A Guide to Home and Community-Based Services Through Medicaid
Medicaid Home and Community-Based Services Waiver Program was started in the early 1980s. According to an article in Health Care Financing Review, it was found that,” A disproportionate percentage of Medicaid resources were being used for institutional long-term care.” About one-third of those in institutional care were capable of living at home or in a community based residential setting.
The HCBS waiver program was established by Section 2176 of the Omnibus Budget Reconciliation Act of 1981 and was incorporated into the Social Security Act in Section 1915(c).
Katie Beckett’s story was instrumental in this change. When she was five years old, she developed encephalitis that resulted in partial paralysis of her diaphragm. She spent the first three years of her life in a Cedar Rapids hospital needing to breathe on a ventilator at night. Medicaid would only pay for her treatment if she stayed in the hospital.
According to an article from the Lucile Packard Foundation, “Katie’s mother, Julie, a middle-school social studies teacher, worked relentlessly with Congressman Tom Tauke (R-IA) and other officials to waive the Medicaid regulation in Katie’s case, noting among other things that it would be substantially less expensive for Katie to be cared for at home. Ultimately, Senators Charles Grassley (R-IA) and Tom Harkin (D-IA), then-Vice President George H.W. Bush, and President and Mrs. Ronald Reagan all became involved until an exception was made in Katie’s case and she came home.”
Julie went on to advocate for a change in the law state-by-state and was influential in getting the Americans with Disabilities Act, the Individuals with Disabilities Education Act, the State Children’s Health Insurance Program, the Ticket-to-Work Act, and the Family Opportunity Act passed.
Now, more than 2.6 million people nationwide have received Medicaid Home and Community-Based waiver services as of 2021. According to data from the Kaiser Family Foundation, 710,739 people are currently waiting for Medicaid home care. The average time for an individual to be on a waitlist for waiver services is four years in Iowa, according to data from Iowa.gov. These waivers help pay for care and support for people who have disabilities. The goal is to help people live, work, and grow in their communities instead of in places that keep them apart from others. These supports help people stay in their homes and be included in community life.
People who qualify can choose how to use their waiver services. They can also choose what types of services will best meet their needs.
Hand in Hand offers the following waivers
· Intellectual Disability (ID) Waiver
o Those who have a diagnosis of an intellectual disability as determined by a psychologist or psychiatrist and are Medicaid eligible are eligible for the ID waiver.
· Health and Disability (HD) Waiver
o Those who are determined to be blind or disabled by Disability Determination Services and be under 65 or, in some exceptions, receive Social Security disability benefits are eligible for the HD waiver.
o Those who are determined to have a brain injury diagnosis and are Medicaid eligible are eligible for the BI waiver.
Hand in Hand offers five different services through the HCBS waivers:
Respite Care
Respite gives parents or guardians a break. It is used when the usual caregiver cannot be there. Parents may use this time to run errands, spend time with family, or rest.
At Hand in Hand, many families use respite during fun evening and weekend events like movie nights or social group activities. Respite helps caregivers recharge while the person receiving care has a safe and fun experience.
Respite should not be used during the caregiver’s regular work hours. It is short-term care and is meant to support the caregiver’s needs.
Interim Medical Monitoring and Treatment (IMMT)
IMMT is for people with medical needs that regular care cannot manage. For example, a child who has seizures or another serious health problem may need this service.
IMMT allows parents to go to work or take care of other responsibilities while trained staff watch for medical problems and respond if needed.
IMMT is only used when regular Medicaid services are not enough to keep the person safe.
Supported Community Living (SCL)
SCL helps people build skills to be more independent. These services are one-on-one and happen in the community or at home.
People may work on a variety of things. Examples include talking with others, staying safe, following rules, taking care of hygiene, managing emotions, or learning daily tasks like cooking or cleaning.
The support is different for everyone and matches their personal goals.
Day Habilitation
Day Habilitation helps people ages 16 and older learn and grow in the community. At Hand in Hand, this often takes place during "People with Purpose" or “Teens with Purpose” activities. These include social time, volunteering, and learning new things.
This service may also be used during after-school programs, school breaks, summer camps, and on evenings or weekends.
The goal is to help people get involved and feel included while building useful life skills.
Supported Employment (Coming soon)
Supported Employment helps people with disabilities find and keep jobs in the community. This service is part of Iowa’s HCBS waiver programs and is available through the ID and BI Waivers. At Hand in Hand, staff work with participants who have Medicaid waiver funding to explore job interests, learn job skills, and get help with tasks like filling out applications or learning the rules of a new job. Some people also receive support from a job coach while they are working. The goal of Supported Employment is to help each person become more independent and successful at work, based on their interests and abilities.
Participants can mix and match these services to create the best plan for their needs. Hand in Hand can bill services through the ID, HD, and BI Waivers. This gives families more choices and helps lower their costs.
Where to Learn More
You can learn more about Iowa’s Medicaid waiver services at:
https://hhs.iowa.gov/programs/welcome-iowa-medicaid/policies-rules-and-regulations/home-and-community-based-services-hcbs-waivers-program
Or call the DHS Contact Center at 1-855-889-7985
(Monday through Friday, 7:00 a.m. to 6:00 p.m.)
Contact Hand in Hand
To learn more about using waiver services at Hand in Hand, please contact:
Elizabeth Rushin, COO
Email: Elizabeth@handinhandqc.org