DIFFERENCES BETWEEN ICF/MR AND HCBS WAIVER PLACEMENT ICF/MR

1. Guaranteed federal right under Medicaid law. An entitlement. States may not make ICF/MR placements subject to waiting lists. ICF/MR placement must be declined in order to receive an HCBS waiver. This right is what is waived by acceptance of a waiver. 2. Provides an individualized active treatment plan devised by an interdisciplinary team of treatment professionals who together coordinate the plan. (We experience this at the individuals annual review.) The plan promotes functional status and independence. 3. Highly regulated by the federal government. Strict standards of care established regarding health, safety, staffing, management, resident protections, practices, etc. 4. Very thoroughly inspected (surveyed) annually by CMS personnel. 5. Most comprehensive benefit offered by Medicaid, covering residence, health care, nutrition, day programs, special equipment, etc., as components of the individuals treatment plan. The facility itself is responsible for all day programs and all other aspects of life, to facilitate implementation of the active treatment program plan.

HCBS WAIVER PLACEMENT

1. Not a federal entitlement. No active treatment program, no interdisciplinary team of treatment professionals. Services are a la carte. The Settlement Agreement offers 800 waivers for TC residents, however, and puts TC residents at the top of the list. 2. Provides essential life supports and services including residence and nutrition. Other services and amenities vary widely by residence. Some providers offer more than others. There are several categories of residence type available to TC individuals, most notably group homes and sponsored homes. 3. Group homes are owned and operated by private for-profit providers or CSBs (local governments.) Not all offer 24 hour staffing. The individuals needs and services are coordinated by CSB Case Managers and others, to include services provided by doctors, dentists, day programs, transportation, etc. 4. Sponsored homes involve a community family taking a disabled individual into their home and caring for them. Most only take one individual, some take two. 5. Much less regulated than ICFs/MR. Regulations and licensing are by the state. 6. A post-move monitoring schedule appears on the reverse of this document. After one year, TC transfers are monitored and inspected as frequently as the rest of those in the community. State law requires that each provider receive an unannounced DBHDS inspection annually, but most group home providers operate multiple homes, so individual homes receive unannounced inspections less frequently. If the group home houses more than four, monthly inspections continue indefinitely, thus DBHDS discourages placements in homes with five or more beds. However, those five-plus bed providers have less trouble making ends meet, with more income coming in. Fewer short-cuts.