DDS Provides Clarification on CFCO & TEFRA

AWA Members: We recently got a question from one of our members--it's pretty technical and there are some twists and turns, but it's really important stuff, so we wanted to provide the question and the answer that came from DDS:

Question:
"It still seems that those on TEFRA will not be an eligible group under CFCO. Additionally, some of the children on TEFRA have physical disabilities. They will not be able to transition to the ACS Waiver if we keep the Waiver. So, it would be a program that is open to all I/DD, seniors, and adults with physical disabilities, but not available to children with physical disabilities.

The second issue is that the TEFRA Waiver says that the participants are eligible to receive all state plan services. Does that mean that, because CFCO is part of the state plan, they should get the services as a part of TEFRA?

Also, is it not true that TEFRA's latest renewal was through December 31, 2014? If that's the case, won't it pose a problem for DHS/DDS? With CFCO scheduled to start January 1, 2015, there is no "transition" period.

Is the plight of the physically disabled children on the TEFRA Waiver an issue for the AWA? Given the expiration date for the TEFRA Waiver, I think DDS needs to come up with a transition plan for them. They can either transition them to the ACS as soon as the ACS renewal and the CFCO are approved, or they can push for a readoption of the TEFRA eligibility option. What I don't think is an option is to wait until December 31st, and then discover that a big problem exists. Unless someone like the AWA asks questions, I am afraid that our state will simply avoid the issue until it is too late. I will leave it up to you management types to decide how to handle this matter."

Answer:
"Individuals eligible through any 1115 Waiver are not eligible for CFCO services, that is a federal CMS requirement. Therefore there won’t be a transition from TEFRA to CFCO. We expect that individuals with developmental disabilities will move from TEFRA to DD HCBS Waiver to access CFCO services and avoid premium payments. Since under proposed plan DD HCBS waiver will no longer have a restrictive cap, there won’t be a waiting list, once everyone on the existing waiting list is enrolled.

Current TEFRA is good until the end of December 2014. 1115 TEFRA Waiver renewal was submitted today to extend it to December 2017.

Outside of TEFRA, a child with no DD diagnosis, regardless of functional deficits, would not be eligible under current law and policy. The "other" category might fit but only if the condition caused the child the function as if they has ID. Imagine a child with a heart condition or cancer. No ID but lots of deficits. Children with physical disabilities (eligible for Medicaid under any category, including TEFRA) will continue to be eligible for Personal Care State Plan services, but this service is pretty restricted for children. Title V, I believe may provide some support, including respite.

This is an important question to raise with the Department and other policy makers."