December 4, 2012
MEDICAID AUTISM WAIVER
By: Robin K. Cohen, Principal Analyst
You asked for information on the federal waiver the state is seeking to provide Medicaid-funded services to people with autism.
The Department of Developmental Services (DDS) requested a waiver from federal Medicaid rules to provide federally funded home-and community-based services to adults with autism who do not have an intellectual disability (IQ>70). DDS is awaiting approval of its waiver request from the federal Centers for Medicare and Medicaid Services.
The proposed program, which will have 100 slots in its first year, is targeting two groups: (1) adults currently receiving services through the DDS Autism Division (previously the Autism Pilot Program) and (2) children and young adults receiving services through the Department of Children and Families (DCF) Voluntary Services Program, which primarily serves youth and young adults with behavioral health needs. Additional participants can join as slots become available; a waiting list will be established for individuals who apply and for whom there is no slot. (The Department of Mental Health and Addiction Services has filed a separate waiver request for its clients who have both autism and mental health disorders.)
Applicants must meet financial and functional eligibility requirements. The program will offer an array of services to allow participants to live independently in the community. These services are capped at $60,000 per year per participant.
DDS has submitted a Medicaid Section 1115 (c) Home- and Community-Based Services waiver request to the federal Medicaid agency. If approved, the waiver will allow the department to offer Medicaid-funded services to individuals with autism. Medicaid offers a 50% federal match for any state expenditures; currently, services for the target groups are paid with state funds alone.
Since it is a waiver, enrollment is capped, as indicated in Table 1. Included in these figures are 75 individuals each year who are receiving services from DDS' Autism Division and two slots per year, starting in the second year, for the Money Follows the Person program.
Table 1: Enrollment Maximums In Autism Waiver Program
The proposed program will target adults who have been receiving services from DDS' Autism Division and children and young adults who have been receiving DCF Voluntary Services. Participants must be at least three years old with a diagnosis of Autism Spectrum Disorder who live in a family or caregiver's home or their own home.
To qualify financially, the applicant may not have income exceeding 300% of the federal Supplemental Security Income (SSI) benefit ($2,130 per month in 2013) and $1,600 in assets; parental income and assets are not counted.
To qualify functionally, an applicant must have substantial limitations in two or more of the following major life activities: (1) self-care, (2) understanding and use of language, (3) learning, (4) mobility, (5) self-direction, or (6) capacity for independent living. The functional impairments must have been diagnosed before age 22 and be expected to continue indefinitely.
The following services and supports, which are capped at $60,000 annually per participant, will be available under the program if the waiver is approved:
1. community companion homes (formerly community training homes),
2. live-in companion,
4. assistive technology,
5. clinical behavioral supports,
6. community mentor,
7. individual goods and services,
9. job coaching,
10. life skills coaching,
11. non-medical transportation,
12. personal emergency response system,
13. social skills group, and
14. specialized driving assessments.
DDS Medicaid Waiver request C:\Users\cohenr\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\1BEH9CD7\Application for 1915(c) HCBS Waiver CT_0993_R00_00 - Nov 01 2012 (3).htm
OLR report 2012-R-0283, Connecticut's Money Follows the Person Program