At Reach we often use the phrase “community-based” services, but what exactly does that mean? U.S. Legal states, “Providing community-based services refers to having high quality services accessible to families in the least restrictive setting possible. A community-based system of care requires systems to see the home, school, and neighborhood of the family from an asset perspective.” Reach sees the distinct advantages of people being able to maintain as much independence as possible, so we specifically work with people in their homes by leveraging the resources in their community. This can be in their own house or apartment, assisted living facility, adult foster home, congregate care facility, or other supportive housing (but not a long-term care facility, such as a nursing home).
Home and community-based services are funded through Medicare at the federal level, with individual states providing additional funding, such as through county or state programs, through managed care, or by private sources. The terms “community-based services” and “waiver-funded services” or “waiver programs” are often interchangeable. The name “waiver” comes from the fact that the federal government “waives” medical assistance rules for institutional care. Each state then has its own system of operating and maintaining the services they deliver. Therefore, the services we offer in Minnesota are different from our neighbors in Wisconsin, Iowa, and the Dakotas.
Minnesota chooses to have a waiver program. Our program in Minnesota encompasses the six following waiver programs:
- Alternative Care (AC) – Program that supports certain home- and community-based services for older Minnesotans, age 65 years and over, who are at risk of nursing home placement and have low levels of income and assets.
- Brain Injury (BI) – For people with acquired or traumatic brain injuries who need the level of care provided in a nursing facility that provides specialized (cognitive and behavioral supports) services for people with brain injury or neurobehavioral hospital level of care.
- Community Alternative Care (CAC) – For chronically ill and medically fragile people who need the level of care provided in a hospital.
- Community Access for Disability Inclusion (CADI) – For people with disabilities who require the level of care provided in a nursing facility.
- Developmental Disabilities (DD) – For people with developmental disability or related condition who need the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD).
- Elderly Waiver (EW) – For people over the age of 65 years who require the level of care provided in a nursing facility.
These waivers allow people to receive services where they live. Since people require different levels of support, these differing levels are available in a variety of different formats that can be delivered in each of these different living environments. A person doesn’t need to live in group home or assisted living facility to be able to have all of their needs met. Instead, these needs can all be met through the menu of services that are available through the waivers. Some of these can include nursing services, homemaker services, in-home family support, independent living skills, supported living services, PCA, employment services, night supervision services, etc.
Each of the waivers requires that a person be on medical assistance to receive this support, and each of the waivers has its own eligibility criteria. For more information about each specific waiver and the services available under them, visit http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=ID_000852.