Print out the entire Chapter 11 from here.Please Note:
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Printed on: 02/24/2024
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This document is only current up to the day it was printed.
Printed on: 02/24/2024
Please always refer to the online version for the most current up-to-date information.
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Chapter 11: The Medi-Cal Developmental Disability Waiver
(11.1) What is the DD Waiver?
The DD Waiver is the short name for the Medi‑Cal Home- and Community-Based Services Developmental Disability Waiver. The DD Waiver can pay for many home- and community-based services like:
- Supported living services so you can live in your own home,
- Supported employment services so you can work, and
- Respite service for family members and other caregivers.
If your Individual Program Plan (IPP) lists services like these, they may be paid for through the DD Waiver. See Question 25 for a list of other DD Waiver services.
There are other waivers, but the DD Waiver is the most important waiver for people with developmental disabilities. It is called a “waiver” because it lets the state waive some federal rules that Medi-Cal uses. For example, the waiver “waives” income and resource rules. This means you could get Medi-Cal if you are a child and your parents have too much money. See Questions 9 and 10.
(11.2) How does the DD Waiver help people live in the community?
The federal government usually pays states back for part of the cost when people with disabilities live in institutions. They approved Home- and Community-Based Services (HCBS) waivers to allow people to get Medi-Cal to pay for community services instead of institutional care.
The federal rules allow Medi-Cal waivers because people with disabilities are better off when they live at home and the community, instead of an institution. The waivers help keep people with disabilities out of institutions. Waivers recognize that many people at risk of being placed in medical facilities can be cared for in their homes and communities. This keeps their independence and ties to family and friends at a cost no higher than institutional care. The DD Waiver is the largest HCBS waiver in California and the nation.[[Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD) (ca.gov)]]
(11.3) Where can I find detailed information about the DD Waiver?
- Ask to see your regional center’s copy of the DD Waiver.
- Visit Home and Community-Based Services Programs - CA Department of Developmental Services.
(11.4) Does Medi-Cal pay for my regional center services?
If you are eligible, Medi-Cal may pay for some of your regional center services. Medi-Cal is a public program that provides health care services to Californians who are low-income or have disabilities.[[See Disability Rights California publication for basic information on Medicaid/Medi-Cal: https://www.disabilityrightsca.org/publications/fact-sheet-what-is-medicaid-medi-cal]]
Unlike Medicare and most private health insurance plans, Medi-Cal covers:
- Long-term care in institutions, and
- Community alternatives to institutions, like In-Home Supportive Services (IHSS) and services mentioned in Question 25.
Even if you are eligible for Medi‑Cal, it may not cover all of the regional center services you need. If you need a service not covered by Medi-Cal, you still have the right to get that service if it is in your IPP.
It is beneficial for the state to have people on the DD Waiver so Medi-Cal can cover some of the services. You should not notice a difference in your services whether Medi-Cal is covering them or not. But, the state will get matching federal money if you are on the DD Waiver. It is good for Californians when the state gets more federal money. It can also be beneficial for you. See Question 9 for details.
Important! Your IPP should list all services you need, not just services Medi‑Cal will pay for. Even if the DD Waiver does not cover the services you need, you still have the right to get the services listed in your IPP.
(11.5) Am I eligible for DD Waiver services?
You are eligible for DD Waiver services if you:
- Meet California’s definition of developmental disability and are a regional center consumer,[[Welf. & Inst. Code § 4512; DD Waiver, January 1, 2018, Appendix B: Participant Access and Eligibility. See Chapter 2 on regional center eligibility. You must be a regional center consumer to get DD Waiver services. If you applied for regional center services in the past and were denied, but did not appeal, you may be able to reapply for regional center services. If you qualify for regional center services, you could also get DD Waiver services.]]
- Either get Medi-Cal already or would be eligible for Medi-Cal if your spouse’s or parents’ income or resources were not counted, and
- Qualify for care in a Medi-Cal-funded intermediate care facility (ICF)[[The state regulations that apply to ICFs are: Cal. Code Reg. Title 22 section 51164 - 51165.2.]] for people with developmental disabilities.
NOTE: If you are under age 21 and your parents claim you as a dependent, you are considered a child for Medi-Cal eligibility. See Question 11.
NOTE: You do not have to be in an intermediate care facility (ICF) to be eligible for the DD Waiver. You just have to need the care that would qualify you for services in an ICF. See Chapter 7 for ICF information.
(11.6) Do all regional center consumers qualify for DD Waiver services?
No. Some regional center consumers do not qualify for DD Waiver services because:
- Their needs do not match those needed to qualify for an ICF.[[It is possible that people who need a higher level of care than that provided at an ICF could qualify for DD Waiver services.]]
- Their income is too high to qualify for Medi-Cal.
Remember: Even if you are not eligible for DD Waiver services, you can still get the services listed in your IPP. See Chapter 4.
(11.7) If I am eligible and apply for the DD Waiver, am I guaranteed to get the waiver?
Usually. You may be eligible for Medi-Cal waiver services if a waiver slot is available.[[Lewis v. New Mexico Dept. of Health 275 F. Supp. 2d 1319, 1345 (D. N.M. 2003) (“Once the State sets up its waiver program, it is obligated to implement the waiver program as it has fashioned them”); Makin v. Hawaii 114 F.Supp.2d 1017 (1999).]] There are many slots[[Lanterman Act services are an entitlement. So, if you want to live in the community, the regional center should help, even if a waiver slot is not available.]], and more are added each year. For example, there are 145,000 DD Waiver slots for 2021. There will be 150,000 slots for 2022.[[CMS Waiver approval, PDF page 1 of 297 at: HCBS Waiver Application]] This is enough for everyone, so far.
(11.8) How do I apply for the DD Waiver?
You may not need to apply. The regional center usually identifies people eligible for the DD Waiver. The regional center does this because the federal government will pay for half of your DD Waiver services. This frees up money for the state.
But, if your regional center does not identify you for the DD Waiver, you may apply on your own. Make sure there is a service covered under the DD waiver in your IPP. Examples of waiver services are respite or a medical alert bracelet. See Question 25 for more waiver services.
Send a letter to your regional center asking to be identified as eligible for the DD Waiver for the services you need. And, make sure the DD Waiver services you need are included in your IPP. See Chapter 4. The regional center will send you a letter to let you know if you are eligible for DD Waiver services.
(11.9) Is it a good idea to get DD Waiver services if I am eligible?
Yes. If you qualify for DD Waiver services, you will benefit in these ways:
DD Waiver services cannot be limited. Regional centers cannot limit the waiver services they offer. This is because Medi-Cal services available in one part of the state must be available in every part of the state. This is called the “statewideness” requirement.[[42 U.S.C. § 1396a(a)(1) (statewideness requirement).]] So, regional centers must all offer the same DD Waiver services to consumers.
Regional centers cannot use Purchase of Service (POS) guidelines to limit the amount or kind of services you get under the DD waiver. Each regional center has POS guidelines, but the guidelines cannot control the services you get. You have the right to get the services and supports that you need and that are listed in your Individual Program Plan (IPP). Your IPP, not POS guidelines, controls the services you can get under both the DD Waiver and the Lanterman Act.[[Williams v. Macomber 226 Cal.App.3d 225, 233 (1990).]]
Consumers who get DD Waiver services get their IPP reviewed every year. Under the Lanterman Act, you have the right to a new IPP every three years, or whenever you ask for one. But with the DD Waiver, it is every year.[[See page 22 of the DD Waiver Primer and Policy Manual at: https://www.dds.ca.gov/wp-content/uploads/2019/02/HCBS_WaiverPrimerPolicy_20190212.pdf]] See Chapter 4 about IPPs. Remember to list all the services you need in your IPP.
Children who get Medi-Cal under the DD Waiver have extra protections.
If a child no longer qualifies for DD Waiver services, Medi-Cal must do a “redetermination” to see if they are eligible for Medi-Cal under a different program before Medi-Cal terminates them.[[Welf. & Inst. Code § 14005.37(d).]]
Children are also protected by Medi-Cal’s “Continuing Eligibility for Children” rules. This means Medi-Cal coverage must continue with no cost for up to 12 months after a child is found to be no longer eligible for any coverage under Medi-Cal.[[Welf. & Inst. Code § 14005.25; DHCS ACWDL No. 14-05.]]
Consumers eligible for DD Waiver services get an extra vehicle exemption. Medi-Cal usually allows you to not count one of your vehicles as a resource. Under the DD Waiver, you get an extra vehicle exemption. Medi-Cal allows a second vehicle to not count, if it is modified to accommodate your physical or medical needs.[[ACWDL No. 01-67]]
(11.10) Is it better for some people not to be on the DD Waiver?
Yes. If you are a regional center consumer involved in a lawsuit because of an injury, you may not want to on the DD Waiver.
Any Medi-Cal services you get for your injury and recovery may be subtracted from the money you win from your lawsuit.[[California agrees with Disability Right California’s opinion that the costs of Early Intervention services (Individuals with Disabilities Education Act Part C) are not recoverable.]] Coverage under the DD Waiver may reduce the amount of money you get from your lawsuit. Talk to your lawyer and your regional center service coordinator.
(11.11) Would parents’ income and resources normally count against their child’s Medi-Cal eligibility?
Yes. For regular Medi-Cal eligibility (not DD Waiver), a child is usually in their parents’ household. Medi-Cal calls a household a “Medi-Cal Family Budget Unit” or MFBU. When a child is in the household (MFBU) with the parents, the parents’ income and resources are counted for the child’s Medi-Cal eligibility.
NOTE: You are a “child” for Medi-Cal if you are under 18 years old, or if both of these are true:
- You are 18 years or older, but under 21, and
- Your parent claims you as a dependent to get a tax credit or deduction for state or federal income tax purposes.[[22 CCR § 50060 and § 50351(c)]]
You can apply for the DD Waiver through institutional deeming if you are under 21 and your parents claim you as a dependent.[[ACWDL 00-59]] This means you are a child for Medi-Cal. Your parents will need to supply their income and resource information for the application. See Question 12.
(11.12) What if my family’s income is too high to qualify for Medi Cal?
You may still get Medi-Cal under the DD Waiver. The main purpose of the DD Waiver is to help keep you out of an institution and in the community. So, even if your family income is too high, you may be eligible for Medi‑Cal because they will not count your parents’ or spouse’s income or resources.
Medi-Cal is allowed to determine your eligibility using “institutional deeming.” This means Medi‑Cal will evaluate you for eligibility as if you lived in an institution, and not with your parents or spouse. This means you are not in your parents’ or spouse’s MFBU (See Question 11). This is because Medi-Cal only counts your own income and resources (which are often low or none), when you live in an institution.
Medi-Cal is allowed to use institutional deeming to determine your Medi-Cal eligibility, because people on the DD Waiver are already qualified to get services in an ICF/DD (intermediate care facility).
This is how the process works:
- The regional center determines that you qualify for DD Waiver services, but you are not eligible for Medi-Cal because of your parents’ or spouse’s income or resources.
- The regional center contacts the county waiver contact person asking if you are eligible for Medi-Cal without counting your parents’ or spouse’s income.[[The procedures are explained in Department of Health Care Services All County Welfare Directors Letters (ACWDLs) Nos. 00-08, 00-59, 01-24. ]]
- The county waiver contact person uses institutional deeming to look at your application, and will decide if you are eligible for no-cost or share-of-cost Medi‑Cal. See Question 13 and 14 for when you might have Medi-Cal with a share of cost.
- If you are eligible, you will qualify for Medi‑Cal under a special code.
- Your Medi-Cal will be “full-scope,” which means you can see doctors, go to the hospital, and have other Medi-Cal services. The regional center can pay for some of your regional center services using Medi-Cal.
(11.13) Can my child still get Medi-Cal if she gets child support?
Maybe. With institutional deeming, Medi-Cal can evaluate your child’s eligibility without counting your income.
Medi-Cal will count the child support as the child’s own income. But, because your child has a disability, they may only count 2/3 of the support as countable income.[[Your child can have no-share-of-cost Medi-Cal if child support is not more than $920 a month. If child support is more than that, you may want to ask your family lawyer about structuring the child support as alimony instead. This is because alimony is parents’ income (excluded for DD Waiver), whereas child support is the child’s income (counted and may cause a share of cost).]] The Medi-Cal share of cost will be based on the child’s countable income over $600 per month.
(11.14) Can my child still get Medi-Cal if she gets Social Security Survivor’s Benefits?
Maybe. With institutional deeming, Medi-Cal can evaluate your child’s eligibility without counting your income.
Medi-Cal will count the Social Security Survivor’s Benefits as the child’s own income. The Medi-Cal share of cost will be based on the child’s countable income over $600 per month.
(11.15) What are In-Home Supportive Services?
In-Home Supportive Services (IHSS) is a Medi-Cal benefit. IHSS is available if have a disability and need special care to stay safe at home. IHSS pays a provider to give you in-home, non-medical care.
For information about IHSS, please see Disability Rights California’s publications on IHSS here: https://www.disabilityrightsca.org/resources/in-home-supportive-services-ihss
(11.16) Are there other Home- and Community-Based Services (HCBS) Waivers?
Yes. The DD Waiver is the common waiver for regional center consumers. But there are other waivers in California. For example, some regional center consumers are on the Home- and Community-Based Alternatives (HCB Alternatives) Waiver. You may qualify for services under the HCB Alternatives Waiver or the DD Waiver. But, you can only be under one home and community-based services waiver at a time. For more information, see Disability Rights California’s publication here: https://www.disabilityrightsca.org/publications/the-home-and-community-based-alternatives-hcb-alternatives-waiver
State law says that the regional center must use generic resources, such as Medi-Cal, to implement your IPP. The regional center may put you on the DD Waiver or the HCB Alternatives Waiver to have you access generic resources.[[Welf. & Inst. Code § 4648(a)(8).]]
(11.17) Would I know if the regional center put me on the DD Waiver?
Yes. You have to sign a choice form. There is a federal rule that says you must make an informed choice about getting services in the community instead of an institution. The signed form becomes part of your regional center file. Even though you sign this form and go onto the DD Waiver, all your services should be the same. You should see no change to your IPP or how you get your services.
(11.18) The regional center wants to put me on the DD Waiver, but I already have Medi-Cal. Do I have to agree?
No. Being on the DD Waiver is not required. But, there are benefits to going on the DD Waiver, such as the state getting more federal money to pay for services. See question 9 for more benefits to being on the DD Waiver. If you have questions or concerns, you should talk with your service coordinator. You can also ask to talk with the person at the regional center who handles the DD Waiver. They are sometimes called the Federal Revenues Coordinator. They can answer your questions or concerns about the DD Waiver.
(11.19) Will being on the DD Waiver affect my immigration status?
You should consult with an immigration attorney if you have any concerns about public benefits like Medi-Cal and the DD Waiver affecting your immigration status.
(11.20) Will I lose my eligibility for DD Waiver services if I am not getting DD Waiver services now?
You do not have to get DD Waiver services all the time to continue to be eligible. For example, you may have qualified for DD Waiver services, but do not need them every month. You would still be eligible.
But to stay eligible, you must get at least one DD Waiver service once a year. Even if you only use one DD Waiver service (like respite or a medical alert bracelet), you would still be eligible.
If you are on the DD Waiver, your IPP must be reviewed each year. Your IPP must list all services (including DD Waiver services) you get.
Important! If you get the DD Waiver through institutional deeming, your eligibility for the DD Waiver could end if you get no waiver services for a year and your next IPP lists no waiver services. Medi-Cal will send you a Notice of Action. If you disagree, you can appeal.
(11.21) What do I do if the regional center refuses to give me a service available under a waiver?
If you are getting DD Waiver services and the regional center decides that you are no longer eligible for a DD Waiver service, you have the right to appeal. If you think you meet the criteria for a service under the DD Waiver, remember to write that on your fair hearing request form. For example, you can write: “I also want my right to this service to be determined under the DD Waiver – federal Medicaid rules.”
An appeal about a DD Waiver service is similar to an appeal under the Lanterman Act. You may have claims under both the Lanterman Act and the DD Waiver. If this happens, you will have a hearing. An Administrative Law Judge (called ALJ for short) will consider your claims under the Lanterman Act first. If the ALJ agrees with you on your Lanterman Act claims, the appeal stops there, and you will get the services or supports you asked for. [[If the regional center is found responsible for providing the service under the Lanterman Act, the regional center would have the authority to conclude that the service is also coverable under the DD Waiver.]]
If the ALJ does not agree with you on the Lanterman Act claims, the ALJ should consider your DD Waiver and Medi-Cal claims separately.
To learn more about appeals, see Chapter 10.
(11.22) Are DD Waiver hearings and Medi Cal hearings the same?
They are similar, but not the same. DD Waiver hearings and regular Medi-Cal hearings both use an Administrative Law Judge (called ALJ for short) to decide your case.
The ALJ for DD Waiver hearings works for the Office of Administrative Hearings (OAH). The ALJ for Medi-Cal hearings works for the State Hearing Division of the Department of Social Services.
You typically go to the regional center for DD Waiver hearings. You go to a state or county building for Medi-Cal hearings.
(11.23) Are DD Waiver hearings and Lanterman Act hearings the same?
They are the same in most ways. But if an appeal under the Lanterman Act also includes DD Waiver claims, federal law adds these two requirements:((42 C.F.R. §§ 431.200-.250. This means that you agree in writing to extend the deadlines.))
(1) The judge must give a decision within 90 days of the postmark date on your request for a hearing, or the date they got your hearing request. If you agree, the judge can take more time.((42 C.F.R. § 431.244(f).))
(2) The Director of the Department of Health Care Services (DHCS), or someone the Director appoints, has a right to make the final decision. The ALJ will propose a decision about your DD Waiver claims to the Director. The Director (or someone the Director appoints) can:
- Accept the ALJ’s decision,
- Make a different decision (called “alternated” decision),((42 C.F.R. § 431.200-431.10(e). Welf. & Inst. Code § 4712.5(c).)) or
- Let the ALJs make final decisions in certain kinds of cases.((Welf. & Inst. Code § 4712.7. This is the same procedure followed in Medi-Cal hearings by the State Hearings Division of the Department of Social Services. See https://www.cdss.ca.gov/inforesources/state-hearings.))
The current DD Waiver says the Director of the Department of Health Care Services has given the authority to the Director of the Office of Administrative Hearings (OAH).((DD Waiver, January 1, 2018, Page 235 of 295)) The Director of DHCS appointed the Director of OAH. So, under the DD Waiver, DHCS does not adopt or alternate decisions, but the Director of OAH can.
(11.24) What if the regional center says I am not eligible for the DD Waiver?
You can appeal. The regional center must prove you don’t qualify for ICF services. Or, you may already be on the DD Waiver and the regional center says you no longer qualify. There, the regional center must prove your health has improved to where you no longer qualify for ICF services. See Chapter 10 to learn more about appeals.
(11.25) What services does the DD Waiver cover?
The DD Waiver covers many services, including:[[DD Waiver, January 1, 2018, Appendix C, pages 60-206. Note that some waiver services are only available to recipients age 21 and older. This is because the Medi-Cal State Plan (non-waiver Medi-Cal) covers these services under the EPSDT benefits for people under age 21.]]
- Case Management: Case management is provided through the Targeted Case Management benefit contained in California’s Medicaid State Plan.[[DD Waiver, January 1, 2018, Section C-1, page 196]]
- Homemaker: Meal preparation and routine household care, when the person regularly responsible is temporarily absent or unable to manage the home and care for themselves or others in the home.
- Home Health Aide Services: Through a home health agency.
- Respite Care: Temporary non-medical care and supervision provided in or out of the home. Care for a consumer’s basic daily needs while their family is away for a short time, and to relieve family members from the constant care demands.
- Habilitation: Services to help people gain, retain, and improve the self-help, socialization, and adaptive skills needed to live in home- and community-based settings. Habilitation Services Include:
- Behavioral Intervention Services: Includes intensive behavioral intervention programs, behavior tracking, and analysis. Provided in many settings like the consumer’s home or workplace. Also includes Crisis Support.
- Community Living Arrangement Services:
- Licensed or Certified Settings, like group homes, including Enhanced Behavioral Supports Homes
- Supported Living Services, which are social, adaptive skills, financial, and other supports for a consumer to live in a home they own or lease and which is not licensed.
- Day Services
- Community-Based Day Services: Habilitation for 4 or more hours per day, 1 or more days per week, in a non-residential setting.
- Activity-Based/Therapeutic Day Services: Habilitation through physical and therapeutic activities designed to help with problematic behavior, express needs and feelings, enhance motor and communication development, increase socialization and community awareness, and provide experiences.
- Mobility-Related Day Services: Teaching to use public transit or other transportation.
- Pre-Vocational Services: Developing and teaching general skills that lead to competitive and integrated employment.
- Supported Employment Services: Paid work that is integrated in the community. Includes 1:1 job coaching and other supported employment services that decrease until no longer needed, provided on or off the jobsite.
- Dental Services: From licensed dentists and dental hygienists.
- Occupational Therapy
- Physical Therapy
- Optometry/Optician Services
- Prescription lenses and frames
- Psychology Services: Assessment, treatment, prevention, and improving emotional and mental health disorders.
- Speech, Hearing, and Language Services: Speech pathology, audiology services, and hearing aids.
- Financial Management Services (FMS): Paying for goods and services or handling payroll for adult consumers’ or their families’ workers included in the IPP. FMS are available only for these self-directed services: respite, transportation, community-based training service and skilled nursing.
- Chore Services: Services needed to maintain a clean, sanitary, and safe home. Includes heavy household chores and minor repairs like those done by a handyman.
- Communication Aides: Human services needed to help people with a hearing, speech, or vision impairment to effectively communicate with service providers, family, friends, co-workers, and the general public. Includes facilitators, interpreters, and translators, depending on the IPP.
- Community-Based Training Service: A participant-directed service that allows recipients to customize day services to meet their needs. As determined by the person-centered IPP process, the service may include help to:
- Develop or keep employment and volunteer activities,
- Pursue post-secondary education, and
- Increase abilities to lead an integrated and inclusive life.
- Environmental Accessibility Adaptations: Physical adaptations to the home. Ex. Ramps, grab-bars, widening of doorways, bathroom modifications, and installation of electric and plumbing systems needed for medical equipment and supplies. Adaptations which add to the total square footage of the home are excluded from this benefit. Adaptations may be provided up to 180 days before discharge from an institution.
- Family Support Services: Regularly provided care and supervision of children, for periods of less than 24 hours per day, while the parent/primary non-paid caregiver is out of the home. Provided in or out of home.
- Family/Consumer Training: Training by licensed providers to get a better result from treatment. Includes support or counseling for the consumer and family to make sure they understand treatments provided and supports needed in the home to enhance treatments.
- Housing Access Services: Includes two parts:
- Individual Housing Transition Services - Includes finding out what housing the consumer wants, developing a plan, searching and applying for housing, identifying how to pay for moving costs, teaching how to deal with landlord, and planning for if/when housing is in jeopardy.
- Individual Housing & Tenancy Sustaining Services - Services to keep housing once it is secured. Teaching on preventing problems, responsibilities, resolving disputes, and household management.
- Non-Medical Transportation: Service offered to help people gain access to waiver and other community services, activities and resources, specified by the IPP. Private, specialized transportation will be provided to people who cannot safely access and use public transportation. People can also get medical transportation under federal law and the State Plan.
- Nutritional Consultation: Planning to meet nutritional and special dietary needs.
- Personal Emergency Response Systems (PERS): Examples: pagers, medical alert bracelets, life-lines, and fire extinguishers.
- Skilled Nursing: Services from a licensed nurse.
- Specialized Medical Equipment and Supplies: Devices, controls, or appliances which help people increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment. Also includes items needed for life support or to address physical conditions along with equipment needed for the proper functioning of those items, other durable and non-durable medical equipment, and necessary medical supplies.
- Transition/Set-Up Expenses: One-time, non-recurring set-up expenses for health and safety needs when transitioning from an institution to your own home. Includes security deposits, moving expenses, one-time cleaning before moving in, furniture, household items, recreational wishes like TV and cable, and room and board payments. Items purchased are the property of the person receiving the service; they take the property with them if they move. Can get expenses up to 180 days before discharge from an institution.
- Vehicle Modifications and Adaptations: Door handle replacements, door widening, lifting devices, wheelchair securing devices, adapted seat devices, adapted steering, acceleration, signaling, and braking devices, and handrails and grab bars.The repair, maintenance, installation, and training in the care and use, of these items are included. Does not include purchase of the vehicle itself. Vehicle must be owned by recipient or family member (defined broadly).
- New Waiver Services:
- Effective April 1, 2020, a Waiver amendment added State-operated Community Crisis Homes, Enhanced Behavioral Supports Homes, and Mobile Crisis Teams as new waiver services. See Chapter 8 for more about these services.
- Effective January 19, 2021, a Waiver amendment added Intensive Transition Services (ITS) as a new service. ITS are for people who have complex behavioral health needs and have transitioned into a community living option. Staff are available 24 hours a day including weekends, holidays, and times of crisis. ITS includes anger management, health and dietary education, sex education/fostering healthy relationships, behavior training and management, therapy, co-occurring disorders integrated treatment, and transition planning.
(11.26) If I want to enroll in PACE, can I still be a regional center client and be on the DD Waiver?
You can be in PACE and still be a regional center client. You cannot be in PACE and on the DD Waiver at the same time.
Programs of All-Inclusive Care for the Elderly (PACE) provide medical and social services for people age 55 and older who qualify for nursing home care but can live at home with support. PACE is operated throughout California by local PACE organizations. Regional center clients can join a PACE plan without losing regional center eligibility. Even though you can keep your regional center eligibility if you enroll in PACE, you must get all your Medicare and Medi-Cal benefits solely through PACE. This means that if your regional center was giving you any services that are available through Medicare or Medi-Cal, you will have to get them from your PACE plan after you enroll. Your regional center service coordinator must work with your local PACE plan to make sure there is no overlap in the services they each provide you. Your regional center and your PACE plan should work together to create a written agreement that says who is responsible for providing each of your services.
If you are on a Medi-Cal waiver, such as the Home and Community-Based Services Waiver for the Developmentally Disabled (the DD Waiver), you will have to disenroll from the waiver before joining PACE. If you are on the DD Waiver and decide you want to disenroll from the waiver so you can join PACE, you can still get services from the regional center that PACE does not provide, but the funding source for your services will change.
Whether to join PACE is an individual decision. While some services PACE and regional centers provide are similar, there are areas where the two service systems differ. The regional centers offer expertise, providers, and services tailored for people with developmental disabilities. The PACE programs are tailored for people age 55 and older. You may find it is worthwhile to get services from both programs if you have a developmental disability, are 55 or older, are eligible for nursing home care, and think that you would benefit from the complementary specialties of the two systems. On the other hand, if you like your regional center services and current medical providers, you might not want to join PACE. Joining PACE would require you to receive services from PACE’s employed and contracted providers. Most of these will be different from your current providers.
More information is available at www.calpace.org.