What Is Tefra In Healthcare?

What Is Tefra In Healthcare
Watch the February 13, 2019 webinar by clicking below. TEFRA Frequently Asked Questions The Tax Equity and Fiscal Responsibility Act (TEFRA) is a Medicaid program that can help families with children younger than 19 years old who have a disability receive care in their homes rather than an institution. The TEFRA program can help pay for the cost of those services for eligible children. Some families will not have to pay anything as part of the program. Others pay a premium on a sliding scale, depending on their income. Children who live in an institution or receive extended care in an institution are not eligible for TEFRA.

Eligibility Applying TEFRA Premiums: How much will I pay? Important Phone Numbers

What is Tefra in Minnesota?

Medical Assistance topics: Medical Assistance-TEFRA (Tax Equity and Fiscal Responsibility Act) program provides Medical Assistance (MA) benefits for children with disabilities who do not otherwise qualify for MA due to their parents’ income being above the program limits.

Under MA-TEFRA, only the child’s income is counted.
The program is administered by county and tribal lead agencies in Minnesota and is supervised by the Department of Human Services (DHS).
The program is administered by county and tribal lead agencies in Minnesota and is supervised by the Minnesota Department of Human Services (DHS).

See common questions about MA-TEFRA below. MA under the TEFRA Option may be available to your child or children who have a disability and who were denied MA because your family income is too high. Children who may be eligible for this program:

Live with at least one parent Under 19 years of age Certified disabled by the Social Security Administration (SSA) or State Medical Review Team (SMRT) Require a level of care to live at home that is comparable to that provided in a hospital, nursing home or group home for people with disabilities The costs for the child to remain at home are less than those at a hospital, nursing home or group home Child’s income (not family income) is less than 100% of the Federal Poverty Guideline. If the child is over income, they may still be eligible for the TEFRA Option with a spenddown. Refer to What is a Spenddown (DHS-3017) to learn more about a spenddown.

If your child qualifies for MA-TEFRA, they will receive the same MA coverage benefits as children enrolled in standard MA, such as doctor visits, prescriptions and hospital stays. It can also cover PCA services, A PCA worker can help your child with things like daily living activities and health-related procedures and tasks.

Refer to Minnesota Health Care Programs Summary of Coverage, Cost Sharing and Limits (DHS-3860) for a complete listing of benefits and services covered by MA. Applications may take up to 60 days to process for someone with a disability. How long it takes depends on whether additional information or verifications are needed to determine eligibility.

A worker may extend the 60 days if your family needs additional time to gather and submit paperwork. The MA-TEFRA Application Checklist can help you understand your responsibilities during the application process, as well as the responsibilities of your county or tribal eligibility worker and the SMRT.

Online, using the Parental Fee Estimator By calling the Parental Fees Unit at 651-431-3806 or 800-657-3751

Refer to the Important Notice and Parental Fee Worksheet for more detailed information about fees. While counties and tribes administer the program, it is the Minnesota DHS that collects parental fees. They will determine your fee and mail you information that indicates your parental fee for the year and the amount of monthly payments you are responsible for paying.

When your child is enrolled in MA-TEFRA, they do not pay deductibles or copays. Yes. Your child on MA-TEFRA is required to complete a renewal annually, Renewal paperwork will be provided to you by the county or tribe once the renewal date approaches. Additionally, you must complete and return forms needed for t he parental fee determination.

The parental fee forms will come to you separately and may be due at a time other than the MA -TEFRA renewal. Yes. Children with disabilities who qualify for the TEFRA Option may also qualify for a n HCBS waiver program. Children approved under a n HCBS waiver program do not need to use the TEFRA Option.

Refer to Disability Hub MN – Waivers to learn more about HCBS services and what is covered.
Some children’s needs may be met through PCA services.
Others may need to be enrolled in a HCBS waiver program to meet their health care needs.
HCBS waivers offer tailored services and supports which supplement the services received under MA.

A MnCHOICES Assessment at your county or tribal agency will help determine which supports and services your child may need.

MNsure paper applications and online form Contacts for county and tribal lead agencies FAQs about Medical Assistance with the TEFRA Option Parental fees for children on Medical Assistance with TEFRA Option FAQs about the State Medical Review Team (SMRT) Services Covered under MA MnCHOICES Assessment: Steps to Get Help

What is the income limit for Tefra in Arkansas?

Families with annual incomes of less than $25,000 are exempted from the premium requirement. While premium requirements are set based on household income, program eligibility is determined solely on the assets and resources of the child. Calendar year 2021 marks the 19th year of the TEFRA-like demonstration.

Does NC have Tefra?

The State of North Carolina does not impose TEFRA liens. The State defines the terms below as follows: Note: North Carolina does not impose TEFRA liens.

Does Indiana have Tefra?

Medicaid Eligibility for Children with Significant Disabilities Living at Home –

State	TEFRA Medicaid state plan option/Katie Beckett waiver for children
Alabama	Waiver
Alaska	SPA
Arizona	Waiver
Arkansas	Waiver
California	Waiver
Colorado	SPA and Waiver
Connecticut	Waiver
Delaware	SPA
District of Columbia	SPA
Florida	Waiver
Georgia	SPA
Hawaii	Waiver
Idaho	SPA
Illinois	Waiver
Indiana	Waiver
Iowa	SPA
Kansas	Waiver
Kentucky	Waiver
Louisiana	Waiver
Maine	SPA
Maryland	Waiver
Massachusetts	SPA
Michigan	Waiver
Minnesota	SPA
Mississippi	SPA
Missouri	Waiver

table>

State TEFRA Medicaid state plan option/Katie Beckett waiver for children Montana Waiver Nebraska SPA and Waiver Nevada SPA New Hampshire SPA New Jersey Waiver New Mexico Waiver New York SPA and Waiver North Carolina Waiver North Dakota Waiver Ohio Waiver Oklahoma SPA Oregon Waiver Pennsylvania Waiver Rhode Island SPA and Waiver South Carolina SPA South Dakota SPA Tennessee Waiver Texas Waiver Utah Waiver Vermont SPA Virginia Waiver Washington Waiver West Virginia SPA Wisconsin Waiver Wyoming Waiver

Source: Musumeci, M., Chidambaram, P., and O’Malley Watts, M. Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey. (June 2019). The Kaiser Family Foundation. Available at https://www.kff.org/report-section/medicaid-financial-eligibility-for-seniors-and-people-with-disabilities-findings-from-a-50-state-survey-appendix-tables/,

What is Minnesota Tax Equity and Fiscal Responsibility Act Tefra?

TEFRA stands for the Tax Equity and Fiscal Responsibility Act, a federal law that set the rules for this option. The TEFRA option allows a disabled child to receive Medical Assistance (MA) payments, even if the child’s parents have too much income to qualify for the MA program.

What is Tefra SC?

Welcome to the Palmetto State—surrounded by beautiful coastlines to the east, and the scenic Blue Ridge Mountains to the Northwest. Family Connection of South Carolina has been serving families of children with disabilities and special healthcare needs for more than 30 years.

Since 2015 Family Connection has been the Parent Training and Information Center (PTI) for South Carolina.
Family Connection provides information, support, education and referrals to meet the individualized needs of referral families.
Our staff helps parents navigate the stages of their child’s education and healthcare journeys to chart a course for success.

The PTI provides support related to children and young adults ranging in age from birth through 26 years old and serves all 46 counties in the state. Because we are a non-profit and receive funding through grants, our services are currently free of charge. What Is Tefra In Healthcare General Information: Our state education agency is the SC Department of Education (SCDE). The Superintendent of Education is Ellen Weaver. SC has 85 school districts. Some counties are one district while other counties have multiple districts. For information on childcare providers/facilities in your area and their quality ratings: scchildcare.org BabyNet is South Carolina’s interagency early intervention system for infants and toddlers under three years of age with developmental delays, or who have conditions associated with developmental delays.

It is managed by the SC Department of Health & Human Services (DHHS).
Anyone can make a referral by calling 1-866-512-8881.
If you have questions or concerns about your child’s development, check out “Your Child’s Journey Begins” on our home page.
Children who need, or are suspected to need, special education services and are older than three years of age should be referred to the school district in which the child resides.

Contact information for individual schools and the districts can be found at the SC Department of Education website. The Office of Special Education Services (OSES) has resources for parents. All public schools in SC use Enrich web-based product for Individualized Education Plans (IEPs).

More information about Enrich In South Carolina a parent is defined as a person who legally has the care and management of a child. (S.C. Code Ann.
§ 63-1-40 (2010) This includes foster parents and guardians in most cases.
OSES offers an informal dispute resolution for families through a Facilitated IEP process.

Lannette Cox is the SC Ombudsman for OSES.803-734-2833 SC schools have 60 days to complete an evaluation for special education services from the date of signed consent. Once the evaluation is completed, the LEA has fifteen business days in which to determine eligibility.

An IEP must be developed within 30 calendar days of a determination that the child needs special education and related services and must be implemented as soon as possible after written parent consent is granted for the services in the IEP.
When a child with a disability, who has an IEP that is current in another state, transfers to an LEA in South Carolina, the new LEA, in consultation with the parents, must provide the child with a free and appropriate public education (FAPE), including services comparable to those described in the child’s IEP from the previous LEA.

The new LEA may adopt the current IEP or conduct an initial evaluation to determine eligibility and develop and implement a new IEP. Developmental Delay can only be used as the primary disability category on an IEP through the age of 9. A child who initially qualifies for services under the category of DD must be re-evaluated before their 10 th birthday to determine if they continue to qualify for special education (SPED) under another category.

For children who receive SPED services in SC, transition planning begins at the age of 13.
There are three options for these students: SC High School Diploma, The SC Credential, and an attendance certificate.
It is important for parents to clarify which option their child is eligible for to ensure a smooth educational career path and exit to post-secondary education.

For information on The SC Credential visit thesccredential.org On or before the student’s 17th birthday, the student’s IEP must contain a statement indicating that the student has been informed that at age 18, he or she has attained the age of majority in South Carolina and all parental rights transfer to him/her. The Palmetto State is home to the Clemson Tigers and the University of South Carolina Gamecocks. Five of our instate colleges and universities offer non-degree programs for those individuals with intellectual disabilities who want a college experience.

These schools include: University of South Carolina, Clemson University, Coastal Carolina University, College of Charleston, and Winthrop University. Learn about LIFE programs For legal questions related to special education or disability rights, contact Disability Rights South Carolina at 1-866-275-7273 or www.disabilityrightssc.org.

Medicaid: SC Medicaid program is managed by DHHS. Katie Beckett/TEFRA is an eligibility category available in SC. Through this program, children with certain disabilities can qualify for Medicaid benefits regardless of parents’ income. For more information or to download the TEFRA application, check out the Healthcare tab on our website.

The child must be a SC resident before applying for Medicaid. Medicaid coverage and benefits cannot be switched from one state to another. You’ll need to reapply for Medicaid in South Carolina once you have obtained your new address. You can click here to download the full TEFRA application and contact our office at 1-800-578-8750 for assistance completing the application.

Supplemental Security Income (SSI) pays benefits to children and adults who are blind or disabled and who have limited income and resources. If determined eligible for SSI, the child or adult will be automatically eligible for Medicaid. Children receiving SSI may not also receive TEFRA.

Accessible Vehicle Permits For information about applying for a parking placard/permit for your accessible vehicle, visit South Carolina Department of Motor Vehicles’ website or call 803-896-5000. SC Department of Disabilities & Special Needs (DDSN) is the state agency that provides services to children and adults with severe, lifelong disabilities of intellectual disability & related disability, autism spectrum disorder, traumatic brain injury, spinal cord injury and conditions related to each of these four disabilities.

For questions: 1-800-289-7012. There are extensive waiting lists for waivers in SC. Among others, DDSN manages the ID/RD, Head & Spinal Cord Injury and the Community Supports waivers. We encourage parents to put their child’s name on waiting lists as early as possible.

SC has three Centers for Independent Living which cover 37 of our 46 counties.
Find the center that covers your county SC ABLE Savings Program are tax-advantaged accounts that allow people with disabilities to save and invest for their future without jeopardizing their government benefits such as SSI & Medicaid.

For more information call 1-800-439-1653 or www.treasurer.sc.gov We at Family Connection are proud to support our military families. SC is home to every branch of the military and many retirees. If your family is coming to SC due to PCS, please contact our military liaison, Elizabeth Allen DHEC: Division of Children and Youth with Special Health Care Needs ( CYSHCN) Children and Youth with Special Health Care Needs (CYSHCN): The CYSHCN program is managed by South Carolina Department of Health and Environmental Control (DHEC) through Title V.

Through this program, the CYSHCN team of nurses, social workers, and registered dietitians coordinate care for eligible families, children, and youth through referrals, care coordination, and transition assistance.
The CYSHCN program also provides payment assistance for eligible children and youth with special health care needs for medical services and supplies, orthodontic services, audiology services, and more.

The CYSHCN program also offers a rewarding summer residential camping experience at DHEC’s Camp Burnt Gin for eligible participants ages 7-25. For more information, contact: Division of Children and Youth with Special Health Care Needs: 2100 Bull Street, Columbia, SC 29201 phone: 803-898-0784 email: or,

What are the benefits of Tefra in Arkansas?

Watch the February 13, 2019 webinar by clicking below. TEFRA Frequently Asked Questions The Tax Equity and Fiscal Responsibility Act (TEFRA) is a Medicaid program that can help families with children younger than 19 years old who have a disability receive care in their homes rather than an institution. The TEFRA program can help pay for the cost of those services for eligible children. Some families will not have to pay anything as part of the program. Others pay a premium on a sliding scale, depending on their income. Children who live in an institution or receive extended care in an institution are not eligible for TEFRA.

Eligibility Applying TEFRA Premiums: How much will I pay? Important Phone Numbers

Does Oklahoma have Tefra?

Care for children with disabilities – TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) gives states the option to make Medicaid (SoonerCare in Oklahoma) benefits available to children with physical or mental disabilities who would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of their parent’s income or resources.

You can email your completed forms and documents to, fax the information to 405-530-3312 or you can mail your information to: Oklahoma Healthcare Authority Attention: TEFRA unit 4345 N. Lincoln Blvd Oklahoma City, OK 73105.

: TEFRA Children Overview – Care for children with disabilities

What is the monthly income limit for Medicaid in Arkansas?

Income & Asset Limits for Eligibility – Each of the 3 Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary depending on marital status, and is further complicated by the fact that Arkansas offers alternative pathways towards eligibility.

Simplified Eligibility Criteria: Single Applicant for Nursing Home Care AR seniors must be financially and medically eligible for long-term care Medicaid. One must have limited income, limited assets, and a medical need for care. A single individual applying for Nursing Home Medicaid in 2023 in Arkansas must meet the following criteria: 1) Have income under $2,742 / month 2) Have assets under $2,000 3) Require the level of care provided in a nursing home facility.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from an Arkansas Medicaid program. Alternatively, one can take the Medicaid Eligibility Test, IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for Medicaid.

2023 Arkansas Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid	Single	Married (both spouses applying)	Married (one spouse applying)
	Income Limit	Asset Limit	Level of Care Required	Income Limit	Asset Limit	Level of Care Required	Income Limit	Asset Limit	Level of Care Required
Institutional / Nursing Home Medicaid	$2,742 / month*	$2,000	Nursing Home	$2,742 / month per spouse*	$3,000	Nursing Home	$2,742 / month for applicant*	$2,000 for applicant & $148,620 for non-applicant	Nursing Home
Medicaid Waivers / Home and Community Based Services	$2,742 / month	$2,000	Nursing Home	$2,742 / month per spouse	$3,000	Nursing Home	$2,742 / month for applicant	$2,000 for applicant & $148,620 for non-applicant	Nursing Home
Regular Medicaid / Aged Blind and Disabled	$914 / month	$2,000	Help with ADLs	$1,371 / month	$3,000	Help with ADLs	$1,371 / month	$3,000	Help with ADLs

All of a beneficiary’s monthly income, with the exception of a personal needs allowance of $40 / month, Medicare premiums, and possibly a Monthly Maintenance Needs Allowance for a non-applicant spouse, must be paid to the nursing home.

How to apply for TEFRA Medicaid in SC?

How can I apply for TEFRA / ‘Katie Beckett’? Applications are available from the Resource Library, from the South Carolina Department of Health and Human Services at 1-888-549-0820, or from Family Connection of South Carolina at 1-800-578-8750.

Does autism qualify for Medicaid in NC?

Are Autism services covered by Medicaid or my health insurance plan? – Autism services are covered by Medicaid and by many, but not all, health insurance plans.

Does South Carolina have TEFRA?

South Carolina currently has seven Medicaid waivers/programs that can serve children, including a TEFRA program and six additional home and community based 1915(c) waivers. A new waiver for children with serious emotional disturbance was approved in 2020.

All programs are based only on the child’s income, waiving parental income for eligibility. For more information about waivers in South Carolina that serve individuals with developmental or intellectual disabilities, see Medicaid HCBS Waiver Services from the Department of Disabilities and Special Needs.

See also South Carolina Medicaid’s page on waivers, South Carolina also has two adult-only waivers, Mechanical Ventilation Dependent and Community Choices. Advocacy Organizations in South Carolina:

Family Connection of South Carolina Disability Rights South Carolina: Protection and Advocacy Arc of South Carolina

Last updated 11/16/22

Does Florida have a Medicaid waiver program?

Florida Waiver Factsheet Provides life skills development level 3 – adult day training, life skills development level 4 – prevocational services, residential habilitation, respite, support coordination, adult dental services, occupational therapy, physical therapy, respiratory therapy, skilled nursing, specialized medical equipment and supplies, specialized mental health counseling, speech therapy, transportation, behavior analysis services, behavior assistant services, dietitian services, environmental accessibility adaptations, life skills development level 1 – companion, life skills development level 2 – supported employment, personal emergency response system, personal supports, private duty nursing, residential nursing, special medical home care, and supported living coaching services to individuals with autism, developmental disabilities, or intellectual disabilities ages 3 or older who meet an ICF/IID level of care.

This waiver operates with a concurrent 1915(j) authority. Provides respite, support coordination, adult dental services, durable medical equipment, behavioral services, consumable medical supplies, and non-residential support services to individuals who are medically fragile ages 3-64 years who meet a hospital level of care.

Provides adult day health care, case management, homemaker, respite, attendant care, intermittent and skilled nursing, medical equipment and supplies, occupational therapy, personal care, physical therapy, respiratory therapy, speech therapy, transportation, adult companion, assisted living, behavior management, caregiver training, home accessibility adaptations, home delivered meals, medication administration, medication management, nutritional assessment and risk reduction, and personal emergency response system services to individuals ages 65 or older, and individuals with physical disabilities or with brain injury, with HIV/AIDS, or who are medically fragile ages 18-64 years who meet a hospital or nursing facility level of care.

This waiver operates with a concurrent 1915(b)(1) and 1915(b)(4) authority. Provides respite, environmental accessibility adaptations, and transition case management services to individuals who are medically fragile ages 0-20 years who meet a hospital or nursing facility level of care. WAIVER TERMINATED on 1/31/2018 – Provided residential habilitation, assistive technology, attendant care, behavior programming, community support coordination, consumable medical supplies, occupational therapy, personal adjustment counseling, personal care services, physical therapy, transition case management, companion care, emergency alert response system – installation, emergency alert response system – monitoring and maintenance, environmental accessibility adaptations, life skills training, rehabilitation engineering evaluation, and transitional environmental accessibility adaptations services to individuals with brain injury ages 18 or older who met a nursing facility level of care.

WAIVER TERMINATED on 6/30/2013 – Provided personal care, residential habilitation, respite, support coordination, supported employment, adult dental, occupational therapy, physical therapy, private duty nursing, respiratory therapy, skilled nursing, specialized medical equipment and supplies, specialized mental health, transportation, adult day training, behavior analysis, behavior assistant, community guide, companion, dietician services, environmental accessibility adaptations, in-home support, medication review, personal emergency response system, residential nursing, special medical home care, speech therapy, and supported living coaching services to individuals with autism, developmental disabilities, or intellectual disabilities ages 3 or older who met an ICF/IID level of care.

This waiver operated with a concurrent 1915(j) authority. WAIVER TERMINATED on 1/31/2018 – Provided community support coordination, homemaker, personal care, respite, adult dental services, physical therapy evaluation, physical therapy, prescribed drugs, respiratory therapy evaluation, respiratory therapy, skilled nursing, specialized medical equipment and supplies, chore, counseling, home delivered meals, massage therapy, nutritional supplements, personal emergency response system maintenance and monitoring, and personal emergency response unit services to individuals who are medically fragile ages 18 or older who met a hospital level of care.

WAIVER TERMINATED on 3/31/2014 – Provided adult day health care, attendant care, case management, homemaker, respite in-home, consumable medical supplies-enhanced, consumable medical supplies, counseling, occupational therapy, personal care, physical therapy, respiratory therapy, skilled nursing, specialized medical equipment/supplies, speech therapy, adult companion, caregiver training/support-group, caregiver training/support-individual, case aide, chore-enhanced, chore, escort, financial risk reduction-assessment, financial risk reduction-maintenance, home accessibility adaptations, home delivered meals, nutritional risk reduction, personal emergency response system (PERS)-installation, PERS-maintenance, pest control-initial visit, pest control- maintenance, physical risk reduction, rehabilitation engineering evaluation, respite-facility-based services to individuals ages 65 or older, and individuals with physical disabilities 18-64 years who met a nursing facility level of care.

This waiver operated with a concurrent 1915(j) authority. WAIVER TERMINATED on 4/30/2010 – Provided adult day health, case management, personal care, respite, incontinence supplies, behavioral assessment/intervention, caregiver training, environmental mods, pharmacy review, wanderer alarm system, wanderer identification and location system services to individuals ages 65 or older, and individuals with physical disabilities ages 60-64 years who met a nursing facility level of care.

This waiver operated with a concurrent 1915(b)(4) authority. WAIVER TERMINATED on 3/31/2014 – Provided assisted living, case management, and incontinence supplies to individuals ages 65 or older, and individuals with physical disabilities ages 18-64 years who met a nursing facility level of care.

WAIVER TERMINATED on 3/31/2014 – Provided case management, home health aide, personal care, respite, physical therapy, skilled nursing, special medical equipment, special medical supplies, adult companion, adult day health care, chore, environmental accessibility adaptations, family training, financial education and protective services, in-home counseling, occupational therapy, personal emergency response system, special drug and nutritional assessment, special home delivered meals, and speech therapy services to individuals ages 65 or older who met a nursing facility level of care.

WAIVER TERMINATED on 6/30/2013 – Provided personal care, residential habilitation, respite, support coordination, supported employment, adult dental, occupational therapy, physical therapy, private duty nursing, respiratory therapy, skilled nursing, specialized medical equipment and supplies, specialized mental health services, transportation, adult day training, behavior analysis services, behavior assistant services, community guide, companion services, dietitian services, environmental accessibility adaptations, in-home support, medication review, personal emergency response system, residential nursing, special medical home care, speech therapy, and supported living coaching services to individuals with autism, developmental disabilities, or intellectual disabilities ages 3 or older who met an ICF/IID level of care.

This waiver operated with a concurrent 1915(j) authority. WAIVER TERMINATED on 6/30/2013 – Provided adult day training, respite, support coordination, supported employment, transportation, behavior analysis, behavior assistant, community guide, environmental accessibility adaptations, in-home support, personal emergency response system, specialized medical equipment and supplies, and supported living coaching services to individuals with autism, developmental disabilities, or intellectual disabilities ages 3 or older who met an ICF/IID level of care.

WAIVER TERMINATED on 3/31/2014 – Provided adult day health care, case management, homemaker, personal care, respite, adult companion, assisted living, chore, consumable medical supplies, environmental accessibility adaptions, escort, family training, financial assessment and risk reduction, home delivered meals, nutritional assessment and risk reduction, occupational therapy, personal emergency response system, physical therapy, respiratory therapy, and speech therapy services to individuals ages 65 or older who met a nursing facility level of care.

This waiver operated with a concurrent 1915(a)(1)(a) authority.
WAIVER TERMINATED on 1/31/2018 – Provided case management, day health care, homemaker, personal care, skilled nursing care-RN/LPN, specialized medical equipment and supplies, therapeutic management of substance abuse, chore-pest control/other, education and support, environmental accessibility adaptations, home delivered meals, restorative massage, and specialized personal care for children in foster care to individuals with HIV/AIDS ages 0 or older who met a hospital or nursing facility level of care.

: Florida Waiver Factsheet

What is the Medicaid waiver program in NY?

What Programs Are Available To Assist People With Disabilities in New York? Is there a Medicaid waiver program in New York? New York has a dozen waivers including:

SOMRDD-CAHIV; Care at Home I/II; CAH VI; Traumatic Brain Injury; OMH SED; OMRDD Comprehensive; NY CAH III; Long Term Home Health Care Program; Nursing Home Transition and Diversion Medicaid Waiver; Bridges to Health for Children w/SED; Bridges to Health for Children w/DD; Bridges to Health for Children who are Medically Fragile

What state department handles the Medicaid waiver program? The NYS Office For People With Developmental Disabilities handles Medicaid waivers for developmental disabilities. What programs assist people who have developmental disabilities? The OMRDD Comprehensive waiver assists persons with developmental disabilities.

What is the best number to call to get started? The first step in getting started with our services, is a telephone call to our intake number (631) 434-6000. Here we do a preliminary intake gathering general information- name and phone number and other details. Then you will receive a call from an intake worker who will walk you through the process of enrollment into our system and provide an overview to services available in the region.

Is there a website? http://www.opwdd.ny.gov Who Qualifies For Assistance? What is considered a developmental disability? Section 1.03(22) of the New York State Mental Hygiene Law is the legal base for eligibility determination and defines Developmental Disability as: A disability of a person that: (a)(1) Is attributable to mental retardation, cerebral palsy, epilepsy, neurological impairment or autism; (2) Is attributable to any other condition of a person found to be closely related to mental retardation because such condition results in similar impairment of general intellectual functioning or adaptive behavior to that of mentally retarded persons or requires treatment and services similar to those required for such persons; or (3) Is attributable to dyslexia resulting from a disability described in (1) or (2); (b) Originates before such person attains age twenty-two; (c) Has continued or can be expected to continue indefinitely; and (d) Constitutes a substantial handicap to such person’s ability to function normally in society.

For applicants with complete documentation of a developmental disability determinations will be made by a DDSO intake personnel. For applicants lacking complete documentation of a developmental disability, the designated DDSO intake personnel will request the needed additional documentation from the referral source.

The Eligibility Review process is the gateway to OPWDD services in New York State. An individual who has a developmental disability and lives in New York State can request a basic eligibility review by: calling an OPWDD office directly; asking a local government agency to assist them in accessing OPWDD-funded services; or having a voluntary agency make a request on their behalf.

Are there income limits to receive services? Parental income and resources are not considered for children living at home and seeking enrollment in the HCBS Waiver. For most other OPWDD services, the individual and spouse, parents or legal guardian (if he/she is under the age of 21) and any fiduciary acting on his/her behalf are liable for the cost of care (Article 43 of Mental Hygiene Law).

Parents are not liable if the disabled person does not live at home, even if he/she returns for periodic visits. Some services funded by OPWDD, such as Family Support Services, do not require a contribution to the cost of care. For services requiring a contribution, OPWDD can provide funding on an exception basis if the individual cannot qualify for benefits.

Resources can be put into a Medicaid qualifying supplemental needs trust and be exempt for Medicaid purposes. How old do you have to be to start receiving services? People of all ages can get Medicaid waiver services. Is There a Waiting List For Services? How long is the waiting list for New York Medicaid waiver services? There is no waiting list for Medicaid waiver services in New York.

Although you are not waiting to get onto the waiver, you still may have to wait for certain services. Many people in New York state that they receive the bare minimal in supports. For example, There is a waiting list for 24/7 residential opportunities for people with developmental disabilities.

OPWDD only has limited funding to develop new homes with 24/7 supports. New York State’s residential waiting list has reached 6,800 for people needing placement, new people enter the system every day. How many people are on the waiting list in New York? There are no people on the waiver waiting list, but there is a wait for certain services, such as 24/7 residential.

How many people are currently receiving Medicaid waiver services in New York? There are 64,000 people currently getting Medicaid waiver services in New York. The New York State Office for People With Developmental Disabilities (OPWDD) is responsible for coordinating services for more than 126,000 New Yorkers with developmental disabilities, about half through waivers.

Most OPWDD services are funded through the Medicaid Program, including a special Medicaid Waiver called the Home and Community-Based Services (HCBS)Waiver; the cost of room and board in group homes is funded through other benefits, such as Supplemental Security Income. These other benefits are also used to provide a monthly personal needs spending allowance.

What assistance is available while you wait? You shouldn’t have to wait long to get at least some services in New York, however without a support network, New York’s complicated maze of services is difficult to navigate and the state workers simply might not take the time to explain to you everything you need to know.

I would suggest going to www.lifssac.com (a parent advisory board) where you will find more information regarding services, clinics and services, as well as local events.
I also recommend that you visit The Parent to Parent Website at www.p2pnys.org for further information about services or call Parent to Parent 631 434-6196.

Once eligibility is determined, you will be assigned an intake worker and the intake worker will talk with you and determine what services would benefit your loved ones. The intake worker will link you with a provider agency that can help you navigate the system.

It’s best to be informed before meeting with the intake worker. Is there priority preference for people who are in crisis? If an individual wants a new service, the person or their family should talk to the agency they want the service from. The agency will tell you if they can provide the service to the individual and will also explain if the individual has the right Medicaid coverage to pay for the service.

If the individual does not have the right Medicaid coverage, he or she must enroll in the right coverage before new services will be provided. If the individual or family does not apply for the Medicaid coverage needed, the agency can deny the request for service.

However, in cases where the person’s health or safety would be in danger without the service, the agency may choose to provide the service before the individual has enrolled in Medicaid. What Services Are Offered & What Are The Service Limitations? What services does the Medicaid waiver program offer? Some services provided through OPWDD include family support, case management, respite, housing, supported employment, recreation, skills development, training, long term habilitative services, nursing and psychiatric services, respite (short-term caregiver relief).

What services are available to people living in the family home or supported living? Supports for Independent and Family Living include a wide array of services that allow an individual to remain in his or her own home, apartment or family care home.

Whether the individual and/or family’s need is respite services, which provide relief for the caregiver, or assistive technology services, which can, for example, provide environmental modifications to the home to incorporate a wheelchair (such as wider doors, ramps or roll-in showers), or provide communication aids (such as speech amplifiers, guide dogs and adaptive computer hardware/software), the goal of these supports and services is to help people with developmental disabilities lead richer lives that include meaningful relationships, good health, personal growth and productivity, and homes in their communities.

Does this state offer community group homes? Residential settings are licensed by OPWDD to provide housing and related services, operated by either OPWDD or nonprofit agencies. These settings include supervised group living (a home with 24-hour staffing and supervision), semi-independent (or “supported”) group living (a home with less-than-24-hour staffing and supervision), and other residential options (typically, homes for 15 or more people with 24-hour staffing and supervision).

Community Residences (CR) – Provide semi-independent living. There are 2 types of CRs: (1) Supervised; provide housing with staffing available 24hrs. (2) Supportive; which are limited to 3 people, with staff support varying according to individual need. Intermediate Care Facilities (IFC) – Provide a residential treatment option in the community for persons with specified medical and/or behavioral needs. ICFs provide 24 hour onsite assistance and training, intensive clinical and direct care services, professionally developed and supervised activities, and a variety of therapies. ICFs are designed for individuals whose disability severely limits their ability to be independent. Family Care – Is a licensed residential program which provides a family living experience through a structured and stable home environment, including the support, guidance and companionship found within a family unit. Family Care providers are home owners who receive a monthly stipend to provide services within their homes. Non-Certified Housing Options – Includes services that assist persons with developmental disabilities to locate, lease or buy, and access residential arrangements which are 17 alternatives to traditional congregate living situations. Among these types of living arrangements are shared or matched home sharing, independent living, HUD rental subsidies and low income home ownership programs.

Does this state offer supported living? Yes, New York offers supports and services to assist people with disabilities to live in their own homes. Are there still state owned institutions? New York has 10 state institutions, housing nearly 2000 people with disabilities.

Bernard M. Fineson Developmental Center Brooklyn DDSO (Brooklyn) Broome DDSO (Binghamton) Capital District DDSO (Schenectady), Formerly O.D. Heck DDSO Finger Lakes DDSO (Rochester), Formerly Montroe DDSO Staten Island DDSO (Staten Island) Sunmount DDSO (Tupper Lake) Taconic DDSO (Wassaic) Valley Ridget Western NY DDSO (West Seneca), Formerly West Seneca DDSO

How Do You Select A Provider? Do providers work for the state? No, Medicaid waiver providers in New York do not work for the state, but most work for non for profit agencies. About how many providers are there in the state? There are nearly 800 providers in New York.

Nearly 80 percent of service delivery is carried out by the nonprofit network.
Do you have a choice in providers? Once eligibility is determined, the intake worker will talk with you and determine what services would benefit your loved ones.
The intake worker will link you with a provider agency that can help you navigate the system.

There is also a provider directory – http://providerdirectory.opwdd.ny.gov/ Additional Information OMRDD Main Office: 518-474-9689 OPWDD Eligibility Coordinators

Regional Office 1 – (585) 241-5732 or (716) 517-3423 Regional Office 2 – (315) 473-6982 or (315) 473-2969 or (607) 770-0507 or (518) 359-2465 Regional Office 3 – (518) 370-7539 or (845) 947-6011 or (845) 471-9226 x 114 Regional Office 4 – (212) 229-3139 or (718) 642-8629 or (718) 982-1944 or (718) 217-6179 Regional Office 5 – (631) 493-1714

NY Waiver Providers

What is the 1115 waiver in NY?

Executive Summary – New York State (NYS or the State) requests $17 billion over five (5) years to fund a new 1115 Waiver Demonstration that addresses the inextricably linked health disparities and systemic health care delivery issues that have been both highlighted and intensified by the COVID-19 pandemic.

The COVID-19 pandemic devastated many vulnerable populations of Medicaid recipients, with a particularly detrimental impact to populations with historical health disparities, including persons living in poverty, Black and Latino/Latinx and other underserved communities of color, older adult populations, criminal justice-involved populations, high-risk mothers and children, persons with intellectual and developmental disabilities (I/DD), persons living with severe mental illnesses, persons with substance use disorders, and persons experiencing homelessness.

Understanding that health disparities differ by population, geography, and previous community investment, calls for a tailored approach based on these factors. Addressing health equity and achieving an equitable recovery from the COVID-19 pandemic, while advancing other long-standing delivery system reform goals of NYS, is a complex undertaking and requires a transformational, coordinated effort across all sectors of the health care delivery system and continuum of social services.

Indeed, to address the full breadth of factors contributing to health disparities, NYS will not only pursue reforms and investment in the health care delivery system, but also in training, housing, job creation, and many other areas. Accordingly, if approved, this waiver reflects that achieving an equitable recovery from COVID-19 is a process, not just an outcome, and would be just one part of NYS´s intertwined Reimagine, Rebuild, Renew initiatives that collectively form a unified statewide strategy for equitable COVID-19 recovery.

At the same time, because health and healthcare are local and the social service offerings may differ by region, this statewide strategy must also tie back to local gaps and needs, particularly for the health care safety net. Accordingly, NYS proposes an ambitious partnership with the Federal government through an 1115 Waiver Demonstration that creates a pathway to address and rectify these historic health disparities.

This partnership is critical to addressing health disparities exacerbated by COVID-19, promoting health equity, and fulfilling the promise of the Medicaid program to provide comprehensive health benefits to those who need them.
If approved, this 1115 Waiver Demonstration would utilize an array of multi-faceted and linked initiatives in order to change the way the Medicaid program integrates and pays for social care and health care in NYS.

It would also lay the groundwork for reducing long standing racial, disability-related and socioeconomic health disparities, increase health equity through measurable improvement of clinical quality and outcomes, and keep overall Medicaid program expenditures budget neutral to the federal government.

Building a more resilient, flexible and integrated delivery system that reduces racial disparities, promotes health equity, and supports the delivery of social care;
Developing supportive housing and alternatives to institutions for the long-term care population;
Redesigning and strengthening health and behavioral health system capabilities to provide optimal response to future pandemics and natural disasters; and
Creating statewide digital health and telehealth infrastructure

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What is the medical complex children’s waiver in South Carolina?

The Medically Complex Children’s (MCC) waiver is a statewide program to serve medically complex children from birth to age 18. Children qualifying for this program must meet level of care and medical criteria. Eligible children must be residents of South Carolina and qualify for Healthy Connections Medicaid.

What is a history of the Minnesota Family Investment Program?

Project – Overview Project Overview A long-standing dilemma in welfare policy is that while cash benefits reduce poverty, they can also discourage low-income parents from supporting their families through work. Conversely, work requirements like those introduced in the 1996 federal welfare law encourage employment but — given that many welfare recipients command only low wages — can also leave families in poverty.

The Minnesota Family Investment Program ( MFIP ), piloted from 1994 through 1998, was an attempt to break loose from the historical tradeoff between encouraging self-sufficiency and reducing poverty by combining financial work incentives and employment mandates. MDRC ‘s evaluation of the initiative, conducted under contract to the State of Minnesota, was unusual for its extensive analysis of the program’s effects on families’ and children’s well-being as well as its economic impacts.

Because more than 40 states have incorporated the “make work pay” approach — coupled with work requirements — into their welfare programs since 1996, the study’s findings have widespread implications for current welfare policy. Featured Content Report Six-Year Impacts on Parents and Children from the Minnesota Family Investment Program While positive effects on most parents’ earnings and income faded after six years, young children in some of the most disadvantaged families were still performing better in school than their counterparts in a control group.

And, for the most disadvantaged parents, MFIP seems to have created a lasting “leg up” in the labor market. Report An Update on the Effects of Four Earnings Supplement Programs on Employment, Earnings, and Income Four programs that supplemented the earnings of low-income adults increased employment, earnings, and income — particularly for the most disadvantaged — but these effects generally faded after the programs ended.

Agenda, Scope, & Goals Agenda, Scope, and Goals The MFIP evaluation addressed four major issues that remain on the minds of decision-makers:

What can states do to minimize the chances that long-term welfare recipients reach a welfare time limit without any way to support themselves? How should policymakers help low-income workers stay in their jobs and provide for their families? How can social policies avoid penalizing marriage? How have the kinds of policy changes states have made since the 1996 federal welfare reforms affected families and children?

Integrating policies that would become the backbone of Minnesota’s current statewide welfare program, MFIP was distinguished from the traditional welfare program by these key features:

A requirement that long-term recipients work or participate in employment-focused services Financial work incentives for recipients who worked Payment of working recipients’ child care costs directly to providers (rather than reimbursement of recipients later) Simpler public assistance rules and procedures that combined different programs into one and provided food stamps as part of the cash welfare grant

MDRC ‘s evaluation of MFIP examined the program’s implementation, costs, and effects on economic, family, and child outcomes. Featured Content Report Six-Year Impacts on Parents and Children from the Minnesota Family Investment Program While positive effects on most parents’ earnings and income faded after six years, young children in some of the most disadvantaged families were still performing better in school than their counterparts in a control group.

And, for the most disadvantaged parents, MFIP seems to have created a lasting “leg up” in the labor market.
Report An Update on the Effects of Four Earnings Supplement Programs on Employment, Earnings, and Income Four programs that supplemented the earnings of low-income adults increased employment, earnings, and income — particularly for the most disadvantaged — but these effects generally faded after the programs ended.

Design, Sites, & Data Sources Design, Sites, and Data Sources The MFIP evaluation included more than 14,000 welfare recipients and applicants, most of them single parents. Starting in 1994, each one was randomly assigned to MFIP, which made them eligible for the program’s services and benefits, or to Aid to Families with Dependent Children, the traditional welfare program.

Because the two groups did not differ at the outset, any differences between them that later emerged can be attributed to MFIP,
MFIP was implemented in seven Minnesota counties, three of them urban (Anoka, Dakota, and Hennepin, which encompasses Minneapolis) and four of them rural (Mille Lacs, Morrison, Sherburne, and Todd).

The evaluation relied on data from myriad sources, including unemployment insurance records, public assistance benefit records, and client surveys. Featured Content Report Six-Year Impacts on Parents and Children from the Minnesota Family Investment Program While positive effects on most parents’ earnings and income faded after six years, young children in some of the most disadvantaged families were still performing better in school than their counterparts in a control group.

MDRC Staff MDRC Staff

President Virginia Knox became President of MDRC on October 15, 2019. Prior to being named president, Knox served as vice president and as leader of the organization’s Families and Children Policy Area. Senior Fellow, Economic Mobility, Housing, and Communities Miller is an economist whose work focuses on policies and programs to increase the employment and earnings of low-wage workers and disadvantaged young adults. She is the project director for the Paycheck Plus evaluation, testing an expanded Earned Income Tax Credit for single workers without dependent children in New York City.

Does MN allow Medicaid annuities?

Protections for the Community Spouse – Community Spouse Resource Allowance (CSRA): $148,620.00 Increased CSRA: Permitted, but rarely used. Minnesota follows the income-first rule. Annuities: Actuarially sound annuities are permitted (but restrictions apply; check with attorney). Monthly Maintenance Needs Allowance: Minimum: $2,289.00 Maximum: $3,715.50

What is the phone number for the Minnesota parental fee unit?

The calculated monthly fee is only an estimate and not a legally binding amount. Your actual fee will be determined by DHS after receiving your completed questionnaire (DHS-2981) and copy of applicable federal income tax return. The monthly fee will be recalculated each year to account for changes in your financial situation.

What does Tefra cover in Arkansas?

Eligibility Applying TEFRA Premiums: How much will I pay? Important Phone Numbers