APD > Medicaid Waiver Update

The Florida Legislature required the Agency for Persons with Disabilities to make changes in its Developmental Disabilities waiver this year. It has become necessary to reduce the number of services and limit the use of some of the other waiver services in order for the agency to work toward reducing its deficit in the DD waiver. State agencies are required by law to remain within their budgets.

Waiver services changes effective January 1, 2008

The rate paid to Personal Care Assistants will be reduced by four percent.
Support coordinator's caseloads may be increased to 43 people a month; previously they could serve up to 36 people. APD will no longer require support coordinators to conduct a customer's needs assessment or develop their cost plan. Because of the reduced workload, support coordinators will be able to serve more people. Support coordinators will still be able to earn up to $68,000 a year if they have a full caseload. APD will work with support coordinators to better define their roles as service coordinators and to focus their advocacy initiatives toward enhancing natural and community supports and resources.

Waiver service eliminations effective Dec. 1, 2007

Chore, Non-residential Support Services, and Homemaker Services have been eliminated. However, the definition of In-Home Support Services has been expanded to include some activities previously provided in the eliminated services.
Massage Therapy and IQ Testing (Psychological Assessments) have been eliminated.
Residential Habilitation service rates have been consolidated into a simpler rate matrix based on an individual's support needs. Rates for the service have been reduced, but service levels for individuals receiving the service should remain the same. The new rate matrix meets the Legislative requirement to limit the service to 8 hours a day unless the person has intense adaptive, medical or behavioral needs.

Waiver services that have been limited effective August 1, 2007
The services the Legislature limited by law are listed below.

Supported Living Coaching are limited to no more than 20 hours a month for persons who also receive in-home support services.
Support Coordination to all persons under the age of 18 who live in the family home are limited to Limited Support Coordination only.
Personal Care Attendant services have been limited to 180 hours a month unless the person has intensive needs. Additional hours may be authorized only if there is a substantial change in circumstances.

Will the 180 limit for Personal Care Attendants affect people under 21?
APD and the Agency for Health Care Administration have reached an agreement which allows for people under the age of 21 to receive more than 180 hours of Personal Care Assistance, if medically necessary. The Medicaid State plan will cover the cost of the additional hours.

The proposed 4 - tiered waiver system
In addition to the changes listed above, the Agency for Health Care Administration, in consultation with the Agency for Persons with Disabilities, is required to seek federal approval for two additional waivers and implement a four-tiered waiver system. The new waiver system calls for waiver clients to be assigned to one of four "tiers", based on an assessment of their needs, according to the following criteria:

Tier 1 – Current DD waiver with no cap: Limited to individuals with intensive medical, behavioral and adaptive needs that cannot be met in other tiers.
Tier 2 – Capped at $55,000: Limited to clients whose service needs include a licensed residential facility and greater than five hours a day of Residential Habilitation as well as clients in supported living who receive more than six hours of in-home support services
Tier 3 – Capped at $35,000: Will include all individuals who do not fall into Tier 1 or Tier 2.
Tier 4 – Current FSL waiver with a cap of nearly $15,000: Additional services may be added to this tier after July 1, 2008.