Medicaid Waivers in Virginia
What is a Medicaid Waiver?
Funding for individuals who are eligible for long-term care in a nursing home, hospital or intermediate care facility is provided through Medicaid. Medicaid waivers allow the state to waive certain requirements, including the requirement that an individual must live in an institution in order to receive Medicaid benefits. Medicaid waivers were created to help residents with disabilities and the elderly to access a combination of medical, rehabilitative, and other services in their homes and communities.
Individuals with a brain injury who may be eligible for a Medicaid waiver have been determined to 1) have a disability, 2) meet the requirements to receive care in a nursing home or hospital and 3) are eligible for Medicaid. To find out if you are eligible for Medicaid, go to www.commonhelp.virginia.gov
What waiver options are available?
The Commonwealth Coordinated Care Plus Waiver (CCC Plus) This waiver is available to the elderly or disabled. To find out if you or a loved one is eligible,you need to be screened at a hospital or your local Department of Health or your local Department of Social Services. The screening tool used is called the Uniform Assessment Instrument.
To find out if you are eligible for Medicaid you can go to: www.commonhelp.virginia.gov
Services that can be provided:
- Adult Day Health Care
- Personal Assistance Services
- Environmental Modifications
- Assistive Technology
- Respite Care
- Transition Services
- Personal Emergency Response System & Medication Management
What is Commonwealth Coordinated Care Plus (CCC Plus)?
- Statewide Medicaid managed care program began Aug 2017 for over 214,000 individuals .
- Participation is required for qualifying populations.
- Integrated delivery model that includes medical services, behavioral health services and long term services and supports (LTSS).
- Care coordination and person centered care with an interdisciplinary team approach.
What if I have CCC Plus or am receiving CCC Plus waiver services and I have a concern or complaint?
Contact your Long Term Care Ombudsman.
Virginia Department of Behavioral Health & Developmental Services manages three Medicaid Waivers for individuals with a developmental disability.
If an injury happens before an individual's 22nd Birthday they may be eligible for a Developmental Disability Waiver.
The currently available Developmental Disability waivers are:
- Building Independence Waiver
- Family and Individual Supports Waiver
- Community Living Waiver
Not everyone is eligible for one of the developmental disability waivers. For individuals with a brain injury your injury must have occurred prior to your 22nd birthday to be considered eligible. If this is the case for you or your loved one, contact your local Community Services Board (CSB) or Behavioral Health Authority (BHA) to find out if you are eligible. When you call ask to start the process for determining eligibility for a Developmental Disability Waiver.
More than 12,000 Virginians with developmental disabilities are on waiting lists for community-based support, so there will more than likely be a delay in receiving services through one of these waivers.
Emergency waiver slots may be available for some people, if in the absence of waiver services, the individual would not be able to remain in his home. Eligibility criteria include
- The primary caregiver has a serious illness, has been hospitalized, or has died
- The individual has been determined by the Department of Social Services (DSS) to have been abused or neglected and is in need of immediate waiver services
- The individual demonstrates behaviors which present risk to personal or public safety
- The individual presents extreme physical, emotional or financial burden at home and the family or caregiver is unable to continue to provide care
- The individual lives in an institutional setting and has a viable discharge plan in place.
Navigating the Developmental Disability Waivers: A guide for Individuals, Families, and Support Partners