New Home and Community-Based Services Waiver Changes and Updated State Plan Amendments in Washington State, Tennessee And Indiana
States have continued to submit transition plans to bring their Medicaid Home and Community-Based Services (HCBS) waiver programs into compliance with new rules for community integration of HCBS settings.
Washington State has submitted transition plans for the Children’s Intensive In-Home Behavioral Support waiver, the Core waiver, the Basic Plus waiver, and the Community Options Program Entry System (COPES) waiver, and has received approval from CMS for a Community First Choice state plan amendment and a new Individual and Family Services waiver program. Under the proposed plans, personal care, personal emergency response systems and community transition services will be removed from the COPES waiver and offered instead under the Community First Choice program, which aims to maximize flexibility and choice for program participants. The new Individual and Family Services waiver provides services, supports, and a small benefits package, for participants three and older who live in their family home. Services available include transportation, assistive technology, and peer mentoring, which can help waiver participants access and maintain employment in the community.
Tennessee has submitted several amendments to CMS for its TennCare 1115 Demonstration Program. The Demonstration already includes the CHOICES program, which provides HCBS to three groups of eligible participants: (1) people of all ages who receive nursing home care; (2) adults with physical disabilities over 21 and seniors 65 and older who qualify for nursing home care but elect to receive home care; and (3) adults with disabilities over 21 and seniors 65 and older who do not qualify for nursing home care and for whom home care services could delay or prevent a need for nursing home care. A brand new amendment includes an Employment First HCBS model, focused on competitive integrated employment and independent integrated community living as the first and preferred options for people with intellectual and developmental disabilities. This new program will be called “Employment and Community First CHOICES.” This most recent amendment also adds community-based residential alternatives, including adult care homes and companion care, as well as adding community living supports at multiple levels of reimbursement depending on intensity of services. Tennessee is awaiting CMS approval.
Indiana recently received CMS approval for an amendment to its Community Integration and Habilitation waiver for people with intellectual and developmental disabilities. The amendment adds a new Extended Services option to the waiver, which replaces the former Supported Employment Follow-Along service. Participants receiving extended services may generally not also receive pre-vocational services except for participants receiving the former supported employment services simultaneously with prevocational services. Extended services are time-limited and aim to maximize development of natural supports with tangible outcomes, including overall hours reduction in paid services that an individual needs; however, this service does not penalize individuals unable to secure natural supports. These services may be provided in small groups and seek to promote job seeking and retention skills.