For 4 years, Texas government has had a committee working on redesigning the services for Texans with IDD… while proceeding down the path to Medicaid managed care. (Read the document creating the IDD-SRACommittee and setting their priorities.)
Prior to 2015, Medicaid acute care and Long-Term care services (Waivers & ICFs) were managed by Texas HHSC, a government agency.
When managed care rolled in, Medicaid recipients switched from “traditional Medicaid” to Managed Care Medicaid – under the groupings called STAR, STARHealth, STARKids, STAR+Plus. Recipients had to choose between 3 MCOs (managed care organizations) and go to doctors and pharmacies based on contracts with their MCO.
And 2 long-term care Waivers were included in the move to Managed Care – MDCP & CBA (which became STAR+Plus Waiver).
The Redesign Committee
In January 2021, I sent a COVID-19 rule question to HHSC and I was told to submit my question the SARC. I did, and I was added to the agenda of the next meeting… which was online and 6 hours long.
I listened in while I worked, and became more and more intrigued. Subcommittees were making reports on how services in current Waivers were working and recommendations on how they should change in the future.
- The topic of changing “Day Programs”/“Day Hab” to “Meaningful Day Activities” was full of optimism and hope for better options.
- But the topic of dental comparing utilization in CLASS, HCS, and StarPlus’s limited $500 value-added service was inaccurate in the subcommittee’s knowledge of factors effecting utilization in the waivers.
The coolest part was that even as an observer, I was able to email in comments in real time and have my comments read to the committee.
Call to Action
We need to be listening and offering feedback as the Intellectual & Developmental Disability System Redesign Advisory Committee redesigns the services that shape our lives.
- Start by going to the IDD SARC page.
- Read the Implementation of Acute Care Services and Long-term Services and Supports System Redesign for Individuals with an Intellectual or Developmental Disability – 2020
- Go to the Meeting section and put a Webcast for a subcommittee on your calendar. Make notes and comment.
- Add a Reminder in your Task app to check the IDD SARC page at regular intervals.
I can’t believe I am just learning about the Social Security SSI Threshold for Medicaid benefits!
For the past 16 years, my understanding was that to get Medicaid through SSI, you needed to qualify for a monthly SSI payment.
That is NOT true, and here’s the proof on the Social Security website.
One of the biggest concerns SSI beneficiaries have about going to work is the possibility of losing Medicaid coverage. Section 1619(b) of the Social Security Act provides some protection for these beneficiaries.
To qualify for continuing Medicaid coverage, a person must:
- Have been eligible for an SSI cash payment for at least 1 month;
- Still meet the disability requirement; and
- Still meet all other non-disability SSI requirements; and
- Need Medicaid benefits to continue to wminork; and
- Have gross earnings that are insufficient to replace SSI, Medicaid and publicly funded attendant care services.
This means that SSI beneficiaries who have earnings too high for a SSI cash payment may be eligible for Medicaid if they meet the above requirements. SSA uses a threshold amount to measure whether a person’s earnings are high enough to replace his/her SSI and Medicaid benefits.
This threshold is based on the:
- amount of earnings which would cause SSI cash payments to stop in the person’s State; and
- average Medicaid expenses in that State.
If a SSI beneficiary has gross earnings higher than the threshold amount for his/her State, SSA can figure an individual threshold amount if that person has:
2017 1619(b) THRESHOLD AMOUNTS FOR DISABLED SSI BENEFICIARIES
In layman’s terms, this means that even if you earn too much money to receive an SSI payment, you can continue to get Medicaid while earning up to $34,821 (or more if you ask for an individual threshold of more than $34,821).
YOUNG ADULTS WITH INTELLECTUAL DISABILITIES are deserving of high quality programming that is client-centered enabling them to become valued, respected, contributing members of society. With this simple goal in mind, The Summerhouse team has built a creative, powerful program.
Their staff creates an environment that fosters opportunities for all of our members to bloom continuously through a customized approach. The programming is designed to meet members where they are, with their abilities and goals in mind. They focus on developing skills that will contribute to a more engaged, active life.
Three key areas of focus are:
Develop skills that would allow members to fulfill their employment potential.
Develop skills to engage and connect with peers and the broader community.
Refine skills that allow members to maintain a high quality of life and independence on a daily basis.
I just learned about a program called Lifespan Respite.
This is a program that provides respite care for people who do not qualify for publically funded respite care from any other source. It serves persons of any age and any disability, as well as caregivers for the elderly.
Lifespan Respite provides a voucher for 80 hours of respite to be used within 60 days.
To get the voucher:
- Contact Care Connections Aging & Disability Resource Center to request Lifespan Respite 1-877-393-1090. A Resource Specialist will prescreen you and invite you to orientation on a specific date.
- Go to orientation at Care Connections Aging & Disability Resource Center 4802 Lockwood Drive
Houston? Texas? 77026. Orientation is from 9am-3pm. (Bring along the proof of disability for the person you need respite from caregiving.)
- Fill out the application for the voucher from Easterseals. (To request this application in advance, email Julia Serrano.
Established in 1997, the Challenged Athletes Foundation recognizes the athletic greatness inherent in all people with physical challenges and supports their athletic endeavors by providing unparalleled sports opportunities that lead to success in sports — and in life.
desperate for Respite provides support to caregivers caring for special needs children, dependent adults and their families in the northwest Houston area. Their services concentrates on raising the awareness of caring for caregivers, educating the community and developing relationships for supporting their families.
They are a non-profit charitable corporation organized exclusively for charitable and community development purposes.
They partner with businesses, ministries and organizations within your community. Your partnership with us aids in gathering resources for caregivers and their families while educating and promoting awareness about the importance and benefits of Respite care.
dfR also serves the community at large by focusing on Community Education, Intellectual Disabilities and individuals needing Special Attention.
They achieve the goal of educating the local community about Respite care through various avenues such as partnering with churches and their members, area businesses and organizations. This education also focuses on the benefits of utilizing community Respite programs.
We serve individuals with Autism, Blindness, Deafness, Cerebral Palsy, Downs Syndrome, Medically fragile, Tourette’s Syndrome, ADHD and more. We work alongside national and local advocacy/support groups and health & human service professionals in order to provide caregivers and their families with the necessary support and networking opportunities needed to maintain a healthy family environment.
The H.E.A.R.T. Program was created by Educational Programs Inspiring Communities, Inc.
The program provides Occupational Skills Training to low-income developmentally disabled adults residing within the city limits of Houston, Texas.
The purpose of the H.E.A.R.T. program is to prepare the
participants for gainful employment through an innovative client-managed entrepreneurial venture.
Stage 1 prepares the participants for employment by providing individualized assessments and job readiness training.
Stage 2 allows the participants to work both within the general community and in a sheltered workshop as appropriate, through the client managed entrepreneurial venture, H.E.A.R.T. Vending and Concessions.
If you or a family member are interested in applying for this unique program, please use Online Application.