Talking Points on Tier Waivers
- The Agency for Persons with Disabilities (APD) is committed to protecting the health and safety of the people it serves and assisting them to live as independently as possible and to achieve productive lives.
- Over the past year, there have been many changes to the Medicaid waiver program. The changes have been difficult for both APD customers and employees.
- The Agency for Persons with Disabilities (APD) is committed to protecting the health and safety of the people it serves and assisting them to live as independently as possible and to achieve productive lives.
- Over the past year, there have been many changes to the Medicaid waiver program. The changes have been difficult for both APD customers and employees.
- In 2007, the Legislature changed the law to require a four-tier waiver system to serve individual's receiving Medicaid Waiver services from APD.
- This change establishes four waivers for people who are receiving services under the Developmental Disabilities Waiver, the Family and Supported Living Waiver, or the Consumer Directed Care Program. The law also establishes eligibility criteria for the waivers.
- APD recently mailed notices to all people receiving waiver services to inform them of their enrollment in a specific Tier Waiver.
- Three of the Tier Waivers have annual limits on how much can be spent for services as follows:
- Tier 1 Waiver: No limit
- Tier 2 Waiver: $55,000
- Tier 3 Waiver: $35,000
- Tier 4 Waiver: $14,792
- For most people, transferring to one of the new Tier Waivers will have no impact on services. For some people, the state may not be able to pay as much for services under the new waiver system as it has in the past.
- All Tier notices to customers included Notices of Hearing Rights regarding Tier waiver assignment with information about where to submit a request should the person wish to file for a fair hearing. This Notice of Hearing Rights is available in Spanish on the APD web site.
- If a customer is assigned to a Tier Waiver which has a cap lower than what the person annually spends on services, he or she should work with his or her support coordinator or CDC Consultant to prioritize the services in his or her cost plan to bring expenses within the cap. These modified cost plans should be submitted to the Area office for review and approval by September 24, 2008.
- APD has supplied waiver support coordinators with information on how to assist customers in prioritizing their cost plan to stay within the spending cap, if necessary.
- Customers or their families and guardians may also work with their Waiver Support Coordinator to request a review of their Tier assignment from the APD Area office if they feel that an error has been made.
- Submitting a modified cost plan and/or requesting a tier assignment review does not interfere with the person's due process rights for their Tier assignment.
- The Tier Waivers are expected to be implemented on October 15, 2008.
- The Agency for Persons with Disabilities has additional information about the Tier Waivers on its Web site (http://apd.myflorida.com). Contact your Waiver Support Coordinator or the local APD office if you have questions.
Specific Criteria for Waivers
Tier 1 Waiver
Individual has service needs that have been determined "intensive" for medical, adaptive, and/or functional areas.
- The individual has intensive medical or adaptive needs that are essential for avoiding institutionalization, or
- The individual has behavioral problems that are exceptional in intensity, duration, or frequency and present a substantial risk of harm to themselves or others, and
These individual's needs cannot be met in Tier Waivers 2, 3, or 4.
Tier 2 Waiver (Capped at $55,000 a year)
Limited to individuals whose service needs include: Residential Habilitation services in a licensed residential facility to include:
- Behavior Focus Residential Habilitation at the Minimal level or higher,
- Standard Residential Habilitation at the Moderate level or higher,
Or
Individuals in supported living or who live in their own home and receive greater than 6 hours a day of in-home support services and whose cost plans total over $35,000.
Individuals living in their family home may not be assigned to this Tier waiver.
Tier 3 Waiver (Capped at $35,000 a year)
Individuals living in licensed residential placements, or in independent or supported living situations who do not meet the criteria for Tier Waivers 1, 2, or 4.
People living in the family home who do not meet the criteria for Tier Waivers 1 or 4. (even if cost plan total is greater than $35,000.)
Tier 4 Waiver (Capped at $14,792 a year.)
Individuals currently assigned to the Family and Supported Living (FSL) waiver.
Individuals living in independent or supported living situations, or in the family home, or dependent children living in a DCF licensed foster home, who do not meet the criteria for Tier Waivers 1, 2 or 3.
Individuals under the age of 21 living in the family home who have no behavioral issues or services.
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