MT Severe and Disabling Mental Illness Waiver

In the vast healthcare landscape, the Severe and Disabling Mental Illness (SDMI) Waiver Program in Montana gives hope and support to Medicaid members grappling with severe mental health challenges. This program is paramount in promoting the independence and well-being of individuals with disabling mental illnesses, providing them with the necessary long-term care to thrive within their communities.

The SDMI HCBS waiver program is firmly rooted in the belief that recovery is attainable within one's community with the aid of comprehensive support offered by the program. It aims to enable members to reach their full potential, fostering social participation, preserving the rights of people with mental illness, and striving for equality in healthcare. The ultimate goal is to integrate these individuals into the very fabric of their communities, empowering them to become valued members and contributors.

Overview of Severe and Disabling Mental Illness (SDMI) HCBS Waiver Program

The overarching purpose of the Severe and Disabling Mental Illness (SDMI) HCBS Waiver Program is to ensure the independence and overall well-being of Medicaid members who have severely disabling mental illnesses and require long-term care. The program supports these individuals to live within their communities, promoting recovery and fostering social integration.

The SDMI HCBS waiver program is designed to address its target population's unique needs, including those grappling with severe mental illnesses that significantly impact their daily functioning. The program aims to empower its members to achieve their full potential and actively participate in their communities by offering access to appropriate services and support.

Key goals and objectives of the SDMI HCBS waiver program encompass the following:

1. Independence: The program strives to keep members as self-reliant as possible, allowing them to remain in their communities rather than institutionalized settings.
2. Recovery-Oriented Care: With a strong emphasis on recovery, the waiver focuses on providing services that aid healing and regaining control over one's life.
3. Social Participation: The program aims to reduce isolation and stigmatization by facilitating community integration and fostering meaningful social connections.
4. Advocacy for Rights: Upholding the rights of individuals with mental illness is paramount, ensuring they receive equal opportunities and are treated with dignity and respect.
5. Value and Contribution: The program seeks to integrate its members as valued community contributors, recognizing and supporting their unique talents and abilities.

The SDMI HCBS waiver program is a testament to Montana's commitment to providing compassionate care and support to its most vulnerable citizens while acknowledging family caregivers' pivotal role in this endeavor. Through the dedicated efforts of caregivers and the targeted services offered by the program, it aspires to improve the lives of those affected by severe mental illnesses and foster a more inclusive and understanding society.

Eligibility Requirements

To qualify for enrollment in the Severe and Disabling Mental Illness (SDMI) Home and Community-Based Services (HCBS) waiver program in Montana, individuals must meet specific eligibility criteria, as outlined below:

1. Age Requirement: The individual must be at least 18 years old.
2. Medicaid Eligibility: The applicant must be eligible for Medicaid, which is determined based on income and other factors.
3. Level of Care (LOC) Requirement: The individual must require a Level of Care in a nursing facility, as assessed and determined by the Quality Improvement Organization (QIO) under contract with the department.
4. Severe and Disabling Mental Illness: The applicant must meet the requirements for having a severe and disabling mental illness, as specified in the SDMI HCBS policies (SDMI HCBS 005).
5. Level of Impairment Criteria: A licensed mental health professional must evaluate the individual using the waiver program evaluation and Level of Impairment (LOI) Form. To meet the impairment criteria, the applicant must score a three or higher in at least three areas.

Once an individual is eligible for the waiver program, they are referred to the appropriate case management team (CMT). The CMT will offer openings for program services, if any, or place the individual on a waitlist until a space becomes available in their chosen service area. However, eligibility for consideration does not guarantee selection and entry into the program.

To be enrolled in the SDMI HCBS waiver program, an individual must demonstrate a need for at least two SDMI HCBS waiver services, with one of the services being case management.

Removal from the SDMI HCBS waiver program may occur under the following circumstances:

1. A mental health professional determines that the individual no longer meets eligibility criteria.
2. The individual refuses to undergo required assessments as directed by the waiver program.
3. The individual only actively participates in at least two services within 45 calendar days of agreeing to and signing the Person-Centered Recovery Plan.
4. The department determines that the individual failed to utilize or attempted to use at least two waiver services for over 90 days, with documented repeated attempts by the CMT to engage the individual.
5. The individual no longer requires a nursing facility's Level of Care (LOC), as determined by the QIO.

Services and Supports

The Severe and Disabling Mental Illness (SDMI) HCBS Waiver Program offers a comprehensive range of services and supports tailored to meet the unique needs of individuals facing severe mental health challenges. These services, as of the specified dates, include:

1. Adult Day Health: Providing structured daytime activities and health-related services to support community integration and enhance overall well-being.
2. Behavioral Intervention Assistant: Assisting individuals in developing coping skills and managing behaviors to improve their quality of life.
3. Case Management: Offering personalized support and coordination of services to help individuals navigate the complex healthcare system effectively.
4. Community Transition: Assisting in transitioning back to the community from institutional settings, promoting independence and reintegration.
5. Consultative Clinical and Therapeutic Services: Offering specialized therapeutic interventions to address mental health needs.
6. Environmental Accessibility Adaptations: Modifying living spaces to improve accessibility and independence.
7. Health and Wellness: Supporting individuals in achieving and maintaining physical and mental well-being.
8. Homemaker Chore: Assisting with household tasks to enhance daily living.
9. Life Coach: Offering guidance and support to help individuals achieve personal goals and improve life skills (as of March 2023).
10. Meals: Ensuring access to nutritious meals to support overall health.
11. Non-Medical Transportation: Assisting with transportation needs to enable access to essential services and activities.
12. Pain and Symptom Management: Providing interventions and support for managing pain and symptoms related to mental health conditions.
13. Personal Assistance Service: Offering support with activities of daily living to foster independence.
14. Personal Emergency Response System: Providing access to emergency assistance for added safety.
15. Private Duty Nursing: Delivering specialized nursing care for individuals requiring medical attention (as of 03/01/2021).
16. Residential Habilitation - Adult Group Home: Offering supportive living arrangements in a group home setting.
17. Residential Habilitation - Assisted Living: Providing assistance and support in an assisted living environment.
18. Residential Habilitation - Adult Foster Care: Supportive care within a foster care setting.
19. Residential Habilitation - Intensive Mental Health Group Home: Providing specialized support in a group home for individuals with intensive mental health needs.
20. Residential Habilitation - Mental Health Group Home: Supporting individuals in a group home setting focused on mental health care.
21. Respite: Providing temporary relief for caregivers while ensuring continued care for the individual.
22. Specialized Medical Equipment and Supplies: Offering necessary equipment and supplies to address specific health needs.
23. Supported Employment: Assisting individuals in finding and maintaining employment, fostering independence and self-sufficiency.

These services and supports are crucial in empowering individuals with severe mental illness to lead fulfilling lives within their communities while receiving the necessary care and assistance to achieve their fullest potential.

Compensation for Family Caregivers

Under this waiver, unpaid family caregivers may be eligible for compensation through the self-directed option. This innovative approach allows qualified individuals receiving services under the waiver program to have more control over their care by selecting their caregivers, including family members, and compensating them for their caregiving duties.

Through the self-directed option, family caregivers are recognized as essential healthcare team members. They can receive payment for the valuable work they contribute to supporting their loved ones with severe mental illness. This option addresses the underpaid workforce of family caregivers and recognizes their dedication and the critical role they play in ensuring the well-being of program members.

Learn more about Medicaid self-directed care >>

A note from Givers

Family caregivers are the backbone of compassionate care, yet their efforts often go unrecognized and unrewarded. If you or a loved one is caring for someone with a severe disabling mental illness in Montana, take the first step towards recognition and compensation. Fill out this form to determine if you are eligible for compensation as a caregiver.