Transitioning a Child to Consumer Directed Health

Care

Preventing Service Gaps and Planning the Move to the Consumer

Directed Adult System of Care

Consumer Direction Regional Conferences - June, 2006Sponsored by

Colorado Department of Health Care Policy and FinancingIndependence Plus Grant #18-P-92019/8-01

Colorado Medicaid • Offers a range of consumer directed

service options• Maintains a leadership position

among states’ Medicaid programs with consumer direction program innovations

• Receives broad community, legislative and executive support of consumer direction initiatives

Workshop Objectives:

• Identify barriers to seamless transition to the adult system of care

• Identify resources and skills to ease the transition to consumer directed adult health care

Workshop Content

• Parents’ transition activities– Skills and timing

• Quick review of Medicaid (very quick)– State plan, HCBS, consumer direction

• Intro to the adult system of care• Authorized Representatives

When Should Transition Begin?

• Parents should begin to plan at the initial onset of the child’s disability– Birth, or– Date of injury

• Children can begin to absorb pertinent info at the age of 14

•START EARLY!

Seamless Transition Depends On:

• The wishes of the child and family• Complexity of child’s health condition• Presence (or absence) of adult health

care resources in the community• Parent’s knowledge (and willingness to

teach the child) of transition process and community resources

Building Appropriate Skills in the Transitioning Child/Consumer

• Identify and communicate changes in health condition

• Communicate effectively with a provider– Obtain appointments– Evaluate interventions– Express the child’s/family’s wishes

COMMUNICATION!

Building Appropriate Skills: SHARE YOUR KNOWLEDGE

• Prevent injury and/or illness

• Manage child’s health needs

• Coordinate services

Medicaid 101

• Federal and state partnership providing payment for health care services for the disabled and low-income populations– Federal/state share of costs is 50/50

• Financial Eligibility is determined by results of an asset/means test– Consult the county in which you live

Medicaid 101

• State Plan:– A package of medically necessary

services available to all Medicaid eligible clients.

•Includes:– Acute care– Home health care

Medicaid 101 - Waivers

Home and Community Based Services

• Allow the state to offer services in addition to the State Plan services

• Services are appropriate and specific to a population with a specific diagnosis

• Called “waivers” because the equal access to equal services requirement of the state plan are “waived” for specific populations

Medicaid 101 - Waivers

HCBS eligibility requirements• Client must be eligible for Medicaid• Client must need long-term care at an

institutional level of careHCBS offers a spectrum of client choice• Traditional agency model – least choice• IHSS (agency with choice) – moderate

choice• CDAS – most choice

Medicaid 101 – Consumer Direction

• IHSS – “agency with choice”- consumer direction option available to HCBS-EBD and C-HCBS clients only.

• CDAS – most flexible consumer

directed option available to all eligible Medicaid clients with long term care needs

Two Systems in Long Term Care Physically Disabled

Children

Waiver: C-HCBS

Apply: SEP, CCB, CMA

Wait list: Yes

Adult

Waivers: EBD (18+), BI (16-64), PLWA (all)

Apply: SEP

Wait list: No, except SLP in BI waiver

Two Systems in Long Term Care Cognitively Disabled

Children

Waiver: CES

Apply: (CCB)

Waiting List: Yes

Adult

Waivers: SLS, DD, MI

Apply: CCB SEP (MI only)

Waiting List:SLS: YesDD: Yes

Case Management Responsibilities

SEP/CCBResponsibiliti

es

Eligibility Determination HCBS Waivers

Case Management

Service Coordination

Referral and Information Distribution

Quality Assuranc

e

SEP Responsible

for all Authorization of Home

Health

Authorized Representative (AR)

• AR may be a family member, a friend or a legal guardian of the client

• AR may assist the client in the direction of the client’s care

• AR assists the client to define quality, risk and safety in the client’s care

Requirements to be an AR

• AR must be at least 18 years old• AR must know client for two years• AR must not be convicted of

abuse, exploitation or assault• AR must not have a condition that

could result in harm to the client

Preventing conflicts of interest

• AR may not be paid• AR may not be a paid caregiver• AR must enjoy the trust of the client• AR must be willing to accept client’s

responsibilities for the client’s consumer directed care

• AR must be able to distinguish between the client’s and AR’s wishes

Authorized Representative - Benefits for the Consumer

• Any eligible client may choose this option• AR option enables cognitively disabled

clients to transition into consumer directed services

• Transitioning clients may choose an AR to help identify service quality standards

• With an AR, transitioning clients can turn service deficiencies to strengths and improve support quality

Authorized Representative

in IHSS• Client’s physician determines need

for an AR to assist in client’s care

• Client and AR select provider agency

• Client and AR select attendant

• Client and AR determine training needs of attendant

Authorized Representative

in IHSS – (cont)• Client and AR conduct training

• Client and AR select back-up attendants

• Client and AR establish procedures for critical incident management, back-up utilization – within the confines of the provider agency’s requirements

Authorized Representative in CDAS

• Client or legal guardian designates• Complete affidavit and questionnaire• May not be paid• May not have a conviction for abuse,

exploitation, or assault• May not have a mental, emotional, or

physical condition that could harm client

Emergency Backup, Safety and Prevention Strategies

• See the Strategies Resource Manual– Safety and Prevention – Decision tree– Back-up care– Community disaster– Identity and property safety– Health care emergency forms

Finally…..

What you risk reveals what you value    

Jeanette Winterson

When you're through changing, you're through    

William Safire

Contact Information

IHSSGeorge Good-deCurnou

in Denver metro:303-866-2704

in state:1-800-221-3843 x 2704

CDASMarie Garcia

in Denver metro:303-866-2755

in state:1-800-221-3943 x 2755

Questions?

Please write down questions you have for the Q&A panel and leave them in the box

provided on the registration table.

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Information” section of your conference binder.

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