Department of Health, Department of Health Facilities, and Department of Human Services

The West Virginia Department of Health and Human Resources Bureau for Medical Services (BMS) has finalized changes to the five-year renewal application for the Intellectual/Developmental Disabilities (IDD) Waiver.  The IDD Waiver program provides community-based services to more than 4,500 West Virginians who have intellectual and/or developmental disabilities.

“As a result of the comments, modifications were made to the Waiver with the main objectives to help the program operate within its budget and offer services to some of the more than 1,000 West Virginians on the waiting list, many of whom have been waiting for three years,” said Jeremiah Samples, DHHR Deputy Secretary of Public Health and Insurance. 

For the last three years, the IDD Waiver has exceeded its budget by tens of millions of dollars.  In fiscal year 2014, the total expenditure for the Waiver was $385 million.  Since fiscal year 2006, the amount spent for IDD Waiver recipients has increased almost $200 million a year, including over $110 million since FY2010.  These fiscal trends are unsustainable and inhibit the state’s ability to serve additional individuals eligible for the program.

This Waiver is intended to support the recipient, not the entire family. In comparison to other states, West Virginia’s waiver is one of the most generous in the nation with respect to services for the recipient’s caregiver.  For example, not all states reimburse parents for providing care for their own children. 

None of the changes reduce direct medical services or therapies to the recipient.  Benefits to family members have been modified to align with other states and to free up the necessary funds to serve additional eligible individuals on the waitlist.

Specific modifications to the Waiver application following the public comment period include:

• Allowing recipients to receive other services on the same day as respite services.
• Increasing respite hours from the proposed 2 hours per day to 2.5 hours a day, which amounts to 912.5 hours annually that can be used in a flexible manner. 
• For recipients under age 18, the application was amended to allow flexibility in how the allocated annual Person Centered Support (PCS) hours will be used. These hours may be accessed on the same day as other direct care services. This flexibility would allow an average of 52.5 hours per week to be available to support the child, permitting the parent or caregiver to work outside the home if they so choose. 
• For recipients over age 18, the application was also amended to allow flexibility in how PCS hours will be used.  This flexibility would allow an average of 93.5 hours per week of combined PCS, respite, and services such as Facility-Based Day Habilitation, Pre-vocational, Job Development or Supported Employment to be available to support the adult recipient, permitting the parent or caregiver to work outside the home if they so choose. 
• Increasing to the maximum amount of time for a recipient to participate in a Facility-Based Day Habilitation program in order to comply with the Centers for Medicare and Medicaid Services’ (CMS) rule. In addition to this modification, BMS will submit a formal request to CMS requesting additional flexibility in the program for these services. 

The Waiver will be submitted this week to the Centers for Medicare and Medicaid Services which must approve the application.

To view the comments and additional modifications received, please visit http://www.dhhr.wv.gov/bms/news/Pages/Intellectual-Development-Disabilities-Waiver-Comments-and-Responses.aspx.