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 Who does what

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   What I can do

As your Medicaid Waiver support coordinator, I perform several tasks that help you reach your desired goals.  Just a few of those are discussed here. They include:

1.     Maintaining or reestablishing Medicaid Eligibility.

2.     Identification of which goals you want to work towards.

3.     Produce support plan and related documents.

4.     Obtain funding necessary to reach your goals.

5.     Follow-up with you and providers on progress towards your established goals.

 

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   Medicaid Eligibility

In order to remain on the APD Medicaid Waiver program, you must maintain your Medicaid eligibility.  To do this, simply comply with the annual reviews conducted by Medicaid.  They normally make a request for updated information such as financial or other changes.  Basically you will lose your Medicaid eligibility if your assets exceed over $2,000.   There are certain exceptions, such as if you have a special needs trust established or an irrevocable funeral trust that owns a cemetery plot or prepaid service plan.  Medicaid needs to still know about these though.

 

If you fail to reply or report for an interview date, Medicaid normally terminates your eligibility.  When this happens, your MW providers no longer get paid for the services they provide you.  So it is important to not ignore Medicaid requests for information or interviews.  Notify me immediately if you get a letter from Medicaid requesting information, an interview or termination of benefits.  I can help resubmit an application that can reinstate your benefits retroactive from the date of the signed application.

 

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   Identification of Goals

In order to identify your goals, I will help you to discover what some of your needs and dreams are.   Part of this process involves you sharing what your preferences as well as dislikes are.  What do you enjoy the most or what would you like to try or where would you like to go that you havenít been before? 

 

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   Support Plan

A support plan is a document that identifies your preferences in the work, home and leisure settings.  It purpose is be a roadmap for where you have been, where you are now and where you want to be in the future and what supports you will need to help get you there.  Specific goals you desire are listed in this plan.  Each goal is tied to a support or service that will assist you in obtaining that goal.  These may be paid or free community based supports.  In order to create a support plan.

 

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   Gather Information

 In order to adequate prepare your annual support plan, I will need lots of updated information from you or your family or group home.  The most important thing I need from you is what your goals are and what if any changes you want to make in your life.  If you are not sure, your providers and I will help you to educate, explore and experience some activities that will help you to discover some goals and new preferences that you did not know were available.

 

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   Assemble documents

There are many other documents that need to be completed as a part of the support plan and meeting that I will arrange and conduct with input from you.  Many of these forms give permission or consent for various things which I will explain as well as inform you about your rights, choices and future final planning preferences.  After I create and assemble all these documents, I will review them with you and you can sign them.

 

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   Health Summary

In order to maintain optimal health, it is important to stay up to date with various doctor exams and / or treatments you may need.  To accomplish this, your group home, supported living coach or family member caretaker may assist you in staying current with exams and treatments including medications.  I will list your doctors and medications as indicated by you or above party.  I will encourage and / or notify you or above party if I see that it appears you need to see the doctor for a given reason that you have indicated or that I have noticed.

 

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   Track Progress

I will track your progress throughout the year based upon the support plan goals you indicated.  Visits to your daily activity and to where you live will be made by me to determine the amount and quality of progress you are making.  I will recommend modifications or changes if what the provider is doing is not effective in reaching a given goal.  You should call me or tell me in person when I visit if you ever feel you are not making adequate progress towards a goal or if you want to change a goal or add a new one. 

 

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   Submit and Implement

Once all the particulars within the support plan have been established and all the supplemental documents completed, I will submit them to APD and the fiscal reviewer for approval.  The two reviewer firms that will review your plan and request for funding are Maximus or APS Healthcare.  They will either approve, approve with changes or deny funding. They may request additional clarifying documents which I will obtain on your behalf.

 

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   Funding

Obtained funding for supports will be sought in the following mandated order: private money, community based, Medicare, Medicaid, Medicaid Waiver.  As a result, if possible, I will identify community supports instead of MW funding which must be exhausted prior to using MW funds.

 

If this is not possible, a request for MW funding will be made for supports with a provider of your choice.  You donít have to worry about the rates or units of service or how to complete a cost plan since I will do all this for you.  Keep in mind that many services have maximum amounts that can be funded using MW money.  Once funding approval is granted, I will send an service authorization to the provider.  They can then provide the service to you and bill for services rendered.  If a provider stops providing a service or quality is no longer satisfactory, please inform me.

 

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   Follow-up

Many times during the year issues come up that you may need assistance with.  Please let me know about something that you want help with since I may or may not be aware of your concern.  If you prefer or are able or desire to follow-up on some item on your own, you may wish to let me know so I can offer any recommendations or jump in to help should you need it if you feel the provider is not doing what they said they would.  I will call, email, fax or visit the provider or entity that is not dealing adequately with the issue and inquire, get status of and recommend a new course of action to meet your needs.  

 

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   What you can do

There are several things you may wish to do to further your progress towards reaching goals you have established.  The most important thing is to decide what things are important to you and what activities you want to become involved with as a result.  In other words, make decisions about goals that you desire not what someone else thinks you should do. 

Try to listen and learn as much as you can from a provider of supports.  Remember they are trying to help you realize your goals.  When the provider and you think you are ready, try to perform that new task or skill they have been working with you on.  Practice it until it becomes natural for you.

 

Advocate for yourself to make your concerns known to others.  If they donít know your concern or choice, you may miss an opportunity.  Taking self-initiative will help empower you and help towards becoming more self-sufficient and less dependent on others.  This will help you increase your dignity, self reliance and respect from others.

 

Report any concerns you have to me.  This includes any changes you desire or if you feel there is a lack of progress.  When I visit with you, tell me any health concerns you have, any financial issues, or provider issues.

 

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   What APD can do

APD stands for Agency for Persons with Disabilities.  They are the governmental agency that operates the Medicaid Waiver program you are enrolled and participate in.  They license various places to live called group homes.  They help monitor providers of service in areas of financial and medical healthcare in addition to looking into any problem areas a provider may have.  If you decide to move to a group home or into support living, they can assist with placement.  I will act as your liaison (contact) with them.  They can approve emergency funding when indicated.  They review and tentatively approve requests for behavioral services.  I would make the request to the district behavior analyst on your behalf.  They provide various trainings throughout the year and help implement program changes.  If you lose your Medicaid, they also facilitate reestablishing your eligibility once you complete the application.

 

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   What Providers do

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      Create IPP

Providers offer services and supports to you that help you to reach goals you established for yourself.  For example say you want to get a job in the community, then a supported employment coach will assist you in obtaining and keeping a job.  To help you reach your goal, they establish an IPP (individual program plan) document.  This is basically the steps they will use and track your progress towards goals.

 

Group Home providers offer home-like settings where you can live and learn new skills in effort to become more independent.  Adult Day Training program offer simulated work-like settings so you can learn a basic skill set to ready you for competitive employment once you are ready. They are many other services available.  To mention a few they include supported living, companion, respite care, consumable medical supplies and behavioral therapy supports. 

 

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       Strategies for Success

After reviewing the support plan goals established for the year, a provider will develop strategies for success.   This involves breaking down your goal into stages where one thing will follow another. 

 

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   Health, Safety & EEE

One of most important things to have is good health and safety.  Providers such as group home operators can help you achieve these.  This may involve being on a low fat diet and taking prescribed medications.  If you have a seizure or diabetic condition this may also involve getting regular lab work done.  Providers will help you reach your healthcare goals. 

 

Education, Exposure, Experience (EEEs) are strategies for you  and providers to use in order to expand your choices and more fully develop your preferences and as a result to improve successful outcomes from goals established.   For more on this, you may wish to watch a multimedia Power Point presentation on this which myself and my backup coordinator developed and presented to providers.

 

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       Track Progress

Providers of services will use tools and techniques that will allow them to measure how much progress you are making month to month.  They will issue monthly reports to the support coordinator as they bill for their service.  They will write an annual report that will summarize the amount of progress you made during the year.  Whether you  reached your goal or not, you can replace it with a new one or keep working on the existing goal.  Remember, its up to you, its your choice as to what is important to you in establishing your goals.

 

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       Reassess & Modify

Based on your input and progress, providers of services may also recommend strategies for future success.  This may involve making certain changes along the way. For example, if you feel you are not making enough progress towards a goal you have established, then the provider can reassess and modify what strategy or method they are using to help you towards that goal.  If you donít like the way the provider is helping you, let them know and tell the support coordinator also.

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