Learning how to access available services for adults and children with disabilities in Virginia can be a complicated and difficult process for families to navigate. Most families will access services for children through three state agencies: their local Department of Social Services (DSS), the Department of Medical Assistance Services (Medicaid), and through their local Department of Health.
The child will be screened through the local Community Services Board (CSB) or the local Department of Health to determine what types of waiver services he or she may be eligible for. A request for screening should be made to the local CSB to determine if a child qualifies for one of the Developmental Disability Waivers.
Things to Remember:
- If determined eligible and a slot is made available to the child, only the child’s income is considered: parent income is never considered for Medicaid Waiver eligibility.
- The child’s Medicaid eligibility must be reviewed every 12 months.
- The child must have a disability determination performed by Disability Determination Services (Social Security) before age 18.
- The child’s level of care must be reviewed annually to ensure he/she continues to meet functional eligibility to receive waiver services.
Virginia’s Waiver programs
Virginia Medicaid provides options for two types of waivers:
1. Developmental Disability Waivers (DDW)Virginia has three waivers that are focused on those individuals that have a diagnosis of developmental disability. The three waivers that provide a continuum of services are:
- Building Independence (BI) for individuals 18 and older,
- Family & Individual Support (FIS), and
- Community Living (CL).
2. Commonwealth Coordinated Care (CCC) Plus WaiverEffective July 1, 2017, the Elderly Disabled and Consumer Directed (EDCD) and Technology Assisted waivers were combined into the new CCC Plus Waiver. The CCC Plus Waiver is part of Medicaid's managed care program: CCC Plus Health Plan. It serves all ages and does not have a waiting list. The CCC Plus Waiver provides supports and services options for successful living, nursing, respite, assistive technology and environmental modifications.
Accessing the programs:
To be eligible for DD waiver:
- The child must meet diagnostic eligibility consistent with Virginia’s [PDF] Definition of Developmental Disability.
- The child must meet the functional criteria for the VA Individual Developmental Disability Eligibility Survey (VIDES). Click to view the: [PDF] VIDES Adult, [PDF] VIDES Child, [PDF] VIDES Infant.
- The child must meet financial eligibility. As noted earlier, the child does not have to apply or be enrolled in Medicaid when being screened for a waiver. Remember that parent income is never considered for Medicaid Waiver eligibility for a child once he or she has been approved for a waiver slot To utilize the waiver the child must apply and qualify for Medicaid if he or she is not already enrolled in Medicaid.
- meets the definition of a developmental disability and
- meets the functional criteria as assessed on the VIDES screening tool.
CCC Plus Waiver
The Screening for Long-Term Services and Supports (LTSS), formerly known as Pre-Admission Screening (PAS), is required for individuals who, at the time of application for admission to a skilled nursing facility, skilled care facility, nursing or nursing care facility, or nursing home, are eligible for medical assistance or will become eligible within six months following admission. Long term services and supports include various supports and services.
LTSS are provided to an adult or child who requires a level of care equivalent to that received in a nursing facility (NF). LTSS help meet medical, nursing, or personal care needs. These services can be provided at home, in the community, or in a facility. The Department of Medical Assistance Services (DMAS) oversees the Medicaid LTSS Screening Process in Virginia in partnership with the Virginia Department for Aging and Rehabilitation Services (DARS), Virginia Department of Health (VDH), the Virginia Department of Social Services (VDSS), Acute Care Hospitals, and Rehabilitation Hospitals within the Commonwealth. The Medicaid LTSS Screening is a process to:
- Evaluate the functional, medical or nursing, and social needs of each adult or child believed to be in need of or at risk of NF admission, and needing services within 1 month or less;
- Analyze specific services and supports that the adult or child needs;
- Evaluate whether a service or a combination of existing home and community based services is available to meet the adult or child’s needs by applying existing criteria for NF, and HCBS, including CCC Plus Waiver and the Program of All-Inclusive Care for the Elderly (PACE);
- Provide the adult or child with the choice of home and community-based or NF services for which the individual qualifies; and
- Conduct an additional screening for adults and children who have selected NF services to identify any suspected or known diagnosis of mental illness (MI), intellectual disability (ID) or a related condition (RC) so that they can be evaluated through the “Preadmission Screening and Resident Review” (PASRR) process.
The ARC of Virginia: Home Page
Find a Community Service Board: Community Services Boards
Medicaid’s Role for Children with Special Health Care Needs: A Look at Eligibility, Services, and Spending
VCU Center for Family Involvement: VCU Center
Got Transition: Youth Health Care Transition
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