The Take Me Home (TMH) Transition Program is a program of the West Virginia Bureau for Medical Services (BMS). The purpose of TMH is to identify qualifying residents of long-term care facilities who wish to return to their own homes and apartments in the community and provide them the supports and services they need to do so.
Individuals wishing to transition to the community often face numerous obstacles including a lack of funds for security and utility deposits, lack of basic household items and furniture, limited community supports, and no one to help develop comprehensive plans to transition home. TMH helps address many of these barriers by providing services and supports including Transition Coordination, Pre-transition Case Management and Community Transition Services to qualified applicants.
Transition Coordination is the lynchpin of TMH. Transition Coordinators work one-on-one with TMH participants and their Transition Teams to develop person-centered transition plans and facilitate delivery of necessary services to support TMH participants’ transition to the community.
Pre-transition Case Management is available to members of the Aged and Disabled Waiver (ADW) and Traumatic Brain Injury Waiver (TBIW) programs to ensure that direct-care services are in place day-one of the TMH participant’s return home. The Community Transition Service is a Waiver service that can cover many one-time expenses needed to establish a home in the community for TMH participants. Allowable Community Transition Service expenses include, but are not limited to, home modifications, moving expenses, home furnishings, essential household items, rental security and utility deposits. The total expenditures for Waiver Community Transition Services cannot exceed $4,000 per transition period.
To qualify for these Waiver transition services, individuals must:
- Live in a nursing facility, hospital, Institution for Mental Disease or a combination of any of the three for at least 90 consecutive days and;
- Have been determined medically and financially eligible for either the Aged and Disabled Waiver (ADW) or Traumatic Brain Injury Waiver (TBIW) program, and;
- Wish to transition from facility-based living to their own home or apartment in the community consistent with the Centers for Medicare and Medicaid Service (CMS) Settings Rule (1915(I)) and;
- Have a home or apartment in the community to return to upon leaving the facility that is consistent with the CMS Settings Rule and;
- Require Waiver transition services to safely and successfully transition to community living and;
- Reasonably be expected to transition safely to the community within 180 days of initial date of transition service.