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As parents and caregivers of a person with a disability, it’s natural to worry about the future. We understand this well because we are all on a similar journey. We work tirelessly to secure income through Social Security and healthcare coverage through Medicaid or Medicare. However, what matters most is ensuring that our loved ones receive the right set of services and supports that meet their individual needs. This concern often intensifies as your young adult approaches graduation and prepares to enter a new phase of life.
As a mom of a 32-year-old with Autism, Anna Maki has walked the walk and experienced the fear and frustration you may have gone through as well. This is why she started the Benefits Navigation program at Bobby Dodd Institute (BDI) to help other parents facing the same challenges and save you time, so you can focus on what matters most – your family and your own wellbeing.
First things first…
What is a Waiver?
Any individual with disabilities transitioning into adulthood needs three things: some level of income, some level of health insurance, and some level of services. Social Security is critical because it provides both income and health insurance. For example, Supplemental Security Income automatically enrolls you in Medicaid.
Waiver programs, on the other hand, provide access to services. Anna explains, “Years ago, we didn’t have home- and community-based services; we had institutionalization. No one wants their loved ones in an institutional setting. What we’re waiving is access to the institution, allowing our loved ones to receive services at home instead. So, when you hear “Medicaid waiver,” that’s really code for “services at home.”
There are different types of waivers, and they often track the life cycle.
- Georgia Pediatric Program (GAP) – for children
- Independent Care Waiver – for adults
- Elderly and Disabled Waiver – for older adults or adults with specific disabilities
- NOW/COMP – for individuals with intellectual and developmental disabilities
Understanding these programs and their eligibility criteria is essential for identifying the best track for your loved one.
Waivers for Children with Disabilities
What is GAPP?
The Georgia Pediatric Program, or GAPP, was implemented in August 2002 as a Medicaid in-home nursing program. Its purpose is to serve eligible children under 20 years and 11 months, based on medical necessity. More recently, in April 2023, GAPP added behavioral supports, similar to Applied Behavioral Therapy (ABA) services.
Services offered through GAPP include community living supports, behavioral supports, and skilled nursing.
Community living supports provide assistance with daily living activities, like preparing meals, bathing, dressing, light housework, and chores. Parents can be paid as the child’s personal care support person if they are competent in their child’s care.
Behavioral supports are provided by Registered Behavior Technicians (RBTs). These services include ABA-style interventions to improve communication, social skills, daily living skills, academic support, and behavioral interventions.
Skilled nursing covers services like wound care, medication management, trach care, catheter hygiene, tube feeding, and some physical or occupational therapy, including school nursing services.
Is My Child Eligible for GAPP?
To be eligible for services through GAPP and remain covered until their 22nd birthday, your loved one must have Medicaid. Additionally, they must be deemed medically fragile through the in-home nursing program. However, it is no longer required to meet nursing home or hospital criteria; they need nursing care or personal care assistance in the home.
Waivers for Adults and the Elderly with Disabilities
What is the Elderly and Disabled Waiver
The Elderly and Disabled Waiver, formerly called the Community Care Service Program (CCSP), provides services typically not covered by Medicaid for adults with physical or intellectual disabilities.
What Services Does the Elderly and Disabled Waiver Cover?
The Elderly and Disabled waiver covers a wide range of services for those who are eligible to receive them. These services include personal care, like assistance with daily living, home-delivered meals, adult day health programs, and respite services to give family members a break.
Am I Eligible for the Elderly and Disabled Waiver?
To be eligible for services through the Elderly and Disabled waiver, you must be a Georgia resident, and you must have Medicaid. To meet the age requirements, you must be 65+ or under 65 with specific disability requirements. Additionally, you must choose to receive services in the home or community rather than a nursing facility.
What is the Independent Care Waiver?
The Independent Care Waiver (ICWP) assists adults aged 21-64 with severe physical disabilities or traumatic brain injuries. These individuals typically require nursing home or hospital-level care but can remain at home with the right supports.
The goal of the ICWP is to help the individual live independently in the least restrictive setting and receive safety and care at home rather than a facility.
What Services Does the Independent Care Waiver Cover?
Personal care supports, home health services, durable medical equipment, specialized medical supplies, counseling, emergency response systems, and home modifications are all covered under the ICWP.
Am I Eligible for the Independent Care Waiver?
To meet the criteria for an ICWP, the individual must be capable of managing their own services. Moreover, you must be medically stable but at risk of placement in a hospital or nursing facility. Additionally, you must be safely placed in a home or community setting.
What is the NOW/COMP Waiver?
The NOW/COMP waiver is for individuals with intellectual and developmental disabilities. It offers home and community-based services for independent living. It’s the most targeted program for this population and provides a broad range of services. This waiver tracks across the life cycle. Ideally, it starts when the individual exits the school system. While on the planning list, Family Support Services can serve as a safety net.
Am I Eligible for the NOW/COMP Waiver?
To be considered for the NOW/COMP Waiver, various criteria need to be met first. The person must be diagnosed with an intellectual or developmental disability documented via psychological evaluation. The disability must be established before the individual reaches the age of 22. Adaptive function scores, especially if IQ is above the intellectual disability threshold, are considered.
When Should I Apply for the NOW/COMP Waiver?
The answer is as early as possible, but not earlier than the age of 3, around the time you apply for Family Support Services. Getting on the planning list early helps to ensure access to family support services. Applying for the NOW/COMP waiver early gives you peace of mind and helps you prepare your child for long-term needs and unexpected catastrophic events. Remember, documentation, like psychological evaluations, should be submitted as soon as possible. Determination of waiver award is based on who is most in need.
Once awarded a waiver, services are based on individual needs. Usually, the first services include Support Coordination Services, where your main point of contact is a Planning List Administrator, through the Department of Behavioral Health and Developmental Disabilities (DBHDD). The Planning List Administrator walks you through all of the steps necessary to then develop an ISP and receive services.
What Services Does the NOW/COMP Waiver Cover?
The NOW/COMP waiver covers a variety of targeted support to secure independence for the individual with disability and support for their caregivers.
Community Access Group covers group activities, day programs, or recreational services. For example, summer camps can be funded here. Community Access Individual is a one-on-one support for community outings, appointments, or social events. Pre-Vocational Support helps develop employment readiness skills, often through day programs. Community Living Support covers home-based services like laundry, meal prep, bathing, and dressing. Community Residential Alternative secures supports outside the individual’s home, e.g., group homes or host homes. Respite covers temporary care for short-term relief, and it can be billed for 24-hour cycles. Behavioral Support covers behavior intervention plans and also includes social skills and independent living skills development. Supported/Customized Employment begins with the Vocational Rehabilitation Agency (GVRA) and transitions to DBHDD funding for job maintenance.
How to Apply for NOW/COMP Waiver.
The application for the NOW/COMP waiver could be submitted online through the DBHDD portal. Before you submit your application, make sure you review the How to Apply for a NOW/COMP Waiver—Simplified Checklist we created. Make certain you have all the required documentation before you apply. This includes up-to-date psychological evaluation, Individualized Education Plan (IEP), birth certificate, Georgia ID, Social Security, and guardianship documentation if applicable. It’s essential to note that Medicaid waiver recipients are required to have Medicaid, but you can be placed on the planning list even if you don’t have Medicaid yet. For example, minors who don’t have Medicaid through SSI or the Deeming Waiver can still be on the planning list. The NOW/COMP application typically takes 20 minutes to complete if all required documents are ready.
What Happens After I Submit My NOW/COMP Waiver Application?
After submission, a DBHDD social worker may conduct a short virtual meeting to confirm eligibility. Once approved, you will receive a letter stating you are predetermined eligible and placed on the planning list. The planning list navigator reviews your case at least annually to determine who is most in need.
What to Do When I am already on the NOW/COMP Planning List?
- Build a relationship with the planning list navigator.
- Demonstrate utilization of available resources, like Family Support Services and Voc Rehab.
- Document significant risks or changes in care to move higher on the “most in need” list.
How Would I Know I Was Approved for the NOW/COMP Waiver?
The planning list navigator informs you when the waiver is awarded. The planning list administrator ensures completion of all requirements, which include:
- DMA-6 physician sign-off
- Selection of a fiscal agent
- Selection of the support coordinating agency
- Completion of assessments: Supports Intensity Scale, Health Risk Screening Tool, Behavioral Assessment
- Self-direction training for managing your own services
- Individual Support Plan (ISP): ISP includes prior authorization and budget. Services under the ISP are specific to the individual needs and reviewed annually. If you are self-directing, you must track goals and progress, while agencies manage tracking for agency-directed participants. ISPs are renewed yearly, but you don’t have to reapply for the waiver every year.
Summary
Medicaid waivers provide home and community-based services as an alternative to institutional care, with different waivers tracking the life cycle of individuals: GAPP serves children, Elderly and Disabled, and Independent Care addresses adults with physical or age-related needs, and NOW/COMP focuses on adults with intellectual and developmental disabilities (I/DD). Eligibility often requires proper documentation, including psychological evaluations and proof that the disability was established before age 22 for NOW/COMP. Early planning is critical to securing services and creating safety nets, as services are individualized, flexible, and can evolve over time based on the person’s needs. Advocacy and effective communication with DBHDD staff are essential for navigating waiting lists and ensuring priority placement. Practically, families should apply for NOW/COMP as soon as eligibility criteria are met, keep documentation up to date, maintain relationships with their planning list navigator, utilize all available resources to demonstrate need, and carefully consider self-direction, which allows for more choice but also comes with responsibility for managing staff.
If you have more questions, schedule a free consultation with one of our benefits navigators for personalized advice.
