Medicaid Programs in Texas

CAROLINE: Let's talk about Medicaid waivers. ROSEMARY: The Medicaid waiver programs are the best way to provide funds and services for any aged person in our country. And it's a more progressive use of funding, because the money follows the person. It's user friendly because the family or the person with the disability isn't able to make decisions about how to use their budget. And it's the highest level of funding that person can get in our country. So it comes from the federal government to the state level. And the bad news is that the funds are allocated at our state level, and so Texas is among the worst users of the Medicaid waiver programs in the country, because we have so many people not able to use them. We have long waiting lists for our programs. The main purpose of a Medicaid Waiver Program is to keep a person living in the community as opposed to the state school, a nursing home, or a large group home. So a person must be living in the community to use these funds or be eligible for these funds. CAROLINE: And that means living at home or living in their own place or-- ROSEMARY: Small shared group homes, or combined living situation. So my son has been on a Medicaid waiver, the CLASS program, for about 10 years now. And it really raises the quality of our lives beyond measure, because a person can assist him one-to-one each day to do what he wants to do. What he enjoys and finds productive is a one-to-one situation. But there's so much flexibility in where you live and how you use these funds that it can be individualized. CAROLINE: Medicaid waiver funds-- the way I conceptualize the role of Medicaid waiver eligibility in putting together a support system for a person with a disability is that it's almost like a revenue stream. Even though it doesn't come in to the person or the family in the form of revenue, it does come in in the form of eligibility for things that you would have to spend money on if you were crafting that type of support for your loved one on your own. So becoming eligible for one of the Medicaid waiver programs, as Rosemary said, can really increase your flexibility planning for how to support your loved one in the way of providing therapies. Building modifications. What else qualifies there? ROSEMARY: Equipment, recreation opportunities, even things like social work, counseling-- CAROLINE: Job coaching. ROSEMARY: --really, all of the kinds of supports a person needs to live a productive, possibly high-quality life in the community as an adult. As I've already said, Texas has very long waiting lists. So the best thing that staff can do for their students and their families is to be sure whenever you find a student, a family that's open, you need to help them. Be sure they're on the waiting list for these programs. We said there are 10-year waiting lists right now. And so what we really want is to give you some language for the best way to have staff help parents see the importance of getting on the waiting list for these programs like CLASS and HCS. CAROLINE: The tricky thing in that situation is that because of the length of the waiting lists, often the students who we're talking about are very young. If we're hoping that the Medicaid waiver eligibility is going to kick in around transition time, or even before, that means that in reality we need to be getting kids on these waiting lists when they're really little, like four or five or six, PPCD and early elementary age. The thing that's tricky on the family side for that is that there is so much growth and development still yet to come that oftentimes parents really don't know how that's going to go for the kid. And it's a hard conversation sometimes when we're talking about supports for what could be pretty significant disabilities. And we're also dealing on the family side with a lot of hope that the student is going to grow out of it, that we're going to be able to intervene enough to teach them to work around it, and that really that the kid isn't going to need this kind of support in the long run. So it can be a dicey conversation for professionals and families to have because of the timing. ROSEMARY: But what you might be able to say is, just get on the waiting list. And it's like buying an insurance policy. You have to cover your car or your house. This is like a simple step to take now that, if you need it in the future, it will be there. Because if you don't get on the list, it won't be there for sure. CAROLINE: I tell parents and professionals both that getting on the list is about a five-minute phone call. Parents, all you have to do is be ready with your child's social security number and a telephone. You can get your kid on the list in that five-minute phone call. And after that, you're not committed to anything. You're not locked into anything. Years later, when their number comes up and it's time to engage in that eligibility conversation, if they've made enough progress and grown out of everything they need to grow out of, they will either not be found eligible for Medicaid waiver programs, or you can decline it. It does keep an option open, like Rosemary says, like an insurance policy, early on that we don't want to foreclose and then later discover that this would be really needed and important support. And then we have to start that ten-year clock ticking. ROSEMARY: And you don't have to prove eligibility when you get on the waiting list, as you were saying, Caroline. So it really is a simple thing to do. And one thing, last thing we have to remind families of, is that you will get communications from the state agencies once a year while the child is on the waiting list. So you do have to remain aware of responding to any communication from the state agency and keeping your contact information up to date so that when the day comes for great celebration and you get on this list, you get the eligibility, you finally come up for these services, they can find you. Thank you.