Florida: DS/HCBS Waiver

        The Developmental Services/Home and Community Based Waiver is available to individuals who are receiving medicaid and are receiving services from Developmental Services.  The state-wide program is designed to keep people out of institutions and integrate them in their home communitites.  There are other waivers for different groups of people like mental health services consumers, the elderly and those diagnosised with HIV/AIDS.  (Sooooo..what's a waiver?)
         You can receive services under the DS/HCBS Waiver by applying with your local Developmental Services Program Office of the Department of Children and Families.  Once you are on the Waiver, you will need to select a Support Coordinator.   The consumer/customer and their family meet with the available WSCs (Waiver Support Coordinators) to select the one that they feel the most confident and comfortable with.  The individual has the power to hire or fire this person for any reason at any time.  It is this provider that arranges for all other services and supports.  The WSC is also an advocate.  It is their job to ensure that the rights of the individual are respected and that they have equal access to goods and services in their community.
        The job of the Support Coordinator is to serve the individual and their family, identify needs and desires, seek appropriate funding , manage the service delivery system and monitor their health and well-being.  Then there is the documentation.  You must have a college degree in a discipline-related field, have experience working with people who have special needs and be able to complete the application process.  You must have a security screening, complete state, district specific and ABC (computer billing system) training.   You can apply to be an independent provider or work for an agency that provides this service.  Contact you district Developmental Services Program Office for more information.  (Florida, District 6: 813-554-2214, Margaret Buono)

Home-and Community-Based Waivers

1. Medicaid home- and community-based service (HCBS) waivers afford States the flexibility to develop and implement creative alternatives to placing Medicaid-eligible individuals in medical facilities such as nursing homes. The HCBS waiver program recognizes that many individuals at risk of being placed in a medical facility can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institutional care.

2. Under section 1915 (c) of the Social Security Act (the Act), States may request waivers of certain Federal requirements which impede the development of Medicaid-financed community-based treatment alternatives. The requirements that may be waived are in section 1902 of the Act and deal with statewideness, comparability of services, community income and resource rules, and rules that require States to provide services to all persons in the State who are eligible on an equal basis.

3. The Act specifically lists seven services which may be provided in HCBS waiver programs: case management, homemaker
services, home health aide services, personal care services, adult day health, habilitation, and respite care. Other services,
requested by the State because they are needed by waiver participants to avoid being placed in a medical facility (such as
transportation, in-home support services, meal services, special communication services, minor home modifications, and adult day care) may also be provided, subject to HCFA approval. The law further permits day treatment or other partial hospitalization services, psychosocial rehabilitation services, and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness.

4. States have the flexibility to design each waiver program and select the mix of waiver services that best meets the needs of the population they wish to serve. HCBS waiver service may be provided statewide or may be limited to specific geographic
subdivisions.

5. States can make home- and community-based services available to individuals who would otherwise qualify for Medicaid only if they were residents of a medical facility. Federal regulations permit HCBS waiver programs to serve the elderly and disabled, the physically disabled, the developmentally disabled, or the mentally retarded or mentally ill. States may target 1915(c) waiver programs to individuals with a specific illness or condition, suchas technology-dependent children or individuals with AIDS.

6. To receive approval to implement HCBS waiver programs, State Medicaid agencies must assure HCFA that, on average, the cost of providing home- and community-based services will not exceed the cost of care for the identical population in an institution. The Medicaid agency must also document that there are safeguards in place to protect the health and welfare of beneficiaries.

7. HCBS waiver programs are initially approved for 3 years and may be renewed at 5- year intervals.

8. HCFA's first home- and community-based waiver program was established in 1981. There are currently over 200 HCBS waiver programs in effect, serving more than 250,000 people as cost effective and humane alternatives to confinement in a medical facility. All States except Arizona have at least one such program. Arizona is a technical exception, though, because it runs the equivalent of an HCBS waiver program under section 1115 demonstration waiver authority.

9. HCBS waiver programs are currently the responsibility of the Medicaid Bureau's Office of Long-Term Care Services within
HCFA.