DHS (Department of Human Services)
Medicaid Waiver Programs

by Suzanne Crisp, Assistant Director, Community & Consumer Services-DHS.

The Division of Aging and Adult Services has focused on services for the elderly since the late 1960ís. And for a good reason - Arkansas's elderly population is the sixth highest in the nation. Almost 35% of these elderly are poor or near poor. But the number of younger Arkansans with disabilities is also alarmingly high. It has only been in recent years that the Division has begun to concentrate on understanding the needs and creating services for the younger population. As a result, a range of services and supports are now available.

Two programs, in particular, are successfully meeting the needs of Arkansans with disabilities. The Alternatives Waiver Program and IndependentChoices Project utilize a consumer-directed approach where each individual must agree to and be capable of hiring, training, supervising, terminating and approving payment of their attendant's services.

The Alternatives (Adults with Physical Disabilities) Waiver Program is a Medicaid Waiver program designed to serve adults with physical disabilities. Participants work with a counselor to develop an individualized plan of care. Waiver services include:

• Attendant Care - Assistance to accomplish tasks of daily living for recipients who are unable to complete these tasks independently. rways, modifying bathroom facilities, or installing specialized electronic and plumbing systems to accommodate medical equipment and supplies necessary for the welfare of the recipient.
• Medicaid Eligibility - Recipients who meet the Alternatives Waiver Program criteria and are approved will receive full Medicaid benefits.

To be eligible for Alternatives, an individual must:

• Have income of no more than 300% SSI;
• Have a physical disability;
• Be between 21 to 64 years of age
• Meet Intermediate Level Nursing Home placement criteria.
• Community Based Services Waiver services can not be offered to individuals with care needs that exceed the cost of nursing home placement.

Alternatives currently serves 450 clients throughout the state. These clients have more than 750 people identified as providers including personal care assistants and contractors to make home modifications. The program has been in operation for three years and is growing steadily. Applications are mailed by the Division of Aging and Adult Services upon request. To obtain an application, interested parties are asked to call 1-800-981-4457. A brief screening is completed to establish initial eligibility at the time of the request.

The second program designed for persons with disabilities is the IndependentChoices Project. Funded with a grant from the Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services, this project gives Medicaid personal care clients the opportunity to exchange agency personal care for a monthly cash allowance. In the IndependentChoices Project, each participant can make many choices about their personal care, and how the money is spent to provide that care. Participants work with a counseling/fiscal agent who is their partner in self-direction.

Individuals are eligible for IndependentChoices if they:

• Are receiving Medicaid;
• Are 18 or older;
• Need personal care;
• Want to be responsible for their services and able to make responsible care decisions or
• Have someone to assist in making decisions.

Individuals interested in receiving more information about IndependentChoices may call toll-free 1-888-682-0044. At that time, Medicaid eligibility is verified and basic program information will be provided. IndependentChoices is part of the National Cash and Counseling Demonstration and Evaluation Program. Operating in three states, New Jersey, Florida and Arkansas, this program is testing one of the ultimate forms of consumer-direction of personal assistance services. Based on an experimental design, half of the people who enroll receive the cash allowance and half continue to receive agency personal care services. Both groups are vital to the evaluation, which is expected to broaden the availability of consumer-directed programs nationwide.

Arkansas and the Division continue to seek opportunities to expand services for persons with disabilities and older Arkansans. Please call us at one the of toll-free telephone numbers for more information.