Section 1115 of the Medicaid statute allows sates to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP). The home health waivers are designed to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. Thirty-seven states currently have section 1115 demonstration projects, including projects that cover people who wouldn’t otherwise be eligible for coverage, provide additional benefits not usually covered under Medicaid, and implement innovative payment and delivery system reforms.
In theory, these waivers should provide “more” to Medicaid recipients than traditional Medicaid. States are supposed to show these waivers will promote the objectives of Medicaid, such as expanding coverage or access to care. In practice, they are often used to limit State Medicaid expenditures. The TennCare program, for example, is constantly in litigation with advocates for Tennessee Medicaid because Tennessee’s overriding goal seems to be cutting costs. Most recently, “block grant” proposals have been used as a way to limit Medicaid.
In Georgia, the following waiver programs are currently available:
Community Care Services Program
Elderly Disabled Waiver Program (EDWP) formally known as Community Care Services Program (CCSP) is a Class of Assistance (COA) designed to provide in home and community-based services to individuals. These individuals meet the criteria for nursing home placement but choose to remain in a residential home situation. Financial eligibility criteria is generally the same as nursing home Medicaid with one exception; the applicant’s monthly cost-share from income is equal to the current SSI rate. Services provided include:
- Adult Day Health
- Alternative Living Services
- Emergency Response Services
- Home-Delivered Services
- Personal Support
- Extended Personal Support (respite)
- Out of Home Respite
- Home Delivered Meals
- Skilled Nursing Services
- Structured Family Caregiving
Generally these services being with a referral to the Area Agency on Aging. For 35 counties in North Georgia, Legacy Link serves that function. After an evaluation if performed, the application is sent via a CCSP Communicator Form to DFCS to determine whether the applicant meets financial eligibility criteria.
New Options Waiver (NOW)
The NOW waiver program enables individuals with less intense and urgent needs than out-of-home residential treatment or extensive waiver services to live independently in the community. The New Options Waiver (NOW)/ Comprehensive Supports Waiver Program (COMP) are classes of assistance (COA) designed to provide in-home and community-based services to Medicaid eligible intellectually disabled and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program. The NOW/COMP Waiver Programs offer the following services, unless otherwise indicated:
- Adult Occupational Therapy Services
- Adult Physical Therapy Services
- Adult Speech and Language Therapy Services
- Behavioral Supports Consultation Services
- Community Access Services
- Community Guide Services
- Community Living Support Services
- Environmental Accessibility Adaptation Services
- Financial Support Services
- Individual Directed Goods and Services
- Natural Support Training Services
- Pre-vocational Services
- Respite Services
- Specialized Medical Equipment Services
- Specialized Medical Supplies Services
- Support Coordination Services
- Supported Employment Services
- Transportation Services
- Vehicle Adaption Services
See An Overview of New Options Waiver Program (NOW) and Comprehensive Supports Waiver Program (COMP). Individuals seeking the NOW or COMP waiver must have a documented diagnosis of an intellectual disability or a closely related condition, such as cerebral palsy, epilepsy, autism, or neurological problems. You can apply for the NOW/COMP waivers through the Georgia Department of Behavioral Health and Developmental Disabilities website.
Comp Waiver
The COMP waiver program is for individuals who need comprehensive and intensive services to live in the community. Individuals eligible for the COMP waiver program need out-of home residential support and supervision or intensive in-home services to remain in the community. The New Options Waiver (NOW)/ Comprehensive Supports Waiver Program (COMP) are classes of assistance (COA) designed to provide in-home and community-based services to Medicaid eligible intellectually disabled and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program. In addition to services provided unit eh NOW waiver, COMP offers Community Residential Alternative Services. See An Overview of New Options Waiver Program (NOW) and Comprehensive Supports Waiver Program (COMP). You can apply for the NOW/COMP waivers through the Georgia Department of Behavioral Health and Developmental Disabilities website.
Independent Care Waiver Program (ICWP)
The Independent Care Waiver Program (ICWP) is a class of assistance (COA) that provides in home care to individuals who are Severely Physically Disabled (SPD) or who have Traumatic Brain Injuries (TBI). Generally applicants must be between the ages of 21 and 64. SPD individuals are those who cannot physically care for themselves and require assistance from another for daily functioning. These individuals need more care than can be provided by EDWP. ICWP applicants must meet the criteria for nursing home placement although they remain at home. ICWP Medicaid recipients receive certain waivered services not normally covered by Medicaid, including the following:
- case management
- companion services
- counseling
- emergency response system (ERS)
- environmental modification
- homemaker services
- occupational therapy
- personal care services
- skilled nursing
- specialized medical equipment and supplies
- transportation
To be eligible, applicants must meet these general guidelines:
- Must be a Medicaid Member
- Must be between ages of 21 and 64 when applying
- Do not have a primary diagnosis of mental disorder/mental illness
- Must have a severe physical disability and/or traumatic brain injury
- Must live in their own home or community instead of hospital or nursing home
- Must be capable of directing their own services
- Individuals with TBI do not have to meet this criteria
- Their physical impairment or TBI must substantially limit one or more activities of daily living and require assistance from another individual.
- Must be medically stable but at risk of placement in a hospital or nursing facility because community based support services are not available
To apply for ICWP, contact Alliant Georgia Medical Care Foundation at 800-982-0411 or 888-669-7195. Alliant will complete a screening by asking potential members questions over the phone. If screening requirements are met, Alliant will have the potential member submit an application. After receiving the application, Alliant will schedule an in-person assessment. Based on the information provided, applicants may be eligible for ICWP and approved to receive services as funding becomes available.
Service Options Using Resources in Community Environments (Source)
The Source waiver is administered as part of the Elderly & Disabled Waiver described above under CCSP. a primary difference is that applicants must be eligible for SSI. There is no waiting list for SOURCE.
Deeming Waiver (Katie Beckett)
This waiver does not provide services, per se. Instead it removed the deeming rules that ordinarily cause a parent’s income and resource to be considered when a minor needs medical assistance. Katie Beckett is a class of assistance (COA) available to children under age 18 who are financially ineligible for SSI.
To be eligible under the Katie Beckett COA, an applicant must meet the following conditions:
- The applicant’s age does not extend past the month s/he turns age 18.
- The applicant is chronically impaired to the extent of being a suitable candidate for institutionalized care (nursing facility, hospital or intermediate care facility for the intellectually disabled).
- The applicant is financially ineligible for SSI in a private living arrangement due to his/her own income and/or resources or income/resources deemed from his/her parent(s).
- The applicant meets the Level of Care basic eligibility criteria.
- The applicant meets all other basic and financial eligibility criteria
Georgia Pediatric Program Waiver (GAPP)
The GAPP waiver is for children under age 21 who are medically fragile with multiple systems diagnoses, requiring in home continuous skilled nursing care. Child must also meet the level of care criteria for a hospital or nursing facility. Contact the GAPP Program Specialist at 404-657-7882. To apply for services contact a GAPP provider agency directly. GAPP nursing agencies can be found in Appendix U of the GAPP provider manual on the GAMMIS website.
