Employment and Community First CHOICES (Part 4)

     About the Authorjanetblog[1]

Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.

Our hope is that this weekly blog will offer information you want to know, so if you have a question you want answered about employment for people with disabilities or other mysteries of the world of work, please email me at janet.shouse@vanderbilt.edu.

By Janet Shouse

This week, I am sharing some technical answers to some technical questions that readers have posed, and I examine some of the additional service definitions for the Employment and Community First CHOICES program. (If the first part is too technical, please read on for some new and interesting services available under the ECF Choices program.)

First, a quick reminder of a few key acronyms used in this section:

  • ECF – Employment and Community First CHOICES program
  • SSI – Supplemental Security Income
  • FBR – Federal Benefits Rate
  • FPL – Federal Poverty Level
  • NF – nursing facility

The second thing to remember regarding financial eligibility is that resource limits of $2,000, which means a person cannot have more than $2,000 in the bank in his or her name or own things (other than a home or a car) that add up to more than $2,000, apply across all long term services and supports (including new ECF CHOICES) categories.

Patti Killingsworth, assistant commissioner and chief of Long-Term Services and Supports for TennCare, kindly provided answers to our questions.

Question 1: I am wondering about income limit for the at-risk of nursing facility level of care group (i.e., people with disabilities who would be at risk of having to live in an institution without services). Is the 150% of the federal poverty level applicable at the initial eligibility determination only, and then once the person is in the ECF program, will the Medicaid Income Cap (300% of the Supplemental Security Income/ Federal Benefits Rate) apply? (In 2016, the Medicaid Income Cap is $2,199 a month.)

Answer 1: The new ECF CHOICES At-Risk Demonstration Eligibility group with income up to 150% federal poverty level will not be implemented until Phase 2 of the program. For now, TennCare will use an Interim ECF CHOICES At-Risk Demonstration Eligibility group with income up to 300% of the SSI FBR ($2,199 a month).  Everyone applying who does not meet nursing facility (institutional) level of care and who is not eligible for SSI will be subject to the 300% of the FBR income limit ($2,199 a month).  This is the same income standard as will be applied in the ECF CHOICES 217-Like Demonstration Group.  Even when Phase 2 begins and the new ECF CHOICES At-Risk Demonstration Eligibility Group is open (with income up to 150% of the FPL), people who have previously qualified in the Interim ECF CHOICES At-Risk Demonstration Eligibility group (based on income up to 300% of the SSI FBR) will be permitted to continue to qualify under that 300% of the SSI FBR income standard, and will not have to qualify under the new 150% of the FPL limit.  New applicants would be expected to meet the new 150% FPL income standard, or could qualify in the ECF CHOICES Working Disabled Group if they are working. (See pages 4-7 of Amendment 27 for definitions of the various groups.)

Question 2: Regarding financial eligibility — is it family income or is it the individual’s income? And if it is the family income, is that true only for those under 18?

Answer 2: For the ECF CHOICES 217-Like Group (for individuals who meet nursing facility level of care), institutional deeming rules will apply (i.e., the parents’ income will not be deemed (or considered) to a child under age 18).  For the Interim ECF CHOICES At-Risk Group,  and in Phase 2, the ECF CHOICES At-Risk Group, the parents’ income will be deemed (or considered) to a child under age 18 since individuals who qualify in these groups will not meet institutional level of care. In the ECF CHOICES Working Disabled Group (implemented in Phase 2), institutional deeming rules will apply to children under age 18 if they meet institutional level of care.  Parental income will be deemed to children who qualify in the ECF CHOICES Working Disabled Group and do not meet institutional level of care but are “At-Risk” of NF placement

The easy explanation is that in ECF CHOICES, we can waive the deeming of the parents’ income to the child under age 18 ONLY if the child meets institutional or nursing facility level of care.  If the child qualifies for an At-Risk level of care, the parents’ income WILL be deemed to the child.

Question 3: How do individuals apply if they are not already on the waiting list for Medicaid waiver services with the Department of Intellectual and Developmental Disabilities (DIDD)?

Answer 3: We will be conducting outreach. There will be an online form that individuals or families can fill out to apply. Assistance in completing the online form will be available through the managed care organizations for people on TennCare and through DIDD for people who are not. Enrollment is scheduled to begin on July 1, 2016.

Now, for some other service definitions:

1. Community Integration Support Services – Designed to promote maximum participation in integrated community life while facilitating meaningful relationships, friendships and social networks with persons without disabilities who share similar interests and goals for community involvement and participation.

This service is available only:

  • For children not yet old enough to work and/or not yet eligible for employment services who are enrolled in Essential Family Supports;
  • As “wrap-around” supports to employment or employment services for individuals not receiving Community Living Supports or Community Living Supports-Family Model; or
  • For individuals who are of legal working age (16+), and who are not receiving Community Living Supports or Community Living Supports-Family Model who have decided not to pursue employment after going through an ‘Employment Informed Choice’ process (defined by TennCare); or
  • For individuals of retirement age who are not receiving Community Living Supports or Community Living Supports-Family Model who have made a choice not to pursue further employment opportunities.

2. Independent Living Skills Training – Designed to provide education and training to improve the person’s ability to independently perform routine daily activities and utilize community resources, such as:

  • Personal hygiene
  • Food and meal preparation
  • Home upkeep/maintenance
  • Money management
  • Accessing and using community resources
  • Community mobility
  • Parenting
  • Computer use
  • Driving evaluation and lessons

3. Personal Assistance – Designed to assist an individual with a disability to perform activities and instrumental activities of daily living at the person’s own home, on the job or in the community that the individual would typically do for themselves if he/she did not have a disability. PA services may be used to:

  • Support the person at home in getting ready for work and/or community participation;
  • Support the person in getting to work and/or community participation opportunities; and
  • Support the person in the workplace and/or in the broader community.

4. Community Transportation – Non-medical transportation services offered in order to enable individuals, and their personal assistants as needed, to gain access to employment, community life, activities and resources. These services allow individuals to get to and from typical day-to-day, non-medical activities such as their job, the grocery store or bank, social events, or attending a worship service. This service is made available when public or other no-cost community-based transportation services are not available, and the person does not have access to transportation through any other means. Whenever possible, family, neighbors, co-workers, carpools or friends are utilized to provide transportation assistance without charge.

 5Community Living Supports – A community-based residential alternative service for seniors and adults with disabilities that encompasses a range of support options for up to four individuals living in a home that supports each resident’s independence and full integration into the community, ensures each resident’s choice and rights, and meets requirements for home- and community-based services settings (not institutions.)

Services may include hands-on assistance, supervision, transportation, and other supports intended to help the individual exercise choices such as:

  • Selecting and moving into a home
  • Locating and choosing suitable housemates
  • Buying furniture and household items Learning or improving skills needed for activities of daily living or assistance with activities of daily living as needed, such as bathing, dressing, personal hygiene and grooming, eating, toileting, transfer, and mobility
  • Learning or improving skills needed for instrumental activities of daily living or assistance with instrumental activities of daily living as needed, such as household chores, meal planning, shopping, preparation and storage of food, and managing personal finances
  • Building and maintaining relationships with family and friends
  • Pursuing educational goals and employment opportunities
  • Participating fully in community life, including faith-based, social, and leisure activities selected by the individual
  • Scheduling and attending appropriate medical services
  • Self-administering medications, including assistance with administration of medications.
  • Managing acute or chronic health conditions, including nurse oversight and monitoring, and skilled nursing services as needed for routine, ongoing health care tasks.
  • Becoming aware of, and effectively using, transportation, police, fire, and emergency help available in the community to the general public
  • Asserting rights through self-advocacy

6. Community Living Supports-Family Model – A community-based residential alternative service for seniors and adults with disabilities that encompasses a range of support options for up to three individuals living in the home of trained family caregivers (other than the individual’s own family) in an adult foster care arrangement. In this type of shared living arrangement, the provider allows the individual(s) to move into his or her existing home in order to integrate the individual into the shared experiences of a home and a family, and provide the individualized services that support each resident’s independence and full integration into the community, ensure each resident’s choice and rights, and support each resident in a manner that meets standards of home and community based services setting. Services are similar to those listed for Community Living Supports above.

7. Assistive Technology, Adaptive Equipment and Supplies – This service covers purchases, leasing, shipping costs, and as necessary, repair of equipment required by the person to increase, maintain or improve his/her functional capacity to perform daily tasks in the community and in employment that would not be possible otherwise.

ECF CHOICES will not cover Assistive Technology or Adaptive Equipment and services which are otherwise available to the individual under section 110 of the Rehabilitation Act of 1973, or under Individuals with Disabilities Education Act (IDEA). Assistive Technology, Adaptive Equipment and Supplies shall be limited to $5,000 per person per calendar year. An MCO may authorize services in excess of the benefit limit as a cost-effective alternative to institutional placement or other medically necessary covered benefits.

8. Minor Home Modifications – Provision and installation of certain home mobility aids (e.g., a wheelchair ramp, hand rails for interior or exterior stairs, grab bars and other devices) and minor physical adaptations to the interior of a member’s place of residence that are necessary to ensure the health, welfare and safety of the individual, or which increase the member’s mobility and accessibility within the residence.

9. Individual Education and Training Services – Reimbursement up to $500 per year to offset the costs of training programs, workshops and conferences that help the person develop self-advocacy skills, exercise civil rights, and acquire skills needed to exercise control and responsibility over other support services.

10. Peer–to-Peer Support and Navigation for Person-Centered Planning, Self-Direction, Integrated Employment/Self-Employment and Independent Community Living – Designed to assist an individual and his/her family member(s) or conservator in one or more of the following areas:

  • Directing the person-centered planning process;
  • Understanding and considering self-direction;
  • Understanding and considering individualized integrated employment/self-employment; and
  • Understanding and considering independent community living options.

Services are provided by a peer (another individual with a disability) who has successfully directed his or her person-centered planning process, self-directed his or her own services, successfully obtained individualized integrated employment or self-employment and/or utilized independent living options.

For more in-depth explanations, time limitations and how providers are paid for services, check out the link on ECF Employment Service Definitions: http://www.tennesseeworks.org/wp-content/uploads/ECF-Employment-Service-Definitions-Handout.docx

If you have questions, please email me at janet.shouse@vanderbilt.edu, and I will strive to find an answer.

(Next week’s blog topic: The remaining services offered with the Employment and Community First CHOICES program.)

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