Behavioral Health Division staff discuss developmental disability waivers with small crowd

(Lander, Wyo.) – Members of the Wyoming Department of Health Behavioral Health Division were in Lander last night to talk through coming changes to developmental disability waivers.

Less than 20 people attended the nearly two-hour long discussion at Lander Valley High School. When a forum was held in August in Riverton as potential changes were being discussed, more than 80 were present. (Read about that meeting here.)

The changes have been directed by the state legislature through Senate Enrolled Act 82, BHD Senior Administrator Chris Newman said. The changes, she said, are part of a larger restructuring of the state’s Medicaid program.

“The reason for these changes is to provide better services and to serve more citizens who are currently on the waiting list,” Newman said, and to do do so within existing funding.

WDH has been providing services through an “Adult Developmental Disabilities Waiver,” a “Child Developmental Disabilities Waiver” and an “Acquired Brain Injury Waiver” using a combination of state and federal Wyoming Medicaid dollars.

The law approved by the Wyoming Legislature and the governor earlier this year called for two new waivers: a “Supports Waiver” and a “Comprehensive Waiver.” Current participants will be transitioned to the new comprehensive waiver over the coming months and new participants from the waiting list will be brought on to the supports waiver as funding becomes available.

The supports waiver is to get limited funding to people currently receiving nothing while they are on the waiting list. Newman said youth 0-21 will receive budgets up to $12,500, and those 22 and older will get $16,500.

The comprehensive waiver includes both children and adults with developmental disabilities. (People with acquired brain injuries will remain on a separate waiver as they are currently.) People will be transitioned from the supports waiver to the comprehensive waiver as funds become available. Right now, Newman said, the legislature has not allocated any new funds to the waiver program.

To determine budget levels for those eligible for a comprehensive waiver, two assessments will be conducted: the Inventory for Client and Agency Planning (ICAP) and Supports Intensity Scale (SIS). Newman said SIS is new to Wyoming, but has been used throughout the country to determine levels of need in the areas of behavioral, medical, and protection and advocacy.

After the assessments are done, people will be placed on a scale of needs from 1, needing the least amount of support, to 6, which is for people with extremely high levels of need.

All people on the current waiver system will undergo the SIS, and some could ultimately receive less funding than they are now. In those cases, waiver amounts will be stepped down gradually. Newman said beyond the base budget determined by the 1-6 scale, other needs can be assessed to provide extra funding. Additionally, she said there will be an appeal system.

The new waiver system also boasts coverage of adult day services and behavioral support services, which were not covered before.

Newman also reviewed potential coming changes to the way case managers are going to be required to operate, including the requirement to be part of an agency with at least two case managers and have zero conflicts of interest with service providers. Many of the questions Newman and her team fielded last night dealt with these changes.

Transitions to the new waiver system will begin in the coming months with the implementation of the SIS, with the earliest clients being covered under the new system as early as Feb. 1, 2014. All adults are to be transitioned by June 30, 2014, and all juveniles by the same time in 2015.

Some concerns were raised that there wouldn’t be much funding put toward placing people in residential treatment care. Newman agreed that more people might do well in residential treatment, but the legislature has directed funding to go toward shortening the waiting list.

Newman and her team recognized that many of the details are still being fine-tuned. Up-to-date information can be found at health.wyo.gov/ddd.

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