Presentation on Medicaid Waiver (MI Choice) by: Sylvia Brown, Long Term Care Services of The Detroit Area Agency on Aging

2.  Agency Information
 DAAA’s Mission
 Who Does DAAA Serve?
 What Is Medicaid Waiver?
 Waiver Program Rules
 Why Do Consumers Have Choice of Care Setting?
 MI CHOICE Background
 MI CHOICE Services
 Functions of a Supports Coordinator / Care Manager
 MI CHOICE Eligibility Requirements
 How To Apply for MI CHOICE
 Benefits of MI CHOICE
 Contact Information
Overview

3.  Detroit Area Agency on Aging (DAAA) is a private non-profit agency established in
1980 to assist frail adults 60 and over and people with disabilities 18 and over.
 Paul E. Bridgewater is the President & CEO of DAAA and has been with the
agency for over 30 years.
 DAAA is part of a national network of 670 Area Agencies on Aging (AAAs) in the
United States.
 DAAA is one of 16 AAAs located in Michigan.
 DAAA is responsible for administering and coordinating a comprehensive system
of home and community-based services within its planning and service area.
 The services provided are Community Access, Community Services, Long-
Term Care Services, and Planning and Service Provider Development.
Agency Information

4. 
To educate, advocate and promote healthy aging
to enable people to make choices about home and
community-based services and long-term care that will
improve their quality of life.
DAAA’s Mission

5. 
 Frail seniors and disabled that live in our region of nine
communities: Detroit, the five Grosse Pointes,
Hamtramck, Harper Woods and Highland Park
Who Does DAAA Serve?

6. 
The Social Security Act authorizes multiple waivers and
demonstration authorities to allow states flexibility in
operating Medicaid programs. Each authority has a
distinct purpose and distinct requirements. In our state,
the governing administrative body for Medicaid programs
is the Michigan Department of Community Health
(MDCH).
http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/
What Is Medicaid Waiver?

7.  Within the parameters of broad Federal guidelines, States have
the flexibility to develop Home and Community-Based Services
(HCBS) Waiver programs designed to meet the specific needs of
targeted populations. Federal requirements for states choosing
to implement a HCBS Waiver Program include:
 Demonstrating that providing Waiver services to a targeted
population is no more costly than the cost of services these
individuals would receive in an institution.
 Ensuring that measures will be taken to protect the health and
welfare of consumers.
 Providing adequate and reasonable provider standards to meet the
needs of the targeted population.
 Ensuring that services are provided in accordance with a plan of
care.
Waiver Program Rules

8. OLMSTEAD & HCBS WAIVERS
 In the 1999 Olmstead v. L.C. decision, the Supreme Court
affirmed the right of individuals with disabilities to receive
public benefits and services in the most integrated setting
appropriate to their needs. The Olmstead v. L.C. decision
interpreted Title II of the American with Disabilities Act (ADA)
and its implementing regulations. Medicaid can be an
important resource to assist states in fulfilling their
obligations under ADA. The HCBS Waiver program in
particular is a viable option for states to use to provide
integrated community-based long-term care services and
supports to qualified Medicaid eligible recipients.
Why Do Consumers Have
Choice of Care Setting?

9. 
 In early 1992, the Michigan Medical Services Administration (MSA)
received approval from the U.S. Department of Health and Human
Services (HHS), Centers for Medicare/Medicaid Services (CMS), to
implement a Home and Community-Based Services for Elderly and
Younger Adults with Disabilities (HCBS/ED) Medicaid Waiver Program.
 In the summer of 1997, Michigan upgraded its standardized assessment
system, adopting the Resident Assessment Instrument-Home Care©
(RAI-HC) assessment system to use in the statewide expansion of MI
CHOICE. The MDS-HC is compatible with the RAI Minimum Data Set
(MDS) mandated by the United States Congress for use in nursing
facilities and thus permits comparisons between individuals in nursing
facilities and home care.
MI CHOICE Background

10.  During 1998-99, Michigan deployed the MI CHOICE Information System
(MICIS), a computerized on-line operating system infrastructure for the
RAI-HC assessment system. MICIS allowed both Waiver agents and state
level managers to monitor participant activity and daily program
expenditures. (In 2009, the Center for Information Management (CIM)
deployed COMPASS a new web-based information system for collecting
participant data that serves as the successor to MICIS.)
 During 2000 and 2001, Michigan Waiver staff participated in a three-
nation effort with Inter-RAI involving researchers, clinicians, and policy
makers from Canada, the United States, and Japan to develop quality
indicators from the MDS-HC data set. This research resulted in 22 MDS-
HC Quality Indicators (QIs) that were used in MI CHOICE as new tools
laying the groundwork for a home care quality improvement system.
These indicators provided high-quality evidence on performance at the
agency and State level in MI CHOICE.
MI CHOICE Background Cont’d

11.  In 2004 and 2005, MDCH implemented a new Nursing Facility Level of Care
(NFLOC) determination instrument used in both institutional and community-
based settings. Adopting Self-Determination (SD) as a principle, MDCH applied
Person Centered Planning (PCP) processes to MI CHOICE, resulting in choice
and control by participants.
 In 2005, a leadership group composed of seven participants, their peers, and
seven providers organized formally into the MI CHOICE Person Focused
Quality Management Collaboration (QMC) to work on developing a person
focused quality management plan. The purpose of the QMC is to include
participants and their peers in the development, discussion, and review of
quality management activities for MI CHOICE. The QMC provides a venue
where providers, participants, and their peers review and discuss measured
provider performance and participant outcomes and recommend
improvements to the Michigan Medicaid service delivery system.
MI CHOICE Background Cont’d

12. 
 During fiscal year 2008, MDCH officially implemented PCP and the SD
in LTC option expanded statewide.
 Fiscal year 2009 brought an expansion of MI CHOICE into licensed
residential settings, e.g. Adult Foster Care (AFC) homes and Homes
for the Aged (HFA). MDCH added Residential Services to the array of
available MI CHOICE services. Residential services enhanced the
continuum of care for persons in need of long-term care who choose
not to receive services in a nursing facility.
MI CHOICE Background Cont’d

13.  MI CHOICE performs the following functions to assist the participant to
remain in their care setting of choice:
 Assessment - A comprehensive in-person assessment of physical,
social/emotional functioning, medications, physical environments,
informal support potential and financial status.
 Care Plan Development - A written plan of care, which states specific
interventions to be secured. The care manager and participant establish
which services will be secured and provided, as well as, the frequency and
duration of services.
 Service Arrangements - In-home health and social services for the
participant are arranged and/or purchased by care managers according to
the frequency and duration established by the care managers and
participant as approved in the plan of care.
MI CHOICE Services

14. • Adult Day Services • Homemaker Services
• Chore Services • Independent Living Skills Training
• Counseling • Environmental Modifications
• Home-Delivered Meals • Private Duty Nursing
• Residential Services • Fiscal Intermediary Services
• Goods & Services • Community Living Supports
• Personal Care Waiver
• Nursing Facility Transition Services (NFTS)
• Medical Equipment & Supplies
• Out-of-Home Respite Care
• Personal Emergency Response System
• Non-Medical Transportation
• In-Home or In-Home of Another Respite Care
Based Upon Financial & Medical
Eligibility Services May Include:

15.  Monitor participant’s health and well-being via assessments and phone
contacts.
 Determine financial and medical eligibility via nursing facility Level of Care
Determination.
 Prepare service orders for participants utilizing our Provider Network
System.
 Linking participants to other community resources as needed.
Participants Are Assigned a Supports Coordinator

16.  Age/Disability
 Frail adults 65 years of age or older (MI Choice)
 Frail adults 60 years of age or older (OSA/CM)
 Persons who are physically disabled age 18 or older
 Financial Eligibility
 An individual participant’s income is $2,199 or less per month.
 Allowable assets for an individual participant are limited to $2,000.
 Amounts are for 2015 and are subject to change.
 Service Need
 Participants must need at least one MI CHOICE Waiver service on an
ongoing basis. DAAA contracts with community-based providers for
these services.
Eligibility Requirements

17.  Medical
 The Michigan Medicaid nursing facility Level of Care Determination
(NFLOC or LOCD) must be completed for all individuals enrolling into the
our programs. The Michigan Medicaid Nursing Facility LOCD’s
medical/functional criteria include seven domains of need:
 Activities of Daily Living
 Cognitive Performance
 Physician Involvement
 Treatments & Conditions
 Skilled Rehabilitation Therapies
 Behavior
 Service Dependency
Eligibility Requirements Cont’d

18.  Call the Detroit Area Agency on Aging at (313) 446-4444 and ask for the Intake
& Assessment Division for the MI CHOICE Waiver program.
1. The Intake & Assessment staff
 conduct a telephone screening
 Record financial and medical information to determine potential eligibility
for the MI CHOICE program
 Educate regarding other community service options, when applicable.
1. A waitlist is established whenever there are more individuals requesting
MI CHOICE services than there are available MI CHOICE slots. The DAAA
utilizes the MDCH Waitlist policy for removing individuals from the
Waitlist. Priority placement is as follows:
 Persons no longer eligible for Children’s Special Health Care
Services (CSHCS).
How To Apply

19. 
 Nursing Facility Transition participants (NFTS).
 Individuals facing imminent risk of Nursing Facility placement
(Diversion).
 Participant Transfers from other MI CHOICE Waiver Agents.
3. Once the MI CHOICE program has an available slot, the initial
determination of MI CHOICE eligibility will be conducted in the
participant’s home. If approved, the in-home clinical
assessment is scheduled.
How To Apply Cont’d

20. 
 The benefits of the MI CHOICE program includes:
 An alternative to institutionalized care through the provision of
supportive services in the comfort of your own home.
 Keeping participants in the community as long as it is medically,
socially, and financially feasible.
 Allows individuals to stay in their home for care.
 Allows participants to stay active in their community.
 Reduce hospital readmissions and nursing facility placements.
 Provide supportive services for individuals with long term disabilities
or illnesses.
 Allow participants to maintain dignity and independence.
Benefits of MI CHOICE

21. 
 Person-centered care planning facilitated by a Registered Nurse
and Licensed Social Worker.
 Thorough assessment of participant’s needs.
Benefits of MI CHOICE Cont’d

22. 

23. DETROIT AREAAGENCY ON AGING
1333 BREWERY PARK BLVD., SUITE 200
DETROIT, MICHIGAN 48207-4544
TEL. (313) 446-4444
FAX (313) 446-4447
HTTP://WWW.DAAA1A.ORG/
PAUL E. BRIDGEWATER, PRESIDENT & CEO
SYLVIA BROWN, DIRECTOR LONG TERM CARE SERVICES (EXT.
5230) BROWNSY@DAAA1A.ORG
For more information contact: