Welcome to the TBI-HELP Live Chat
Today's topic is:
"Waiver Programs"
Our Guest is: Dr. Marie
Cavallo, AHRC, NYC
Tonight's Topic Summary:
This presentation will be addressing the issue of waiver services available to
individuals with TBI. It will address the following: What are waivers, pros and
cons, waivers available to people with TBI, how do they differ, what do they
offer, philosophy the waivers and some details about the services available.
[18:58:45] mod: Good evening and welcome to our chat. It is our pleasure to have Dr. Marie Cavallo, Director of Traumatic Brain Injury Services from AHRC. Welcome. Dr. Cavallo.
[18:59:16] Dr.Cavallo: Thank you for inviting me. good Evening
[18:59:47] mod: Dr. Cavallo, can you please explain what exactly is a waiver?
[19:01:51] Dr.Cavallo: Waivers allow states, through, Medicaid, to provide a
package of tailored services to comprehensively meet the needs of a targeted group in a community-based setting.
Waivers are a funding source that is Medicaid based, therefore the individual must have or be
eligible for community Medicaid in order be on a waiver. At least, in NYS, waiver funded services to individuals with TBI are not traditional medical or rehabilitation services, rather they are community-based services and
supports. One note, you do not waive Medicaid when you are on the waiver, rather you waive having to be in an
institutional setting to receive this level of care
[19:05:17] mod: So you must have Medicaid to apply for the waiver? Is there an age requirement?
[19:05:45] Dr.Cavallo: Well, there are a number of different waivers available to individuals with
disabilities in NYS. They have slightly different requirements. The Waiver offered by OMRDD is
available to inds . with TBI who are injured before the age of 22 (essentially in their developmental years) but can be utilized by children with TBI (and of course other Developmental Disabilities). The DOH waiver is
available to inds with TBI who are injured 18 and above and who are currently adults between the ages of 18 and 64.
[19:09:42] mod: Rail: Are there different Waiver programs that can be used to address different issues in rehabilitation? If so what are some of these programs?
[19:10:43] Dr.Cavallo: Yes and No. Each waiver has a different set of services that are available through this funding stream. Both the OMRDD waiver and the DOH waiver for exapmple offer Day Programs. However, the DOH waiver offers Intensive Behavioral Programming, which is an in the community behavioral intervention service. The OMRDD waiver has no such service. The
waivers, while they do provide innovative community-based services, do not offer traditional rehab services.
[19:13:02] mod: Rail: It would be good if there could be a "Table" of issues and program so that one could see-quickly-what the needs are and what support is out there?
[19:14:18] Dr.Cavallo: Do you mean a directory or written description? I can give you some of that now but can also give you some resources for that. The brain Injury Association has published a booklet which outlines all types of services available to inds. with TBI in
NYS. It includes the waiver programs with complete descriptions and who to call etc.. Is that what you mean? The Brain Injury Association is also updating their website and will have this information on the website along with a directory. I am not sure how far along with that they are but you may want to check it out. There is a link to that website from this one.
[19:18:18] mod: Can you please explain what some of the pros of having waivers available would be.
[19:20:00] Dr.Cavallo: First of all, they are available to Medicaid
recipients and allow them to receive a large variety of needed services This may also be seen as a con, since you must have Medicaid to be on the waiver. that leaves off a number of
inds. Let me give you two examples: First,
because the Waiver funding stream is available, a number of new providers who are community based providers have come into
existence. While only a Waiver eligible person can access those services through the
waiver, if a third party payer, like workers comp wanted to buy the service they could
because it now exists.. Second, other programs that may not be
waiver programs have grown up around the waiver, almost piggy backing on it, like the Fairview Day Program, which is funded by straight Medicaid but has a large number of waiver participants involved in the program. if the
waiver did not exist, there might be fewer inds. in the community who could benefit from the program.
[19:25:49] mod: Susan: I'm always confused about the available services and that for someone who was injured between 18-22 they are under OMRDD and to be eligible for, lets say the DOH waiver OMRDD must say its ok?
[19:26:55] Dr.Cavallo: Technically, an ind. injured between 18-22 is eligible for either waiver.. However, the understanding that has been worked out between OMRDD and DOH is that they would attempt to access the OMRDD
waiver first. If OMRDD cannot serve them, they would need to get a letter from OMRDD stating that then DOH would attempt to serve them. This may change in the future and it is somewhat flexible but that is the basic approach.
[19:28:58] mod: Susan: Would waivers be better than just straight
Medicaid to get assistive devices and other equipment?
[19:29:32] Dr.Cavallo: First, let me say that Waivers are the funding of last resort. This means that even if you are on the
waiver, you need to first attempt to get the service through straight Medicaid, if you cannot, then through the
waiver. Both waivers allow for the purchase of special medical equipment and supplies and for environmental modifications.
Also, the certified providers under the wiaver would need to have the equipment avilable and approved by the waiver program.
[19:32:22] mod: How do I access waivers - do I find the service first or what?
[19:33:12] Dr.Cavallo: For the DOH Waiver, you need to contact the Regional
Resource Development Specialist in your region. In NYC there are two regions, and there are another 9 regions throughout the state.
So there are 11 RRDS's. In NYC, you can call Ronnie Gala at 718-515-5500 x2003 for the bronx and queens region;
and my asst., Gloria Liu at 212-634-8671 for Man., Bklyn, and SI. The OMRDD waiver also has regional offices. There is one in each
borough of NYC. I can't list them all here but if you call Gloria Liu she can send you a TBI Resources In NYC booklet with all the phone numbers. For both waivers, you need to contact the regional offices and they will determine eligibility and if you are eligible they will take you
through a choice process to choose a service coordinator
[19:38:26] mod: Susan: Do you first need case management and then how long is the current waiting list for case management?
[19:40:19] Dr.Cavallo: The way it works for the DOH waiver is that once it is determined that you are eligible for the
waiver and there is an opportunity available, the regional office will provide the consumer and his or her advocates/family with a list of
available and approved service coordination agencies. The waiver is very much based on consumer choice and empowerment so the consumer, with the
help of the advocate, chooses who they would like to work with. The service
coordinator then works with the ind. to develop a full plan of services. Its slightly different for omrdd, but the basic process is the same. The only difference is that I think through OMRDD you can get service
coordination even if you are not on the waiver. I'm not completely sure about that, but the service coordination under OMRDD is not a waiver service but rather a Medicaid service.. The waiting list issue is different. It will depend on which waiver, which region, and the current situation for the person. For example, for the DOH waiver, someone who is in a nursing home, in or out of state but who would be a good
waiver candidate may get served very quickly. This is because the waivers are designed to de-institutionalize inds. with disabilities
[19:46:54] mod: Would all day programs be covered or only those that focus on community re-entry?
[19:47:53] Dr.Cavallo: The way it works is that a provider applies to become a provider of day services, any program can apply for that.. Based on an evaluation process a provider would get approved or not.. It is expected that each program may focus on a different subset of needs that inds. may have. Does that answer your question?
[19:50:44] mod: Joanie: How can I access more information about waivers?
[19:51:53] Dr.Cavallo: I would suggest a couple of things. first get the booklet I referred to earlier from the Brain Injury Association which describes all services for inds. with TBI in
NYS. Second, call the regional offices, ask for the written info they have available and speak to the RRDS or , for the OMRDD waiver, you can ask to speak to the TBI coordinator at the regional office. each office has one. If you need the phone numbers again, you can call Gloria Liu at 212-634-8671 and ask for a copy of TBI Resources in NYC.
This is a different in a booklet that the Brain Injury Association
puts out
[19:54:15] mod: MR: What services would
my wife be entitled to if we were to apply for a waiver?
[19:54:56] Dr.Cavallo: Well, lets assume that your wife was injured after the age of 18 and so we are talking about the DOH waiver. Independent Living Skills Training, Intensive Behavioral Programming and Home and
Community support Services. This is in addition to any regular Medicaid Services she may be getting.
Again, the expectation is that regular Medicaid is accessed first and then
waiver services are built around that to provide the needed support for someone to live successfully in the community
[19:58:11] mod: Susan: Can you still be
eligible for home care with waiver services/
[19:58:49] Dr.Cavallo: Absolutely, in
fact the expectation is that you will first seek services that can be paid for without the waiver and the waiver adds services to supplement those services
[19:59:11] mod: Well, I see that our time is up for this evening. I want to thank Dr. Cavallo for a wonderful session and to all of you for good questions. Have a wonderful week, take care and be safe. Good night!
[19:59:55] Dr.Cavallo: Good night. I hope this was helpful and feel free to get in touch with my office if you need further help. 212-634-8671.