The DDD Waiver Manual is intended to complement the approved waivers, not to supplant them. Any lack of clarity or conflict among the documents is unintended. Should a conflict arise, the federal CMS-approved waiver documents are the final authority.
The purpose of the Waiver Manual is to provide uniform direction for providing waiver services for DHS-designated Pre-Admission Screening/Individual Service and Support Advocacy (PAS/ISSA) agencies, case managers (sometimes called Qualified Intellectual Disability Professionals (QIDPs) or Service Facilitators) and other waiver service providers.
The Division of Developmental Disabilities' (Division) mission is to "provide a full array of quality, outcome-based, person- and community-centered services and supports for individuals with developmental disabilities and their families in Illinois." To help accomplish this mission, the State submitted applications to and received approval from the Federal Centers for Medicare and Medicaid Services (CMS) for the following three 1915(c) Home and Community-Based Services (HCBS) waiver programs:
- Waiver for Adults with Developmental Disabilities (Adult Waiver)
- Supports Waiver for Children and Young Adults with Developmental Disabilities (Children's Support Waiver)
- Waiver for Residential Supports for Children and Young Adults with Developmental Disabilities (Children's Residential Waiver)
The waivers afford participants and families the choice between participant direction and more traditional service delivery, or a combination. The number of individuals served each year is based on available State appropriation levels.
The Division operates these waiver programs under an Interagency Agreement with the Department of Healthcare and Family Services (HFS), which administers the Medicaid program in Illinois.
General Medicaid Overview
The Illinois Department of Healthcare and Family Services (HFS), Division of Medical Programs, is responsible for providing health care coverage for adults and children who qualify for Medicaid. The DHS Family Community Resource Center (FCRC), determines Medicaid eligibility based on HFS criteria and also determines eligibility for food stamps.
Individuals must be enrolled in Medicaid to be enrolled in the waiver programs. Special Medicaid eligibility rules and application procedures apply for children determined clinically eligible for the Children's Waivers. See Section II-Participant Eligibility & Waiver Program Enrollment for detailed waiver clinical eligibility criteria. Participants must maintain Medicaid enrollment to ensure continuation of payment to providers for services delivered. Medicaid enrollment enables the individual to receive covered services included in the Medicaid State Plan, in addition to waiver services. This Manual contains policy and procedural details and is designed to be used with applicable programmatic rules and guidelines.
Overview of Waivers
Section 1915(c) of the Federal Social Security Act allows a state to operate Home and Community-Based Services (HCBS) waivers within its Medicaid program if certain requirements are met. Please see Section III-Waiver Services of this manual for descriptions of the covered waiver services. The federal waiver requirements include:
- The State must submit a request and receive approval from the federal Centers for Medicare and Medicaid Services (CMS) to operate a waiver. The approved waiver thus becomes the intergovernmental agreement that, together with applicable federal Medicaid regulations, governs operation of the waiver.
- The waiver must be a cost-effective alternative to placement in a Medicaid-funded institutional setting, such as an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD). In Illinois, federal ICF/DDs include both private facilities and state-operated developmental centers.
- The State and CMS limit the total annual expenditures and the number of people served in each waiver.
- The State must have a quality management strategy in place to ensure the protection of each waiver participant's rights, health, safety and welfare.
Below is an overview of each of the 1915(c) Medicaid waivers addressed in this Waiver Manual. For all three waivers, each participant is assigned an Individual Service and Support Advocate (ISSA) who serves as an independent advocate, participates in the development of the service plan, approves the final service plan, and monitors service provision. For the two children's waiver programs, the ISSA will assist the participant and family during the transition period to adult services. The ISSA will inform the participant and family about adult service options and ensure necessary eligibility screenings are completed.
- Provides supports to eligible adults with developmental disabilities ages 18 and older. The number of participants served each year is based on available State appropriation levels.
- Provides supports designed to prevent or delay out-of-home residential services for participants or alternative residential services for participants who would otherwise need ICF/DD level of service. See Section II-Participant Eligibility & Waiver Program Enrollment for eligibility criteria and the procedures manual for Developmental Disabilities Pre-Admission Screening Agencies (PAS Manual) for detailed information about level of care/level of service requirements.
- Choice between participant direction and more traditional service delivery, or a combination of both.
The Adult Waiver provides services to waiver participants through:
- Home-Based Support Services (HBS): Participants who choose home-based support services may select from a menu of services based on their individual needs within an overall monthly services cost maximum. Typical services chosen by participants may include day programs, as well as direct services provided by domestic employees or by agency employees. Participants also have a variety of therapies and other services available to them.
- Residential Services: Based on need, participants are provided with residential services and supports from the licensed provider of their choice. These participants may also select day programs and have a variety of therapies and other services available to them.
Children's In-Home Support Waiver
- Provides supports to eligible children and young adults with developmental disabilities ages three through 21 who live at home with their families. Children who are wards of the State are not eligible. The number of participants served each year is based on available State appropriation levels.
- Provides supports designed to prevent or delay the need for out-of-home residential services for these children and young adults who would otherwise need ICF/DD level of service.
- Provides choice between participant direction and more traditional service delivery, or a combination.
In combination with school-based services, natural supports, other community resources, and Medicaid State Plan services, services provided through the Children's Support Waiver assist the family in meeting the participant's needs. Within a monthly and annual allocation for each Waiver participant, families select from a menu of services based on the participant's needs. For qualified service providers, families may select from traditional agencies, as well as individual providers identified by the family.
Children's Residential Waiver
Provides 24-hour residential support to eligible children and young adults with developmental disabilities from age three through age 21 as an alternative to ICF/DD services. Children who are wards of the State are not eligible for this program. The number of participants served each year is based on available State appropriation levels.