Fixing the list

Fixing the list

A new rule is now in place that allows for a much overdue update of Ohio’s Medicaid waiver waiting list.

A waiver pays for services that are delivered in the home or in a community setting as an alternative to a person going into a large facility, like an intermediate care facility.

The previous rule for Home and Community-Based Services (HCBS) waivers was complex and confusing and allowed individuals to be on waiting lists in counties where they didn’t even reside.  Many of them have no immediate need for services.

Since September, the Richland County Board of Developmental Disabilities (RCBDD) and other DD boards across Ohio have started using a new statewide assessment tool to determine who should remain on the list.  The assessment process must be done by Dec. 31, 2020.

Currently, Richland County has more than 400 people on waiting lists for Individual Options,  Level One, and SELF (Self-Empowered Life Funding) waivers.  Some are on more than one list.

Under the new rule, an individual can only be on the waiting list in the county where he or she lives.  Also, there will only be one waiting list – not separate ones for each type of waiver.

“The type of waiver that a person is enrolled in will be based on which waiver can address their current needs in the most cost-effective manner,” says Richland Newhope Service & Support Administration (SSA) Director Juanita Shenberger.

Shenberger says, based on the results of the assessment, someone may or may not be placed on the waiting list.

 “A person is not placed on the waiting list if they have an immediate need, they don’t have a qualifying condition as defined in rule, or it is assessed they have no current need,” she adds.

 If someone does have an immediate need, RCBDD must take action within the next 30 days.  This may or may not involve a waiver.  It could be linking the person with other services in the community or providing local funds.

 Examples of an immediate need include loss of the primary caregiver, risk of harm to others, someone who has been abused, neglected or exploited, and nursing home discharge.

 Removal from the waiting list shall occur when an individual no longer has a qualifying condition or current need, asks to be removed, is already enrolled on a waiver that meets his or her needs, declines enrollment on a waiver or community-based alternatives that are sufficient to meet needs, the person fails to respond to at least two attempts to contact, he or she doesn’t meet the level of care, is no longer an Ohio resident, or the person passes away.

 Those that have been on a waiting list are now on what’s called a transitional list until the new assessment is completed.  Shenberger expects that process to take about a year.  Once completed, it’s estimated only 10 to 15 percent of those currently on waiting lists in Richland County will remain on the list.

 “We’re predicting that most of the people that we have are going to come off of that waiting list just because we have some that maybe are already on a waiver…that’s currently meeting their needs,” Shenberger says.

 She points out the SSA Department will send due process rights prior to removing someone from the list and that person has 15 days to appeal.

 Once someone is on a waiver, the RCBDD is obligated forever to provide the local match.  In 2017, that cost totaled $1.7 million.

 “In the last seven years, we’ve increased by 263 waivers,” noted Shenberger.

 “The overall goal should not be to get on the waiting list,” she says.  “It should be to have the person’s needs met.  This is a big shift in thinking for people and families.”

You can contact our board’s Service & Support Administration Dept. or your individual consultant (IC) any time you have questions or an immediate need.  We can re-assess needs and evaluate if immediate action is needed at any time.  Your individual consultant can be reached at 419-774-4201. The IC supervisors can be reached at: 419-774-4204 for Jackie Fry, 419-774-4442 for Michel Smith, or 419-774-4451 for Tracy Miner.  Contact Megan Franta, the manager of Community Contracting, at 419-774-4350 and SSA Director Juanita Shenberger at 419-774-4320.