Waiver? What is that?

If you live in Ohio, and your child is diagnosed with developmental disability, many kind people tell you, “Sign up for waiver!” “Put your child on the waiting list!”

Wait a minute.  What is waiver?  What is waiting list?  How do they help my child?

There are “official” publication at Ohio Department of Developmental Disabilities website  http://dodd.ohio.gov/medicaid/Pages/Waiver-Enrollment-.aspx.  But what I’m writing now is how I did it and what happened along the way.

1. Call Service Support Administration (SSA) of your County’s Board of Developmental Disabilities. https://doddportal.dodd.ohio.gov/INF/additionalservices/cnt/Pages/default.aspx
I
n my case, it was Athens County Board of Developmental Disability’s SSA (740) 592-6006. Their address is 9033 Lavelle Rd., Athens OH, if you prefer to visit in person.

2. Tell the receptionist that I have a son with developmental disability and would like to sign up for Level 1, Individual Options, and SELF waivers.  They are all the waivers they administer and in my experience, you have to tell these specific waiver name; otherwise, they would assume you know nothing so they don’t have to serve you.  After all, their job is a gatekeeper of tax payers’ money.

3. They will assign a case worker for your child, and ask you to have your child evaluated by a specific psychologist.  They will tell you the name and phone number so you make an appointment by yourself, explaining that you’re signing up your child for DD waivers.  County Board pays for this evaluation.  It doesn’t matter if your child has been diagnosed with a top-tier autism specialist or not.  County Board needs the evaluation by the psychologist they have contract with.

4. The psychologist administers some test and interviews.  Chances are, he will write a report that indicate your child has a developmental disability or two.  In my case, he wrote, “autism”, “mental retardation”, “Combined ADHD” “Note – mother did not help the child during evaluation” as though I was the refrigerator mom!  I was restraining myself so the accurate evaluation of my son was possible.  Anyway.

5. Once you got the psychologist report sent to County Board, the case worker will arrange for an evaluation called COEDI (Children’s Ohio Eligibility Determination Instrument) or OEDI (Ohio Eligibility Determination Instrument) depending on your child’s age.  This is NOT the time to show your child’s best behavior.  If you say “Yes” to a question your child can do 50% of time, you’re in jeopardy.  You should say “sometimes” or “50% or so” instead.  Well, my son was so severe, so he just ran around the room while the tester asked questions.

6. A few weeks later, you will receive the letter telling if your child qualified or not.  It will also likely to tell that your child is put on waiting list.  And this must tell the name of the case manager.  Contact him/her and know where in the waiting list your child is and estimated time to actually get it.  Your case manager should tell that information at least once a year, but many caseworkers are so overloaded and such tasks often goes backburner and forgotten.  So you should be proactive and ask them.

7. In my case, we had a true crisis.  So we jump up all the list and received I/O waiver.  That won’t happen for many.  Each county has different rules to manage the waiting list (e.g., adults get priority, single-parent family gets priority, etc.)  So keep asking and emphasize how desperate your family’s needs are.

8. Once your turn comes, your case manager should tell and will have lots of paperwork.  First, if you have income high enough so your child won’t qualify for Supplemental Security Income (SSI) from Social Security, you will need to make an appointment with a caseworker at Social Security Administration.  BE SURE YOUR CHILD HAS NO ASSETS.  Sometimes a kind grandparent opens a savings account on the child’s behalf.  If that has more than $2,000, YOUR CHILD WILL NOT QUALIFY FOR ANY SERVICES!  They basically ask your and your child’s asset and give you a piece of paper that your household income is too high for SSI.  That paper is what you need.  I don’t think this process (and process 9)  is unnecessary if your child already qualifies for SSI and Medicaid based on family income.  But I don’t know about this.

9. Go to your local department of Medicaid (In my time, it was part of Job and Family Services, and I think many still operates similar way but check with your county).  Give that magic paper Social Security office gave you.  A caseworker (again!) asks you some question about the need and verifies the waiver is in.

10.  Your County Board of DD caseworker will call for a meeting to device ISP (Individual Service Plan).  It will have plans for respite, medical appointments, etc.  You can choose the provider from the provider your County Board approves.  You can’t simply pay your favorite babysitter and get reimbursed.  Unless your babysitter goes through the process of becoming an independent service provider.

11. If you need adoptive equipment (my son needed a big stroller to get him around during medical appointment), you first need to get evaluated by a professional.  Depending on the equipment, this might be Speech language pathologist, physical therapist, or occupational therapist.  They will choose the equipment and write a report to the County Board.  County Board will process the order.

So, getting waiver is not an easy process.  BUT WORTH THE EFFORT!!!!  Another huge benefit that comes with waiver is Medicaid.  For children who didn’t qualify for Medicaid because of family income can have Medicaid, that pays a lot more than private insurance, like diapers and pull-ups.  Also, there is no copay.  Generally, your private insurance pays first and then the remainder is billed to Medicaid and it pays the rest. (I had some troubles with Rx meds, but I’ll save it for future blog)

Another important note: Your child must be medically diagnosed with developmental disability before the 22nd birthday to qualify for the DD service.  This makes many children who have received IEP services from school not eligible if they haven’t gotten a formal medical diagnosis.

Hope this will encourage you to apply for DD Waiver.  GET ON THE LIST!!!!

 

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