What are Medicaid Waivers?
Virginia Medicaid Waivers combine money from the federal and state government to provide supports to Virginians in their homes and communities instead of institutions and nursing homes. Medicaid Waivers expand eligibility for Medicaid to people who may not otherwise qualify for services based on financial eligibility.
There are three Medicaid Waivers designed to serve your loved one with a developmental disability. They are:
Building Independence Waiver;
The Family & Individual Supports Waiver (FIS); and
The Community Living Waiver
There is one additional waiver, known as the CCC Plus Waiver that can benefit some individuals with intellectual and developmental disabilities who also have exceptional medical needs. We will outline each of these waivers in depth.
How could a Medicaid Waiver help my loved one?
Medicaid Waivers provide a variety of services that your loved one may benefit from, including, but not limited to:
Employment and community transportation;
Group day and/or residential services;
Independent living supports;
Private duty nursing;
Sponsored residential services;
Therapeutic consultation; and
My loved one doesn't need these services right now. Should I wait to apply?
Many times, when families learn about Medicaid Waivers, they believe there is no rush to get these services, as many of them focus on the teen and adult years.
THIS IS NOT THE CASE.
In Virginia, there are currently over 13,000 people with intellectual and developmental disabilities who are waiting for a waiver, with more individuals being added every day. Your family member may wait for MANY years to receive a waiver, sometimes over ten years! While your loved one may not require these services now, they may require them later in life, such as when they age out of the public school system.
We recommend that you apply for these services AS SOON AS POSSIBLE and make sure your loved one is on the waiting list for services.
How do I apply for my loved one?
Northwestern Community Services Board
Your first step is to contact your local Community Services Board. If you live in the Northern Shenandoah Valley, you will call the Warren County Clinic of Northwestern Community Services Board.
Press the number "1" for new client seeking services.
Leave a message requesting a screening for the Developmental Disabilities Waiver. If you have not received a response within a week, please call back and follow these steps again.
Your call will be returned by a coordinator and an evaluation will be scheduled.
What happens at the evaluation?
When your loved one arrives for his or her evaluation, the Community Services Board staff will determine if your loved one:
Meets Virginia's legal definition of having a developmental disability; and
Meets the functional criteria for waiver services as determined by the Virginia Individual Developmental Disability Eligibility Survey, also known as the VIDES
If your loved one meets the eligibility and functional criteria for a Developmental Disability Waiver, he or she will be placed on a single, statewide waiting list for services. He or she will be assigned a priority level, which will determine how urgent his or her needs are for services. Remember, just because your loved one may have very urgent needs, he or she will likely wait many years for services. At the present time, only individuals with Priority One status are offered a waiver slot. Click the image to the right to see how priority status is determined.
The three Developmental Disability Waivers
Building Independence Waiver
Family & Individual Supports Waiver
The Building Independence Waiver is for adults 18+ who are able to live independently in the community. Services that are available through the Building Independence Waiver include:
The Family & Individual Supports Waiver is for individuals living with their families, friends or in their own homes who have some medical and/or behavioral needs. This waiver is available for both children and adults and include the following services:
Community Living Waiver
The Community Living Waiver includes residential supports and a variety of medical, behavioral and non-medical support services. This waiver is available to both children and adults and include up to 24 hour a day/7 days a week supports for individuals with complex medical and/or behavioral support needs.
My loved one was found eligible for a waiver. What happens next?
If your loved one is found eligible for a waiver, he or she will be placed on a single, state-wide waiting list for services. The waitlist is based on urgency and your loved one will not receive a waiver in chronological order. Here is what happens next:
The Community Services Board(CSB) staff will assess your loved one's situation with you to establish his or her Priority Level on the waiting list. If there are any changes in your loved one's medical or behavioral health needs, or a change in your health status, be sure to contact your loved one's support coordinator.
If your loved one is considered Priority Level One, his or her needs will be assessed by the support coordinator to determine his or her priority needs score on the Critical Needs Summary. This is a form that will be updated annually, or any time there is a change in your loved one's needs. Remember to always contact your loved one's case manager if anything changes that could impact his or her priority level. Keep a copy of the Critical Needs Summary in a safe and secure location.
When waiver slots are available for assignment, individuals with the highest priority needs scores in each local CSB, are considered for a waiver. If your loved one is one of those individuals with the highest needs, his or her support coordinator will prepare a written review of his or her needs in a Slot Assignment Review Form.
Are there any supports for my loved one while he or she is waiting for a waiver?
Yes. If your loved one is on the waitlist for one of the three Developmental Disability Waivers, he or she is eligible for the Individual & Family Support Program, also known as the IFSP.
Each year, individuals on the waiver waitlist may apply for up to $1000 in financial assistance for services such as respite, behavioral treatment, therapy, equipment and more.
For more information and to sign up for important program updates, please visit the Individual & Family Support Program website.
Additionally, your loved one MAY qualify for the CCC Plus Waiver.
The CCC Plus Waiver
Your loved one may be eligible for the CCC Plus Waiver if he or she is:
An adult aged 65+ who has medical or nursing care needs; and/or
An individual under 65 years of age who has a disability and exceptional medical or nursing need
There is currently no waiting list for the CCC Plus Waiver.
How do I apply for my loved one?
Your first step is to contact your local Department of Social Services and Department of Health. Be sure to advise the person you are speaking with that you are requesting a screening for the CCC Plus Waiver.
A social worker from the Department of Social Services and a nurse from the Health Department will come to your home to conduct a screening using the Uniformed Assessment Instrument to determine if your loved one is eligible for the waiver. There are times that an individual can be screened for the waiver by a social worker at the hospital.
If you need further assistance, please send us a request for support.