Three DD Waivers Building Family and Community Living - - PDF document

November 7, 2018

Developmental Disabilities Waivers Update

for the Joint Commission on Health Care

Health and Human Services Subcommittee

Dawn Traver, M.Ed. Director, Waiver Operations

Division of Developmental Services

Slide 2

Three DD Waivers

Building Independence

• Designed to support

adults who reside in an integrated, independent living arrangement who can be supported though the provision of a minimal level of supports

Family and Individual Supports

• Designed to support

individuals who live with their families or in their own homes

Community Living

• Designed to support

those individuals who require some form of 24/7 residential service In the Community

Slide 3

Process for Obtaining a DD Waiver

CSB Screening: diagnostic, functional, priority level Eligible individual added to the DD waiting list DD Waiver slot available: most urgent people reviewed by WSAC* DBHDS assigns slot to person(s) determined most in need Support Coordinator

• ffers choice of

waiver services & providers *Waiver Slot Assignment Committee

Slide 4

Building Independence 2% Community Living 84% Family & Individual Supports 13%

11,752

1,867

325

Total Filled DD Waiver Slots: 13,944

Virginia’s DD Waivers Filled Slots as of 6/30/18

Slide 5

Newly Funded Waiver Slots

Year New Slots for the Biennium

SFY 19

CL waiver FIS waiver BI waiver TOTAL by SFY 129 community + 60 facility + 25 reserve 414 628

SFY 20

CL waiver FIS Waiver BI waiver 135 community + 60 facility + 25 reserve 807 40 1067

Biennium TOTAL by Waiver

434 1221 40 1695

Slide 6

Building Independence 3% Community Living 77% Family & Individual Supports 20%

12,166

3,076

400

Total DD Waivers: 15,642

Virginia’s DD Waivers Total Slots as of 6/30/2020

Slide 7

Waiting List Update

Priority I

Projected to need services in a year

Priority II

Expected to need services in 1-5 years

Priority III

Expected to need services in five years or more

3,501 Individuals 5,656 Individuals 3,837 Individuals

Total Waiting List = 12,994

High Low

Suppor Support Need Need

Establish Groups of Individuals – Levels of Need

1 Mild Support Needs 2 Moderate Support Needs 3 Mild/ Moderate Support Needs with

Some Behavioral Support Need

4 Moderate to High Support Needs 5 Maximum Support Needs 6 Intensive Medical Support Needs 7 Intensive Behavioral Support Needs

Slide 9

2 4 5 6 7

How Much Support Do People Need?

7.1% 37.2% 4.9% 33.7% 1.7% 9.2% 6.2% 0% 5% 10% 15% 20% 25% 30% 35% 40% Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7

Data as of 10/23/2018

Slide 10 2,189 2,446 1,513 50 5,459 214 2,194 2,462 1,635 94 5,682 436 7 2,451 2,331 1,736 123 6,012 422 53

• 1,000

2,000 3,000 4,000 5,000 6,000 7,000 Baseline 9.30.2016 9.30.2017 9.30.2018

8%

104%

How Have Living Situations Changed?

Number of people Living Situation

53 12% 146%

• 5%

15% 10% 97% Arrows indicate change from Baseline

Slide 11

Housing Update

• 132 individuals transitioned to integrated, independent

housing in FY 18 using Housing Choice Vouchers and State Rental Assistance Program (SRAP):

– 64 have DD waiver services (47%) – 68 are on the DD waiver waitlist (53%); using community resources and natural supports to help them obtain and maintain housing

• Expanding SRAP
• Expansion of “Flexible Funding”

Slide 12

Common Elements: Waivers and Managed Care

• Provider Development
• Holistic approach to health outcomes
• Intended to decrease long-term, institutional care
• Intended to decrease use of higher cost settings (e.g.,

congregate settings, Emergency Departments)

“Managed care models don’t necessarily offer cost savings from reduced use of institutions because there is relatively low utilization of facility-based interventions and there is a waiting list of people looking for service. The budget management issue, whether in managed care or not, is really about providing a system that allows people with DD to live with families and friends rather than 24-hour staffed group homes.” ~ Nancy Thaler, past Director of NASDDDS and present Deputy Secretary for the Office of Developmental Programs in PA

Slide 13

Jump-Start

Slide 14

Next Steps: Supports Packages

• A mix of residential and day services equating to an
• verall dollar amount range based on an individual’s

living situation and level of needed supports

• Types of living situations:
• Virginia’s approach: soft touch management tool for

case managers to have critical conversations

Residential - Adults Living with Family - Children Residential - Children Living Independently - Adults Living with Family -Adults Building Independence