UT Community Transitions Waiver

The Community Transitions Waiver (CTW) is a new Home and Community-Based Services (HCBS) Waiver offering services to individuals in Utah who choose to move from Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-ID) into community services. This waiver is designed to help people with intellectual disabilities or related conditions live as independently as possible in the community, with supportive services provided through the waiver program. This article will explore the CTW, who is eligible, what services are covered, and how to apply. We will also discuss how this waiver can benefit caregivers, especially family members caring for their loved ones with intellectual disabilities. 

Overview of Community Transitions Waiver

The CTW is administered by the Utah Department of Health and the Division of Services for People with Disabilities. It is intended for people who meet the level of care criteria for admission to an ICF-ID, which means they have significant functional impairments in three or more areas of major life activity, such as self-care, communication, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency. 

The specific goals and objectives of the CTW are to:

• Provide an alternative to institutional care for people with intellectual disabilities or related conditions who want to live in the community.
• Enhance the waiver participants' quality of life and community integration by offering individualized and person-centered services that meet their needs and preferences.
• Support the caregivers of the waiver participants by providing respite care, training, and other services that can reduce stress and improve their well-being.
• Promote the efficient and effective use of Medicaid resources by delivering cost-effective services comparable to or lower than the cost of institutional care.

Eligibility requirements

To be eligible for the Community Transitions Waiver (CTW), you must meet the following requirements:

• You must be a Utah resident, U.S. citizen, or qualified alien.
• You must receive ICF benefits under the Medicaid State Plan.
• You must have been diagnosed with an intellectual disability or a related condition.
• You must meet the level of care criteria for admission to an ICF-ID, which means you have significant functional impairments in three or more areas of major life activity, such as self-care, communication, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency.
• The condition's onset must occur before age 18 for intellectual disabilities or before age 22 for other related conditions.
• You must meet the financial eligibility requirements for Medicaid, which vary depending on age, household size, income, and assets. For 2023, the income limit for a single person under 65 was $1,482 per month, and the asset limit was $2,000.
• You must move from an ICF-ID into a community-based setting, such as your own home, a family home, or a supported living arrangement. You must also have a care plan outlining the services and support you need to live in the community.

Services and Supports

The Community Transitions Waiver (CTW) offers services and supports to help individuals with intellectual disabilities or related conditions live more independently and comfortably in the community. These services and supports are individualized and person-centered, meaning they are based on the needs and preferences of each waiver participant. Some of the services and supports available under the CTW are:

• Behavioral Consultation: This service provides assessment, intervention, and training for individuals with challenging behaviors that interfere with their daily functioning or community integration.
• Center-Based Prevocational Services: This service allows individuals to develop work-related skills and abilities in a supervised setting.
• Chore Services: This service provides assistance with household tasks that the individual is unable to perform due to their disability, such as cleaning, laundry, or yard work.
• Community Transition Services: This service provides one-time assistance with expenses related to moving from an ICF-ID to a community setting, such as security deposits, utility fees, furniture, or household items.
• Companion Services: This service provides non-medical care, supervision, and socialization for individuals who need assistance with daily living activities or are isolated or lonely.
• Day Supports: This service offers structured activities that promote community inclusion, socialization, recreation, and skill development for individuals not working or attending school.
• Emergency Response Systems: This service provides electronic devices that enable individuals to summon help in an emergency.
• Environmental Adaptations: This service gives modifications or improvements to the individual's home or vehicle necessary to ensure their health, safety, or accessibility.
• Extended Living Supports: This service provides 24-hour residential support for individuals who need assistance with personal care, daily living skills, medication administration, or behavioral management.
• Family/Individual Training and Preparation: This service provides education and training for individuals and their families on topics related to their disability, such as self-advocacy, rights and responsibilities, transition planning, or community resources.
• Financial Management Services: This service assists with managing the individual's funds, such as budgeting, bill paying, or banking.
• Homemaker Services: This service provides assistance with personal care and household tasks that the individual is unable to perform due to their disability, such as bathing, dressing, grooming, cooking, or shopping.
• Massage Therapy: This service provides therapeutic massage for individuals with physical or mental health conditions who can benefit from this intervention.
• Medication Monitoring: This service provides oversight and assistance with the individual's medication regimen, such as reminding, observing, or administering medications.
• Non-medical Transportation: This service allows individuals to access community services, activities, or resources not covered by medical transportation.
• Nursing Services: This service provides skilled nursing care for individuals with medical needs requiring professional intervention.
• Personal Assistance: This service offers assistance with personal care and daily living activities that the individual cannot perform due to their disability, such as bathing, dressing, grooming, eating, or toileting.
• Personal Budget Assistance: This service assists with developing and managing the individual's budget for waiver services.
• Residential Habilitation: This service supports individuals who live in their home or family home and need assistance with personal care, daily living skills, medication administration, or behavioral management.
• Respite Care: This service provides temporary relief for caregivers responsible for the individual's primary care.
• Specialized Medical Equipment: This service includes equipment or supplies that are medically necessary and not available under the Medicaid State Plan.
• Supported Employment: This service assists individuals who want to work in competitive or integrated settings and need ongoing support to maintain employment.
• Supported Living: This service helps individuals who live in their home or family home and need intermittent assistance with personal care, daily living skills, medication administration, or behavioral management.
• Waiver Support Coordination: This service provides case management for individuals who participate in the waiver program. It includes assessing needs, developing a care plan, coordinating services, monitoring outcomes, and advocating for rights.

Compensation for caregivers

One of the benefits of the Community Transitions Waiver (CTW) is that it allows unpaid family caregivers to receive compensation for providing care to their loved ones with intellectual disabilities or related conditions. This temporary service option was introduced in response to the COVID-19 pandemic, as many other services were unavailable or unsafe for the waiver participants. Caregiver compensation is intended to provide relief and support for caregivers responsible for the primary care of individuals who may have experienced increased stress, isolation, or financial hardship due to the pandemic.

Caregiver compensation is available under the self-administered services (SAS) model, which means that the individual or their representative can hire, train, and supervise their employees to provide the support they need. The caregiver must perform supported living (SL1) or personal assistance (PA1) services, including assistance with personal care, daily living skills, medication administration, or behavioral management. The caregiver must also meet the criteria for COVID-19 caregiver compensation, which include having a need precisely due to the pandemic, not having another service provider available, and being in the individual's best interest.

Caregiver compensation is paid through a fiscal agent, a company contracted with DSPD to handle employee payroll, taxes, and insurance. The fiscal agent will issue paychecks to the caregiver based on approved timesheets and service rates. The caregiver must complete an employment packet and submit it to the fiscal agent along with the Form C19 COVID-19 Caregiver Compensation Authorization, which must be signed by the individual or their representative and their support coordinator.

Note: The waiver has an expiration date of June 30, 2025 However, this does not necessarily mean that the caregiver compensation service will expire on that date. The waiver may be renewed or amended by the state and CMS before its expiration date, depending on the needs and preferences of the waiver participants and their families, as well as the availability of federal and state funds.T

A note from Givers

If you are a caregiver for someone with intellectual disabilities or related conditions, you may be eligible for compensation under the Community Transitions Waiver. To find out if you qualify, please fill out this form.