The DD Comprehensive Waiver is a Medicaid program that provides services to eligible individuals with an IDD diagnosis to prevent or delay institutionalization, promote independence, and improve quality life. It includes a self-direction option with the possibility to compensate family caregivers.
Intellectual and developmental disabilities (IDD) affect a person's cognitive, physical, social, and adaptive functioning. According to the American Association on Intellectual and Developmental Disabilities (AAIDD), about 6.5 million people in the United States have an IDD. Some examples of IDD include autism spectrum disorder, Down syndrome, cerebral palsy, and fetal alcohol syndrome.
Many individuals with IDD in Missouri prefer to receive care in their homes or communities instead of intermediate care facilities for individuals with intellectual disabilities (ICF/IID). However, the cost of home and community-based services (HCBS) can be prohibitive for many low-income individuals. Fortunately, there is a Medicaid program that can help: the Missouri Developmental Disabilities (DD) Comprehensive Waiver.
The DD Comprehensive Waiver is a Medicaid program that waives some of the rules of regular Medicaid to provide HCBS to eligible individuals with an IDD diagnosis and who would otherwise require an ICF/IID level of care. The DD Comprehensive Waiver aims to prevent or delay institutionalization, promote independence, and improve the quality of life of its participants.
In this article, we explore the DD Comprehensive Waiver, who can qualify for it, what services it covers, and whether it pays family caregivers.
Overview of the Developmental Disabilities (DD) Comprehensive Waiver
The DD Comprehensive Waiver is one of several Medicaid waivers in Missouri that offer HCBS as an alternative to institutional care. The DD Comprehensive Waiver serves individuals of any age who:
- Have an IDD diagnosis
- Meet the ICF/IID level of care criteria
- Need at least one DD Comprehensive Waiver service
- Live in their own homes or the homes of their relatives or friends
To be eligible for the DD Comprehensive Waiver, individuals must also meet the financial criteria for MO HealthNet (Missouri Medicaid). As of 2023, the monthly income limit for a single applicant is $903, and the asset limit is $5,000. For married applicants, the income limit is $1,215, and the asset limit is $10,000. Some income and assets may be excluded or disregarded when determining eligibility.
The DD Comprehensive Waiver provides a range of services and supports tailored to each participant's individual needs and preferences. These services are intended to help participants with their personal care, health care, employment support, behavioral support, and social needs. The DD Comprehensive Waiver also provides case management to coordinate and monitor the delivery of services.
One of the benefits of the DD Comprehensive Waiver is that it gives participants more choice and control over their care. Participants can choose their providers from a list of approved agencies, or they can opt for a self-directed option that lets them hire their own workers, including family members.
Eligibility Requirements
To qualify for the DD Comprehensive Waiver, individuals must meet the following requirements:
- Be a Missouri resident
- Be a US citizen or a qualified alien
- Have a Social Security number
- Have an IDD diagnosis
- Meet the income and asset limits for MO HealthNet
- Meet the level of care criteria for ICF/IID placement
- Need at least one DD Comprehensive Waiver service
- Live in a home or community setting
An IDD diagnosis must be confirmed by a licensed physician or psychologist based on medical records or an evaluation. The IDD must have occurred before age 22 and resulted in significant functional impairments.
The level of care criteria for ICF/IID placement is based on an assessment of the applicant's functional abilities, medical needs, cognitive status, and behavioral issues. The assessment is conducted by a nurse from the Department of Health and Senior Services (DHSS) or a contracted agency. The applicant must score at least 21 points on a scale of 0 to 60 to be eligible for the DD Comprehensive Waiver.
Services and Supports
The DD Comprehensive Waiver offers various services and supports designed to help participants remain safely and comfortably in their homes or communities. These services include:
- Personal assistance: Assistance with personal hygiene, grooming, dressing, eating, mobility, toileting, etc.
- Day habilitation: Supervised care in a group setting that provides socialization, recreation, skill development, and transportation.
- Group home: Residential care in a licensed facility that provides 24-hour supervision, personal care, health care, and behavioral support.
- Individualized supported living: Residential care in a home or apartment that provides individualized support and assistance based on the participant's needs and preferences.
- In-home respite: Temporary relief for the primary caregiver who provides unpaid care to the participant. Respite care can be provided in the participant's home by a qualified worker.
- Out-of-home respite: Temporary relief for the primary caregiver who provides unpaid care to the participant. Respite care can be provided in another approved setting, such as a group home, by a qualified worker.
- Prevocational services: Services that prepare individuals for paid or unpaid employment, such as training, coaching, and supervision.
- Supported employment: Services that help individuals find and maintain paid work in integrated settings, such as job development, placement, coaching, and retention.
- Support broker: A person who assists the participant with self-directing their services, such as hiring, training, supervising, and paying their workers.
- Applied behavior analysis: A form of therapy that uses positive reinforcement and other techniques to improve the behavior and skills of individuals with IDD.
- Assistive technology: Devices or equipment that enhance the functional capabilities of individuals with IDD, such as communication devices, adaptive switches, etc.
- Benefits planning: Services that help individuals understand and access public benefits, such as Social Security, Medicaid, Medicare, etc.
- Career planning: Services that help individuals explore their interests, skills, and goals related to employment and education.
- Community networking: Services that help individuals participate in community activities that match their interests and preferences, such as clubs, classes, volunteer opportunities, etc.
- Community specialist: A person who provides individualized support and guidance to individuals with IDD who have complex needs or challenging behaviors.
- Community transition: Services that help individuals move from an institutional setting to a home or community setting, such as moving expenses, security deposits, furniture, etc.
- Crisis intervention: Services that provide immediate response and stabilization to individuals who experience a behavioral or mental health crisis that poses a risk to themselves or others.
- Environmental accessibility adaptations: Modifications to the participant's home are necessary to ensure safety, accessibility, and independence, such as ramps, grab bars, widened doorways, etc.
- Health assessment and coordination: Services that comprehensively evaluate and track the participant's physical and mental health status and needs.
- Individual-directed goods and services: Goods or services not otherwise covered by the DD Comprehensive Waiver but necessary to achieve the participant's goals and outcomes.
- Individualized skill development: Services that help individuals acquire or improve skills related to daily living, communication, socialization, self-care, etc.
- Intensive therapeutic residential habilitation: Residential care in a home or apartment that provides intensive behavioral support and therapy to individuals with IDD who have severe behavioral challenges.
- Job development: Services that help individuals identify and secure paid employment opportunities that match their interests and abilities.
- Occupational therapy: A form of therapy that helps individuals with IDD improve their ability to perform daily activities, such as dressing, cooking, working, etc.
- Physical therapy: A form of therapy that helps individuals with IDD improve their mobility, strength, balance, and coordination.
- Professional assessment and monitoring: Services that provide ongoing evaluation and oversight of the participant's needs and services by a qualified professional.
- Shared living: Residential care in a home where the participant lives with another person who provides support and assistance based on a mutually agreed upon arrangement.
- Specialized medical equipment and supplies: Items necessary to treat or prevent the participant's medical condition or disability-related need.
- Speech therapy: A form of therapy that helps individuals with IDD improve their communication, swallowing, and voice skills.
- Transportation: Services that provide access to non-emergency medical or non-medical destinations for the participant.
The DD Comprehensive Waiver also provides case management services to help participants plan, arrange, and monitor their care. The DHSS or a contracted agency assigns case managers. They conduct assessments, develop service plans, authorize services, coordinate providers, and conduct periodic reviews.
Compensation for Caregivers
One of the most frequently asked questions about the DD Comprehensive Waiver is whether it pays family caregivers. The answer is yes, but only under certain conditions.
The DD Comprehensive Waiver has two options for service delivery: agency-directed and self-directed. Under the agency-directed option. Participants choose their providers from a list of approved agencies that employ qualified workers. Under the self-directed option, participants hire their own workers who can be friends, neighbors, or relatives (except spouses or legal guardians).
The self-directed option gives participants more flexibility and control over their care but also involves more responsibilities. Participants must act as employers and handle recruiting, hiring, training, supervising, paying, and firing their workers. They must also comply with state and federal taxes, insurance, and labor laws.
To participate in the self-directed option, individuals must meet the following requirements:
- Be able to direct their care or have a representative who can do so on their behalf
- Complete an orientation and training program
- Sign an employer agreement
- Use a fiscal intermediary to process payroll and taxes
- Use an electronic visit verification system to track service delivery
If participants choose the self-directed option and hire family members as their workers, they can potentially receive compensation for their caregiving. However, the amount of compensation depends on several factors, such as:
- The number of hours of service authorized by the case manager
- The hourly rate of pay established by the DHSS
- The availability of funds in the DD Comprehensive Waiver budget
- Compliance with the DD Comprehensive Waiver rules and regulations
As of 2023, the hourly rate of pay for self-directed workers in Missouri is $12.50 for regular hours and $18.75 for overtime hours. However, this rate may change depending on the state's minimum wage and budget adjustments.
A Note from Givers
If you are interested in applying for the DD Comprehensive Waiver or finding out if you are eligible for other programs that pay family caregivers, we invite you to fill out this form and get in touch with us. We are Givers, a free service that helps caregiving families find and access programs to compensate them for their work. We are here to support you and hopefully make your caregiving journey easier.
