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					Supports Waivers
      November 9, 2007
        Gary A. Smith
Human Services Research Institute
                   Topics
 Background
 Purpose    of the ASPE Study
 Findings
 Role   of Supports Waivers Going Forward
               Background
A “supports waiver” is a §1915(c) HCBS
waiver that usually:
   Targets children and/or adults who live with
    their families
   Does not cover licensed residential services
   Operates under a fixed dollar limit on the
    amount of services that may be authorized
   Operates alongside a “Comprehensive
    Waiver”
            Why States Operate
             Supports Waivers
   Waiting list reduction strategy – Offer home-
    based services to support individuals at a lower
    cost than the “full package” of waiver services
   CMS Olmstead Letter #4 (cannot operate a
    “waiver-in-waiver”)
   Refinance state-funded non-residential
    community services
   Strengthen supports for people who live with
    their families
   Individual/family empowerment
      At the end of the day ….
 Supports waivers have emerged as a possible
  solution to bridging the gap between the
  demand for services and available resources
 Hope: Divert demand to less costly benefit
  packages because “full service” packages are
  increasingly costly.
 By design, supports waivers seek to leverage
  family care giving as long as possible
   Purpose of the ASPE Study
 DHHS   Assistant Secretary for Planning &
  Evaluation contracted with HSRI to
  conduct a study of support waivers
 Purpose: Compile systematic information
  about target populations, services offered,
  funding limits, etc.
 Report was prepared and finalized during
  2006 - 2007
              Study Tasks
 Compile  state waiver applications, related
  materials, and expenditure/utilization data
 Conduct in-depth interviews of
  stakeholders in six states, including
  making on-site visits to two states
            What We Found
 As of early 2007, 17 states operated supports
  waivers. Since then, CMS has approved others
  and more are in the works.
 The new HCBS waiver application gives states a
  clearer pathway for designing dollar-limited
  waiver programs
 There has been steady year-over-year growth in
  the number of supports waivers in operation
  since Colorado launched the first one in 1995
 Number of people served in supports waivers
  has grown quickly
States Operating Supports Waivers
                            States With Comprehensive and Supports Waivers
                                      Enrollment Trends 2000-2006
       180,000


       150,000


       120,000


        90,000


        60,000


        30,000


               0
                    2000        2001      2002      2003      2004      2005      2006
Total People       102,791     115,841   126,737   131,573   138,945   148,807   166,673
% Supports          5.7%        7.8%      9.8%     13.1%     15.0%     22.5%     27.6%
Supports Waiver     5,837       8,991    12,455    17,198    20,842    33,452    46,008
Comprehensive      96,954      106,850   114,282   114,375   118,103   115,355   120,665
                 Findings …
 There are wide differences in the funding caps
  that states apply to supports waivers ($5K -
  $50K)
 Services offered are usually pretty basic –
  personal assistance, respite, day supports
 Only a few states (e.g., Oregon, Connecticut),
  have incorporated full-featured opportunities for
  individual/family direction of services.
 States varied in the extent to which
  individuals/families may actually treat the
  funding limit as a “budget.”
                Findings …
 The jury is still out on whether supports waivers
  have had or will have major impacts on waiting
  lists for residential services
 In some states, the support waiver is where
  people get some support while they wait for their
  name to rise to the top of the Comprehensive
  Waiver waiting list.
 No state has conducted full-scale impact
  evaluation of support waiver
                     Findings …
   Families have mixed feelings about support
    waivers …
       Appreciate the help that they are getting
       But, some feel cheated because their family member
        is receiving “second tier” services
       Afraid of being stuck on the supports waiver forever
   Most states haven’t thought through how
    supports and comprehensive waivers interface
    (transition rules).
                    Findings ….
 Supports waivers appear to work well for most
  individuals/families
 At the same time, many supports waivers are
  less flexible than they could be and need to be
  brought up to date by incorporating self-direction
 Most interesting approach: Oregon
       Self-direction
       Supports brokerages
       Universal access
              Going Forward
 Number   in operation will grow
 States cannot afford to grow 24/7 services
  quickly enough to meet service demand
 New phenomenon:
     Triple stacked waivers
     Quadruple stacked waivers
 Statesneed to take a closer look at role
 supports waivers play and how they
 intersect with “comprehensive waivers”

				
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