded. The Agency for Persons with Disabilities will be examining with self-advocates, family members and other stakeholders the type of consumer direction that may be appropriate to include in the new waiver options.

If I have a service cut under the new law, where can I get information to help me replace the service elsewhere?

Your support coordinator should have information on other resources available in your community. In addition, the APD Area office or the local Family Care Council may be of assistance in identifying replacement resources.

Will I get a new assessment when I have a change in my cost plan? Who will do it?

Not all changes to a cost plan will require a new assessment. Each person receiving services will have an assessment performed during the next year or so to establish service levels and levels of need. APD is currently working on procedures that will better explain the assessment process and timeframes. These policies will be shared with all stakeholders when complete.

Has the role of the support coordinator changed?

Individuals who are under 18 years of age and who live with their family will receive "limited support coordination" rather than full support coordination. This means that the support coordinator will have less contact than they would have with an adult. APD will work with support coordinators to better define their role as a service manager and to focus their advocacy initiatives toward enhancing natural and community supports and resources.

Who may I contact to get more information about the new law?

Your support coordinator should have information about the changes resulting from the new law. In addition, the Agency for Persons with Disabilities Area office or the local Family Care Council may be of assistance. Information on the new law will also be posted on the APD web site: www.apd.myflorida.com.

When will the agency begin enrolling people on the wait list?

One of the agency's primary goals is delivering services to people on the waitlist. Cost efficiencies are being introduced to decrease the deficit. As these savings grow, the funds available will be used to provide services to those who are waiting for services.