Welcome to the World of Waivers
The difference between STS Funding and Waiver Funding
In order to understand what a waiver is and how it works, first you need to understand how services are funded at STS.
How is STS Funded?
- STS is an Intermediate Care Facility for individuals with intellectual disability (ICF/MR). (formally” mental retardation) This type of facility means that the services such as doctors, nurses, direct care, room and board and entertainment are billed together. Funding for STS is paid by the state which in turn gets reimbursed 50% of all costs from the federal government.
What is a Waiver?
- Waivers were developed by the federal government to enable individuals to be served in the community; not just large congregate setting like STS. Connecticut receives 50 percent reimbursement from the federal government for every dollar spent which helps fund services that otherwise might not be affordable.
- When an individual is enrolled in a waiver, his/her services are each billed separately. Room and board is one bill, doctor’s visits, hospital stays, medications and other needs are each billed individually to Medicaid.
What is Medicaid?
- Medicaid is the reimbursement vehicle that the federal government uses to fund many different types of services including residential and day services for individuals with intellectual disability. The Centers for Medicare and Medicaid Services (CMS) oversees the waivers used in the Connecticut.
What types of waivers does Medicaid offer for DDS Services?
Medicaid has three Home and Community Based Services (HCBS) for DDS services.
- Individual and Family Support Waiver
Provides in-home, day, vocational, and family supports services for people who live in their own or family home.
- Comprehensive Supports Waiver
Provides services delivered in licensed settings, and provides for the vocational and in-home services needed for people who need a more intensive level of support to remain in their own or family home.
- Employment and Day Supports Waiver
Provides for people living in their own home or their family home with a strong network of natural supports and provides for employment and/or day support along with a small amount of respite or behavioral support.
Why does a person have to be on a Waiver?
- By enrolling in the waiver it allows the state to be reimbursed 50 % of all services from Medicaid.
By enrolling in a waiver, am I relinquishing any individual rights or services for my loved one?
- No, when the federal government developed the Home and Community Based Waivers it was to afford individuals who lived in congregate settings like STS to move into the community with the same access to services and have a method of funding. When you enroll in the waiver, you are basically exchanging your services in a congregate setting to services in the community.