Michelle P. & SCL Waivers
A person can only receive one Medicaid waiver at a time. If you are on the Michelle P. Waiver, you cannot be on the SCL Waiver at the same time. And conversely, if you are on the SCL waiver, you cannot be on the Michelle P. Waiver at the same time. The Michelle P. Waiver was started to alleviate the very lengthy waiting list for the SCL waiver.
Michelle P Waiver APPLICATION MAP 621 (Microsoft Word)
In 2002 a person (named Michelle P.) sued the state because the SCL waiver waiting list had 3,000 people on it. In 2008 the state agreed to start a new Medicaid waiver (with fewer services than the SCL Waiver) to serve the folks on the waiting list. One of the big differences between Michelle P. Waiver & the SCL waiver was that the Michelle P. Waiver limited individuals services to 40 hours per week of non-residential services. The SCL waiver allows more than 40 hours of help per week AND also offers the option of residential services if they are wanted. Use of residential services on SCL are not required.
It is not true that participating in the SCL waiver is only for individuals who plan to live in a group home. Several people in Lexington with loved ones with intense needs are on SCL waiver and live in the community (NOT in a group home).
It is true that one of the additional services available on the SCL waiver (that is not available on the Michelle P. Waiver) is funding for residential services, like living in a group home. But just because that service is available doesn’t mean you have to use it, it’s just there as an option. And the folks I know do NOT use that optional service that’s available on SCL. They use the increased hours for staff to help their loved one live in their home.
These are services available on the Supports for Community Living waiver (SCL) as of Jan. 2014 (can be more than 40 hours per week of services if needed):
- Community Access is a service designed to support a waiver participant to become involved in clubs and organizations including recreational, educational, religious, civic and volunteer opportunities with an outcome of less reliance on formal supports and more on natural supports such as neighbors, friends, and church members.
- Community Guide is available to provide information and assistance in problem solving and decision making for people who choose to participant direct their own services including recruiting and hiring staff, training, managing, evaluating and terminating staff as necessary as well as understanding provider qualifications, recordkeeping and other waiver requirements.
- Community Transition offers funds for a participant moving from an institution or provider operated residential service, to their own home. This service provides reimbursement for certain one-time set-up expenses such as security deposits, essential household items such as furniture, window coverings, kitchen items, bath and bed linens, set-up fees for utility access such as electricity, telephone service, water or pest eradication, cleaning, and possibly minor accessibility adaptations. The reimbursement is not to exceed $2000.00 per qualified move.
- Conflict Free Case Management means that the case manager and the case management agency does not provide any other SCL waiver service to the participants they provide CM services for. An exemption to the conflict free requirements shall be granted if a participant requests the exemption and submits to DDID evidence that there is a lack of a qualified case manager within thirty (30) miles of the participant’s residence or there is a relationship between the participant and the participant’s case manager.
- Consultative Clinical and Therapeutic Service includes professional consultation, evaluation and assessment of the person in the environment and the system of support for the person and their team. The service may be provided by the following: certified nutritionist, licensed dietitian, licensed marriage and family therapist, licensed professional clinical counselor, licensed psychological associate, licensed psychologist, licensed psychological practitioner, licensed clinical social worker, positive behavior support specialist.
- Day Training supports participation in daily meaningful routines in the community. It includes regularly scheduled activities in a non-residential setting that are designed to foster the acquisition of skills, build positive social behavior and interpersonal competence, foster greater independence and personal choice; career planning or pre-vocational activities, training and supports designed to maintain skills and functioning and to prevent or slow regression, and supported retirement activities.
- Environmental Accessibility Adaptation Service is designed to enable participants to interact more independently with their environment. Service may include installation of a ramp, grab- bar, specialized electric and plumbing, modification of bathroom, and widening of doorways. Funding is limited to a lifetime limit of $8,000.
- Goods and Services include equipment, services or supplies which reduce the need for personal care or enhance independence and safety at home or in the community. Funding is limited to $1,800 per plan of care year.
- Natural Supports Training is education and training about support needs provided to community members who provide unpaid support, training, companionship, and supervision to the waiver participant. Funding is limited to $1,000 per plan of care year.
- Occupational Therapy that is ordered by a physician and provided by a licensed Occupational Therapist or a certified Occupational Therapy Assistant.
- Person-Centered Coaching is available to any participant to be used when a barrier challenges the success of the participant or the implementation of a plan of care. The person centered coach is under the direction of a positive behavior support specialist or other licensed professional in the settings where the plan of care is implemented. The person centered coach operates independently of a residential or day training provider.
- Personal Assistance Services shall enable a person to accomplish tasks that the person normally would do for themselves if the person did not have a disability. This is available only to a person who lives in their own residence or in their family’s residence.
- Physical Therapy that is ordered by a physician and provided by a licensed physical therapist or a certified physical therapy assistant.
- Positive Behavior Supports shall be used to develop the positive behavior support plan. Residential Support Services include:
- Level I Residential Supports may be provided in a licensed group home for no more than 8 people or in a staffed residence with no more than 3 people living together who require up to 24 hours a day, intense level of support, with no more than five unsupervised hours per day per person.
- Level II Residential Supports may be provided in a family home provider setting or adult foster care setting, for no more than 3 people living together who require up to 24 hour a day level of support.
- Technology Assisted Residential Services are available to participants who reside in a residence with three or fewer people and require up to 24 hour a day support. This service should enable people to increase their independence with a reduced need for on-site staff. This service is a real-time monitoring system with a two way method of communication linking a person to a centralized monitoring station with 24 hour availability.
- Respite is available for a person who does not receive residential services and resides in their own home or their family’s home. This is a short term support that is needed due to the absence or need for relief of an individual providing care to a participant.
- Shared Living allows a participant to live in a home or apartment that they own or lease with an unrelated caregiver who supports them as needed. Funding is for the caregiver’s share of room, utilities, and food in lieu of salary or other payment. The maximum amount of reimbursement for the caregivers’ room and board is up to $600.
- Specialized Medical Equipment and Supplies may include a device, control, or appliance which is necessary to ensure health, welfare, and safety and offers greater independence in their home. This may include a computer necessary to operate communication device, scanning communicator, speech amplifier, control switches, and other items.
- Speech Therapy that is ordered by a physician and provided by a licensed speech and language pathologist.
- Supported Employment shall be offered for a person if funding is no longer available through the Office of Vocational Rehabilitation. The person is competitively employed in an integrated business environment and is paid at or above minimum wage.
- Transportation is available to participants to gain access to integrated waiver and other community services, activities, resources and organizations typically utilized by the general population. This service can be provided when transportation is not otherwise and customarily available through natural supports or is included as an element of another SCL waiver service. It can be provided by a neighbor, friend or public transportation vendor including local cabs or bus services. Reimbursement is limited to $265 per calendar month.
- Vehicle Adaptation is a device, control, or service that increases the individual’s independence and physical safety. The adaptations may be made to a participant’s or a participants’ family’s privately owned vehicle. Reimbursement is limited to $6000.00 per 5 year period.
These are services available on the Michelle P. Waiver (limited to 40 hours per week):
- Case Management
- Adult Day Training
- Supported Employment
- Community Living Supports
- Behavior Supports
- Occupational Therapy
- Physical Therapy
- Speech Therapy
- Homemaker Service
- Personal Care
- Attendant Care
- Environmental/Minor Home Adaptation
- Adult Day Health Care