Medicaid Waivers Introduction

Virginia’s Medicaid Waivers for Individuals with Developmental Disabilities

Are you or your family member in need of services such as respite, personal care, assistive technology, employment, residential services, nursing or behavioral supports? If so, you need to find out about Medicaid Waivers. Virginia’s Medicaid Waivers pay for a variety of supports and services for children and adults with developmental disabilities and their families who need long-term support systems to live successfully in the community rather than in institutional settings.

Don’t worry about the financial Medicaid requirements! For children and adults with developmental disabilities, family income is NOT considered.

Already have a waiver? See the waiver types on the right side of this page for information about waiver operations.

What are the Medicaid Waiver Programs?

Virginia offers multiple Medicaid waiver programs. There are two waiver programs that are most commonly used by people with developmental disabilities.  They are:

1.  Developmental Disability Waiver 

2.  Commonwealth Coordinated Care Plus Waiver –  Effective July 1, 2017, the EDCD and Technology Assisted waivers were combined into the new Commonwealth Coordinated Care Plus(CCC) Waiver.  The CCC Plus Waiver is part of a new Medicaid managed care program: Commonwealth Coordinated Care Plus Health Plan which was launched on a regional basis starting in August, 2017. 

Scroll down for a description of the two waiver programs.

1.Developmental Disability Waiver Program serves individuals of any age with a developmental disability and children (birth through age 9) with a substantial developmental delay or specific congenital or acquired condition.  Within the Developmental Disability Waiver Program, there are three waivers that provide a continuum of services:

  • Building Independence (BI),
  • Family & Individual Support (FIS)
  • Community Living (CL).

The Developmental Disability (DD) Waiver Program provides supports and services options for successful living, learning, physical and behavioral health, employment, recreation and community inclusion.

2017 DD Waiver Guide for Individuals, Families and Support Partners from DBHDS   

Click to view the DD Waiver Services & Descriptions. Click to view the definitions of the three new services added to the DD Waiver in 2018.

Customized Rates are for individuals who have exceptional medical and/OR behavioral  support needs that outweigh the resources available within the current waiver reimbursement rate structure. As a result the customized rate may result in: higher level staffing ratios  Or higher credentialed direct support staff to ensure proper supports are given AND increased programmatic costs.  Customized Rate Guidelines

Eligibility Requirements, How to Apply & Waiver Assignment Process

To be eligible for the waiver:

To apply for the Developmental Disability Waiver services contact your local Community Services Board and waiver experts.  The Community Services Board (CSB) staff will determine if you:

1.meet the definition of a developmental disability and

2. meet the functional criteria as assessed on the VIDES screening tool.

The Waiver Assignment Process is coordinated by your local Community Services Board. Waivers are assigned based on support needs. Individuals who meet the eligibility criteria are often placed on the waiting list due to the limited number of waivers funded.  It is not a chronological waiting list.

What happens when you are placed on the waiver waiting list and What YOU Need to Do!

1. The Community Services Board(CSB) staff will assess your situation with you to establish your Priority Level of 1, 2, or 3 on the waiting list. Contact your case manager/support coordinator when your support needs change or you move. Your Priority Level may change as your needs change.  Keep a copy of the Priority Level form in your records.

2. Annually you will receive a letter from the VA Dept. of Behavioral Health and Developmental Services with two forms that must be completed and returned within 3 weeks.  If you do not return the Individual Choice and the Services Needed forms within the time frame you may be removed from the DD Waiver Wait List.  So watch your mail!  You should receive this mailing in the month of the year that you were originally placed on the Wait List.  Contact your Support Coordinator/Case Manager if you have questions.  Make sure the SC/CM has your current mailing address!

2. IF you are in Priority Level One, your needs will be assessed by the CSB/case manager/support coordinator to generate a priority needs score on the Critical Needs Summary. The Critical Needs Summary is reviewed and updated annually and whenever your needs change which may result in a different priority needs score. It is important that you contact your case manager whenever your needs change.  Keep a copy of the Critical Needs Summary in your records.

3. When waiver slots are available for assignment, individuals with the highest priority needs scores in each local CSB, are considered for a waiver. If you are in the pool of people with the highest scores, then your case manager/support coordinator will prepare a written summary of your needs and situation on the Slot Assignment Review FormDiscuss the information requested on the Slot Assignment Review Form with your case manager. Note: priority needs scores are relative to the individuals in priority one at your local CSB.

4. When waiver slots are available for assignment, your anonymous Slot Assignment Review Form is distributed to your local Community Services Board’s Waiver Slot Assignment Committee. The Waiver Slot Assignment Committee scores each individual on the Waiver Slot Assignment Scoring Summary to determine who is assigned a waiver slot.

Emergency Waivers are assigned by the VA Dept. of Behavioral Health & Developmental Services (DBHDS) to individuals who meet the Emergency Waiver Criteria.  There are a limited number of emergency waivers.

P.S. When you are on the waiting list you are eligible for the Individual and Family Support Program. Scroll down to IFSP.

Advocacy Tips for individuals/families requesting services and on the waiting list:

  • Review the VIDES, Priority Level Determination, Critical Needs Summary and Slot Assignment Review forms so that you are prepared to report the information required to the Community Services Board screener/case manager.
  • Review the completed documents for accuracy and request copies for your records.
  • Communicate changes in your situation in a timely manner to your case manager so that your support needs are accurately documented on the VIDES, Priority Level Determination, Critical Needs Summary and the Slot Assignment Review forms applicable to your status.

Resources While You Wait

  • Explore the CCC Plus Waiver (formerly the EDCD and Technology Assistive Waivers).  Individuals may be on the DD Waiver Wait List and receive waiver services from the CCC Plus waiver program.  Scroll down for more info.
  • Crisis services for all ages with developmental disabilities and behavioral or mental health challenges, provide prevention and stabilization supports. Click to view the REACH Program.
  • The Individual and Family Support Program (IFSP)  provides funding for those on the wait list for the Developmental Disability Waiver Program.  Check frequently for updates on the website for VA Dept. of Behavioral Health and Developmental Services and Follow The Arc of Virginia on Facebook for information.
  • Housing Options and Flexible Funds are available to those 18 years and older who are on the Developmental Disability (DD) waiver waiting list or receiving DD Waiver services.  Click to view information on Housing & Flexible Funds.

Appeal Rights:  You have the right to challenge decisions and actions regarding Medicaid.  An Appeal must be requested within 30 days of the decision or action that you disagree with. Click to view Medicaid Appeal information.

Regulations: Click to view the Developmental Disability Waiver Emergency Regulations starting on p. 97.   

Reimbursement Rates: Click to view the DD Waiver Rates for Services

2. Coordinated Care (CCC) Plus Waiver (former EDCD and Tech Assisted Waivers) This waiver serves all ages and does not have a waiting list.

Click to view the CCC Plus Waiver Services 

NOTE: See important changes to the CCC Plus Waiver for those under age 21. Find DMAS 7 form here.

Eligibility Requirements and How To Apply

To be eligible for the CCC Plus Waiver:

  • You must have a medical or nursing need(s).
  • If under age 65, you must also have a disability. (Note: mental illness solely does not qualify as a disability for this waiver).
  • You must meet the criteria for the Uniform Assessment Instrument.
  • To utilize the waiver, individuals must  apply for and qualify for Medicaid if not already enrolled in  Medicaid. You do not have to be enrolled in Medicaid when you apply for a waiver.

To apply for the CCC Plus waiver, contact your local Departments of Health OR Social Services. Requests for the waiver may also occur if the individual is hospitalized.

Advocacy Tips for individuals/families requesting the waiver

  • Review the Uniform Assessment Instrument (UAI) in advance of the screening. To view additional information about the screening click here: UAI Screening Guidance. Request a copy of your completed UAI for your records. For children, important to read prior to screening: Childrens’ Screening Criteria Memo 11.2016
  • If you are not found eligible for the CCC Plus Waiver, explore the Developmental Disabilities Waiver Program described above.
  • Check out Resources While You Wait above.

Appeal Rights:  You have the right to challenge decisions and actions regarding Medicaid.  An Appeal must be requested within 30 days of the decision or action that you disagree with. Click to view Medicaid Appeal information.

Reimbursement Rates: Click to view the CCC Plus Rates for Services 

For more information about the CCC Plus Waiver, CCC Plus Health Plan, referral information needed for screening request, regulations and Medicaid Manual click here.

 

Other Important Resources