Medicaid, Waivers and Wait List
Medicaid Waivers
LEGISLATIVE WINS - CHANGES TO PUBLIC POLICY
Advocates, families, The Arc of Virginia, and partner organizations have worked tirelessly to address the needs of individuals with disabilities, resulting in historic wins over the last couple of years, including:
- 3,440 new DD Waivers
- Extension of the time allowed to keep your waiver while seeking services to one year
- Improvements for Legally Responsible Individuals (LRIs)
- Disregard of SSDI income exceeding the SSI maximum
- Combining the annual service limits for Assistive Technology and Electronic Home-Based Services into an annual $10,000 limit.
Most of these changes require approval from the Centers for Medicare & Medicaid Services (CMS), necessitating the submission of new waiver applications for Building Independence (BI), Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC+) waiver programs.
PUBLIC POLICY CHANGES NOT REQUIRING CMS APPROVAL
Disregarding Social Security Disability Income (SSDI) above the maximum Social Security Income (SSI) as determined by the Social Security Administration for purposes of pre-eligibility treatment of income (BI, CL, FIS), became effective December 1, 2024.
PUBLIC POLICY CHANGES REQUIRING CMS APPROVAL
For those policies requiring CMS approval, the Virginia Department of Medical Assistance Services (DMAS) submitted waiver amendments to CMS to implement changes approved by the General Assembly. DMAS proposed that, pending CMS approval, the amendments would take effect on January 1, 2025.
CMS RESPONSE - AS OF DECEMBER 2024
Amendments Approved by CMS:
- 3,440 new DD Waivers
Amendments Denied by CMS:
- Extension of the time allowed to keep your waiver while seeking services to one year
Amendments in Discussion and therefore ON HOLD:
- Improvements for Legally Responsible Individuals (LRIs)
- Combining the annual service limits for Assistive Technology and Electronic Home-Based Services into an annual $10,000 limit.
- Educational requirements for providers of Consumer-Directed Services Facilitation (CL, FIS, CCC+).
What is in Effect Now for those Policies ON HOLD?
Refer to DMAS provider manuals for current policies on Assistive Technology, Electronic Home-Based Services, and Services Facilitation.
Refer to the Medicaid Bulletin, “Implementation Update for March 1, 2024: Legally Responsible Individuals” dated February 29, 2024.
The Arc of Virginia will continue to advocate with DMAS through this process and keep our members updated.
Please follow us on Facebook and sign up here for updates.
DD Medicaid Waiver Wait List December 2024
Total # on Waitlist: 15,486
Of the Total: 3,314 are in Priority Level 1
Of the Total: 54% are under 18 years of age.
Are you signed up to receive The Arc of Virginia's monthly K/Now? If not click here.
Medicaid Waiver Amendments
There was a 31 day public comment period that ended on Sept. 6, 2024 for the Medicaid Waiver amendments.
It is expected that the amendments will go into affect on Jan. 1, 2025 pending approval by the Centers for Medicare and Medicaid.
You may view the Waiver amendments below:
Building Independence(BI) Waiver Amendment
Community Living(CL) Waiver Amendment
Family and Individual Support(FIS) Waiver Amendment
To view the public comments submitted go to Virginia Town Hall
AMENDMENTS:
DD Medicaid Waiver Wait List - September 2024
Total # on Waitlist: 15,555
Of the Total: 3,658 are in Priority Level 1
Of the Total: 53% are under 18 years of age.
In Case You Missed It!
The Budget was Approved!!!
On May 13, the Virginia Public Budget was approved for July 2024 - June 2026!
The most exciting and historic item in the budget is that 3,440 people in Priority Level 1 will receive a DD Waiver over the next two years!!!
Add 3,440 Developmental Disability Waivers for Priority Level 1
1,720 new DD Waivers in July 2024 and July 2025. There will be a total of 3,096 new Family and Individual Supports waiver slots and 344 new Community Living waiver slots funded over the two years.
Other highlights:
Retention of Waiver Slots
In response to the ongoing provider shortage, this allows children and adults struggling to find services to keep their waiver slot for up to one year while they are seeking service providers. This flexibility will end in June 2026.
Legally Responsible Individuals
Families are protected by ensuring that the waiver regulations regarding their ability to provide paid care for their children are reasonable and appropriate.
Increase in Peer Mentor Rates
This DD waiver service increased after it had been left out of the larger rate increases a few years ago.
Technology Funding
Increase funding limits for Assistive Technology(AT) and Electronic Home Based Services(EHBS) to a maximum annual total of AT and or EHBS up to $10,000.
Medicaid Works Eligibility
A study group will be formed to make recommendations.
Rate Increases for DD Waiver Services
A 3% rate increase effective July 2024 and July 2025 for these services:
Community Engagement, Community Coaching, In-home Supports, Supported Living, Independent Living Supports, Therapeutic Consultation, Private Duty and Skilled Nursing, Group Day, Group Supported Employment, Workplace Assistance, Benefits Planning, Group Homes, Sponsored Residential, and Community Guide.
Medicaid Rate Increase for Personal Care, Companion and Respite
A 2% rate increase for agency and consumer-directed Personal Care, Companion and Respite effective July 2024 and July 2025.
Special Education
Funding related to the implementation of IEPs, professional development, teacher coaching and eight additional state ombudsman positions. Funding total is $8 million over the two year budget.
MARCH 1, 2024
LEGALLY RESPONSIBLE INDIVIDUALS (LRIs) INFORMATION
With new rules coming into effect on March 1, 2024 for LRIs, we have created 3 Resources for Families. These resources are meant to meet you where you are based on your knowledge. We have 3 levels of information:
1) Quick Start Guide - short basic steps to take now to get you started
2) Fact Sheet - one page with all the basic facts you need
3) Overview - 3-page full overview of the new rules and what to do
Click below to Download what you need
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The Updated Rules required "LRI Forms" and training materials are on the DMAS WEBPAGE
Virginia's Budget
On Sept. 15, 2023 The Governor signed the Budget. Here are a few highlights:
Medicaid Waivers: 70 DD Community Living Waiver slots and 430 Family and Individual Services Waiver slots to be available January 1, 2024.
Waiver Reimbursement Rates: DD and CCC Plus Medicaid Waiver Consumer-Directed and Agency reimbursement rates for Personal Care, Companion and Respite will increase 5% effective January 1, 2024.
The Consumer Directed Rate for Northern VA increases to $17.27/hour and the Rest of the State Rate increases to 13.34/hour on January 1, 2024.
Early Intervention Services rates will increase by 12.5% on January 1, 2024.(Does not apply to case management).
The K/Now Newsletter has more detail. Did you get your September K/Now? If not click here.
DEVELOPMENTAL DISABILITY(DD) MEDICAID WAIVER "Slots" Fiscal Year 2024
In January 2024 the following 500 new DD Waivers will be available to those on the Waiver Wait List:
Community Living Waiver -70
Family and Individual Services Waiver - 430
In July 2023 the following new DD Waivers were available to those on the Waiver Waitlist:
Community Living Waiver - 100 waivers
Family and Individual Support - 500 waivers
Additional DD Waivers may become available anytime. They are available when a person no longer qualifies for a DD waiver, when someone moves out of state or no longer wants to use their waiver, when someone dies of the VA General Assembly funds additional waivers.
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DD Waiver Waitlist as of October, 2023
Total # on Waitlist: 14,941
Of the Total, 53% are under 18 years of age.
Of the Total, 3,395 are in Priority Level 1.
What to do if YOU are on the DD Waiver Wait List:
If you are on the DD Waiver Waitlist make sure that your DD Waiver application documents accurately reflect your current situation.
Request the following application documents from your Community Services Board:
VIDES - Everyone on the DD Waiver Wait List
Priority Level - Everyone on the DD Waiver Wait List
Critical Needs Summary - Everyone on Priority Level 1
Waiver Slot Assignment Review Form - those who are going to be reviewed by the DD Waiver Slot Assignment Committee
Review the information on the forms for accuracy. Call your Support Coordinator/Case Manager if updates are needed.
For the documents and more information about the DD Waiver application process click here.
Medicaid Eligibility Redetermination - Can they contact you?
During the Public Health Emergency, the Departments of Social Services(DSS) did not re-determine if people with Medicaid were still eligible for Medicaid. In March 2023 the Departments of Social Services(DSS) started re-determining if people are eligible.
If you have Medicaid and want to keep it, make sure that your local DSS has your current address and contact information. To update your contact information and to find out when your Medicaid renewal date is you may:
Go Online at commonhelp.virginia.gov, or
Call Cover Virginia at 1-855-242-8282 or
Call your local Department of Social Services.
STAY INFORMED
The Arc of Virginia will provide updates as information becomes available. Facebook is the first place we alert readers to changes. Or you may check this webpage anytime.
NEED HELP?
If you need information about Virginia public resources for people with or at risk of disabilities contact The Arc of Virginia ([email protected], (804)649-8481 x 104
If you have questions about Medicaid/Cardinal Care you may email:
Question and Answer:
Q: Where can I get information about advocacy for the DD Waitlist and other information?
A: We are glad you asked! Sign up here.
If you have other questions please submit them to
[email protected] or call 804-649-8481 x 104.