TRANSCRIPT
Demystifying Texas Medicaid Waivers
3-23-26 

>>Heather: This is for teachers and educators looking at the Texas Medicaid Waiver system, all parts of that system, what the options are here in Texas, and how families can add themselves to the interest list and how helpful it is just for educators to be familiar with this stuff so that when families have questions and we have done our presentation, you'll have some resources you can look at later. There's a lot of links and phone numbers just to help support families out there. I'll start with a little bit more about myself. Fun fact, all of us here on the presentation panel have a loved one on the Texas Medicaid Waiver Program. My son, Orion is 15 years old and he is currently on the Deafblind with multiple disabilities Medicaid Waiver. I forgot to mention my role. I am the transition consultant on the Texas Deafblind Project. With that, I'm going to go ahead and turn it over to Vivecca to introduce herself. 

>>Vivecca: Hello. I'm Vivecca Hartman. I'm the mother of a 28 -- almost 29-year-old young man, Christopher. He's my son. And he is deaf and blind since birth. And we have been part of the Deafblind Multihandicapped Association of Texas since he was 2 and we quickly got as involved as we could to learn as much as we could. And it's been a great community to share ideas, learn from each other, and one of those topics is the Medicaid Waivers. So happy to be here to share more about it with you guys. And I pass the baton to Linda. 

>>Linda: Good afternoon. Hi. I'm Linda Litzinger. I live in Austin. I work for Texas Parent to Parent and we serve the entire state, every kind of disability. And everybody that works there is a parent, except my daughter who works there. And she was born a preemie. Has quadriplegic cerebral palsy. Eyesight-wise she has retinopathy of prematurity but nothing really to speak of. So I'm very pleased to be here and to get to know you. And if you want to ever join Texas Parent to Parent, it's free. And later on I'll put "how" in the chat. Thanks. 

>>Heather: Thanks, Linda. Okay. Yes. I second that check out Texas Parent to Parent. It's a -- I've been following them and joining them since, really we moved to Texas. My family moved here to Texas when my son Orion was just 2. And it's funny. We've also been part of DBMAT since he was 2 as well. Fun connections. DBMAT, I want to recognize Vivecca is the president of DBMAT so that's some wonderful things. Okay. We're going to go to the next slide. So here's what we'll cover today. One, what is a waiver? And then some Medicaid Waiver comparisons. We'll talk about the waiver interest lists, eligibility, the CDS option or the agency option. There's a choice that you have to make with that. And then some regular actions. Okay. So, I'm going to go ahead and give this over to Linda. 

>>Linda: Thank you. What is a Medicaid Waiver? Medicaid Waivers provide disability services in the community to a person who is eligible to live in a state institution. It waives off of the eligibility criteria to receive services. And, you know, it's interesting when you tell a legislator about it -- or even a family -- it waives off of an ability to be somewhere else but you get to have it in your community, is basically what it is. Next slide, please. And so there are many Medicaid Waivers and they're all a little bit different. The first one listed here is CLASS. Community Living Assistance and Support Services Program. And I'm going to generalize a little bit but you all know that there are thousands of disabilities here. But CLASS, in general, has children who their IQ is too high to be in Home and Community-Based Services, which is the third one on here. So in general, and kids with all kinds of physical disabilities and kids with autism. And many, many more disabilities. I don't want to discount a single, tiny disability at all. And then Deafblind with multiple disabilities is the one that many people here know the most. And of course we know that you have to have deafness, blindness, and a third disability in order to qualify. And Home and Community-Based Services has an IQ requirement and it is different than many of the others because you can have it in your home, you can have it in somebody else's home. You can have it in a group home. There's just a lot of ways. And Texas Home Living is a smaller disability waiver that allows you to have some services while you wait for the top three. You must be an adult to have them. And then medically dependent children's program you must be a child and you must have some significant disabilities. And the STAR Plus home and community-based waiver is used when you reach age 21 and you're still on a waiting list. Then you can have some services while you still maintain a place on the top three list: CLASS, DBMAT, or HCS. Next slide, please. If I'm going too fast, anybody or interpreter, please let me know. Okay. So we have two ways of comparing the waivers. There's a very easy to read chart, a Disability Rights Texas, and there's a more detailed chart on the HHSC website, which the second one has more about cost caps and other different qualifiers at the bottom. There's asterisks, numbers, and all kinds of things at the HHSC one. And Heather, did we want to show any of those today? Was that your intention? 

>>Heather: Yeah. I think the HHSC one -- yeah. We can take a look at this one here. 

>>Linda: This is the HHSC one. So it goes down several pages but it's always got this same thing at the top. So the DBMD one is the fifth one on here. Deafblind multiple disabilities. It covers all agencies and it was started in 1995. The oldest -- 

>>Vivecca: Can we pause on that page? 

>>Linda: Vivecca, what were you saying? 

>>Vivecca: Do you mind if I chime in? I don't know the audience of everyone that's here so I draw attention to the ages served, because it can vary. On some of those waivers that are all ages, they do have a very long interest list. We try not to use certain words like "waiting list" but you understand. I wanted to point that out because it could be, like Linda mentioned earlier, you could end up on another waiver that's for children only while you're waiting to get on one. For my scenario, we were on MDCP, then we got on CLASS, then we switched to DBMD. It doesn't mean you have to choose one and never change. I don't think we have given the number out to share with families. But I encourage you all to make the interest list number a contact in your phone so it's easy for you to share with other people as well if they ask about it. We'll share that number here shortly. But these are the different waivers. And so you can tell them you want to be on all, if you so choose, and just wait to see who calls you. I just thought I'd throw that out there while we're talking about the various. 

>>Linda: That's a very good point. Keep on going, Vivecca. 

>>Vivecca: If you want. You want to scroll up? We can talk more about them. 1991 -- oh, '84 was the oldest, the STAR kids. There are different services within the waivers. Is that what you want? 

>>Linda: Yes. You know, to me it's so much easier to read the Disability Rights one first. Is it available to look at first? 

>>Vivecca: We have the link for it. It just wasn't fully updated. But that's a risk with any website, right? 

>>Linda: You can see more of it on one page and then we can come back to this one. Okay. So, yes. So you can see that DBMD is the fourth column on here. Just about everything at the top -- it looks like it was written for DBMD because it's just got all these supports. So as you read down, I'm going to read on the left. Residential services. Adaptive aids. Behavior supports. Case management. A day program called day habilitation. That starts when you're out of high school and an adult. Dental care. Emergency response. Employment assistance, which is finding a job. And then later on we're going to read about supported employment, which is keeping the job. Minor home modifications. The next line does not have financial management services. That's only in Texas Home Living. Now, we're back to DBMD. Medical supplies, nursing, professional therapies, respite, supportive employment, which I already spoke about. Transition assistance services, which starts at about age 14. And goes to 26, I believe. Transportation services. Unlimited prescriptions. There's a few caveats that we'll see on the other one. For example, some of the dermal medical equipment and the prescriptions, first you have to try the acute care side in your private insurance first. Okay. Now we're down to chore services. Intervener, which is interpreter, but you're interpreting sight and sound. Orientation and mobility and personal attendant services community first choice, which is a different federal program for attendant care. And they just have different funding and different matches but it's basically attendant care. So they say CFC for community first choice or past hab. And it's all really the same product. Now, you can see all these caveats at the bottom -- and I think there are letters. Pretty hard to read here. But that is it in a nutshell and then we probably could go back to the other one and see some of the finer points, if you guys would like. Vivecca or Heather, are there certain ones on here you want to really highlight, now that we've seen that? 

>>Vivecca: Yeah. 

>>Heather: Yeah. This is Hex here. The day hab. They have changed that to a different name now. I'm going to mix it up. I know it's ISS. 

>>Vivecca: Individual skills and socialization. And they've also asked us not to call it ISS because that's isolation kind of a behavior treatment when you're in schools. So it is individual skills and socialization. Or, as Linda called it, a day program. I call it day program often too because I don't want to say that out loud. But primarily what it means is once you're out of school, you have a program to attend and you are able, in the DBMD program, to have an intervener attend with you at your individual skills and socialization program. So DBMD allows for dual service to attend a day program along with the intervener. That is one of the biggest and best benefits of it. But you have to have a day program to be able to attend. And you need to allow your intervener to join with your attending family member. That's great and it's wonderful. It's not available everywhere but we want to help you create it, if you don't have it somewhere. I would also like to chime in about CFS PAS/HAB. Call to get on the interest list, you don't know what will become available but what is available -- and Hex and Linda, please chime in -- is the CFC. Community first choice. You can get funding for services for an attendant while you are waiting on the interest list to get your Medicaid Waiver Program. That can be very impactive to a family to be able to afford the opportunity to have somebody help care for their loved one while they are waiting. And it could be years. But the pay -- we're always advocating for increased pay -- but what is the common average pay now for a PAS/HAB -- CFC PAS/HAB? Is it around 15? So $15 an hour, I've got to say, when you had nothing option and you don't have to wait ten years. Anything you want to add to that? 

>>Linda: CLASS is at, they passed $13 but they're still at $12. HHSC said this is an average so CLASS is still at $12. 

>>Vivecca: Their pay rate? 

>>Linda: Yes. 

>>Vivecca: That's for people on the waiver? 

>>Linda: That's for people on the waiver. And -- yes. 

>>Vivecca: I think that's the -- 

>>Linda: They have a range that goes up to 20. 

>>Vivecca: You can have the same attendant services when you're on the waiver but I think the cool part about Texas is they have the community first choice, CFC part, before you're on the waiver. Then when you're on the waiver you get access to these specialized services, which we'll go into and explain. I think there's a good summary page. But this page that we're on, like the first page, shows you the unique ages of the different programs. This shows you the unique dollar budgets of the programs. And if you look at the first one, HCBS, 202% of the analyzed cost of care in a nursing facility. And that's essentially what the common cost of care in an institution is a common description when talking about Medicaid Waivers. So for CLASS and DBMD, if you look at the two columns there, there are $149,774. That is supposed to be 200% of the cost of institutionalization today. And that's what that represents. That number represents. If you look at the other waivers, like this -- if I go to the left, youth empowerment services, it's $35,804. STAR kids is going to be less. CLASS and DBMD are 200% of the analyzed cost of institutionalization. HCS is higher level of need based on the level of need, and it can go up to $169,182, 210%. Texas Home Living has a budget of $31,684. Those are things to keep in mind. I will also say that when you are still in the school system, the waiver program cannot be pay out for services while you are in school. So if my son were still in school from the morning to the evening, afternoon time that he's in school, he can not have waiver services or attendant. They are for outside school hours. For holidays, summers, et cetera. So although DBMD is from birth to Earth, you just wouldn't use that funding source while you're in school. So a school-age child may only use half of their budget but a child outside of the school system, fully dependent on their waiver, may use the full waiver but cap. Okay. 

>>Heather: Thank you, Vivecca. Awesome. That's great. You know, I just learn every day. While we were preparing for this presentation together, I feel like I picked up so much from these guys. I do remember the CFC that's available before you get on a waiver. That's a really fantastic thing to look into because it can feel like a long time before you're on the waiver so CFC can be very helpful during that time. And one more thing I want to spotlight is picking the best waiver for your loved one. It could be as simple as the first one that you get to the top of the list on. You know, the first one that comes up. Hey, we're going to get in there and that's really great. That might be part of the decision. When you're thinking about, you know, if you come up on another waiver, you can transfer over. You can be on multiple waivers at the same time and just go to the one that gets best when it comes up for you. We know that the Deafblind people on CLASS, there are Deafblind people on CLASS, there are Deafblind people on the DBMD, it just depends on what fits that individual the best. Sometimes DBMD, you know, they have intervener services which can be a real boon for some people. While CLASS has recreational therapies on there, which can be really amazing for other people. I'm always looking at that recreational therapy. But, you know, DBMD works the best for us right now so that's where we stay. So before we move on, I just want to say that this document is very informative. So the link will be in your handout. Really, all of the links will be in your handouts with all the resources and the different waivers are all going to be in there. So you'll have that. Vivecca or Linda, anything else before we move on to the next one? 

>>Vivecca: Just that you'll have to make the phone call to get on the interest list and then become eligible for the CFC. 

>>Linda: Yes. 

>>Heather: Yes. Uh-huh. Yes, we cannot emphasize enough. Call to get on that interest list for your loved one. It's so important to get on the interest list as soon as possible. And we do have the phone number listed here coming up soon. So we are going to get into some examples of some of the waiver services under the different Waiver Programs. A little bit of a comparison. So we just picked three just to show you some examples. The first one is the Deafblind one. They have intervener services, so basically that's a one-on-one person with Deafblind-specific skills. This one is only available on the DBMD waiver. I'm going to show you a quick home video of an intervener at work, just so y'all can see what that looks like, if you have never seen it before. And there is no sound with this. It's intentional. Maybe. So this is some tactile tunes for Orion. It's a subpack. It's like a big speaker backpack on your body. And then we see here, this is Orion's intervener who's working with Orion, exploring this subpack. And they're exploring it together. The interveners also connect other family members to the Deafblind person. That can happen. It's not always necessary, but a lot of times they can end up coaching people to feel comfortable on how to approach a Deafblind person. You know, they might say, okay. Have some good tips on how to connect and really build those relationships. This is another -- sometimes the intervener is kind of like a PR agent for the Deafblind person. They're just making those community connections. I'm going to pause it here so we've got Orion and his big brother, Skyler, and the intervener, and they're all interacting together. It's just another great example of how interveners, community interveners can really be engrained in the family and a whole family experience. They don't have to be always out in the community just the two of them. They really can be, you know, with the family and working all together. Or a community intervener. Okay. So back to our slide. DBMD services also include orientation and mobility. O&M teaches sensory awareness and skills of or for the self, the environment, and travel. And really O&M is everything. So this orientation and mobility services are specific to the DBMD waiver. Those are the only ones you can get that on. Earlier Vivecca mentioned individualized skills and socialization. And so that is teaching and supporting self-help and adaptive skills for independence, socialization, and participation. Vivecca, I'm going to click on this, just to show one program that offers individualized skills and socialization. And here we have Touch Base Center for the DeafBlind. Vivecca, do you want to say anything about Touch Base? 

>>Vivecca: Certainly. An intervener in the schools is paid by the schools. An intervener outside of the school system is a community intervener. At touch base center for the Deafblind. Everyone who attends comes with their intervener. That's my son in the red T-shirt in the middle of the screen with his intervener, Heath. All learn the mode of communication unique to their client that they work with. There's a picture where we all went down to Galveston and did some exploring in the community there. That's what individual and socialization skills requires. It was part of our plan to begin with so it worked out great. Our individuals who are deaf and blind with that sensorineural -- that loss of access to information, we need to give them the experiences of it. We get out in the community multiple times a week. Their interveners are with them to make certain it's a safe experience out in the community. They go as a group. And they have that intervener to help bridge that gap, that communication between others in the community. Or with their family. Or like even an O&M, if they are needing supports with the individual that's Deafblind. The intervener can help facilitate that communication and delivery of specialized services because they're trained on that individual. Plus, it's a strong bond of trust and support. I even went to something I had to do for another nonprofit where we were supporting a fundraising event. And my intervener was with us and it was very funny how my son wanted me to go away and wanted his intervener to go do the playground things and experience with him. At first when I was a young mother I thought, oh, no way. That's always going to be me. I am so thankful that he has that trusted relationship with someone else in the world so that I have the ability to work and do other things. It's amazing. So I am very grateful, very thankful to the state for this DBMD waiver. For all of the waivers for all of our families. So that the families have the ability to not be the only sole and primary caregiver at all times. So, I encourage you to share our numbers out as well for any families that you know of that are exploring waiver options. And if I don't have a personal experience like it, I will reach out to someone else who might like Linda or other organizations around Texas, because we have memberships statewide. Happy to share more about that. And the O&M services, you know, they get that at school but they need it at home and out in the community as well. There are times when we are navigating various places like church or the grocery store. And the intervener -- I mean, the O&M, through the waiver, can attend those places with you as well to help you navigate outside the school system in the community. 

>>Heather: Yes. Hex here. I'll add to that specifically with O&M. O&M can also help troubleshoot access issues in the home or in the community as well. So sometimes that might be sharing better routes or be like furniture placement and setup. Or just how, you know, ways to play it safe as well. You know, maybe walking around a swing set. How do we navigate this playground safely? You know, the swings can be -- they can be hard to navigate. Those individual skills and socialization, that waiver service is only available on three of the waivers, not all of them. The Deafblind multiple disability waiver is one. HCS is one and the Texas home health waiver is the other one. Those three -- those are the only three with the individual skills and socialization services so far. 

>>Vivecca: I thought I would mention that Touch Base has a Facebook site, if y'all wanted to see more pictures and activities. Just to share. 

>>Heather: Yes. Perfect. Excellent. Oh, maybe we can throw that in the handout later too. 

>>Linda: Do we need to show where that bike is highlighted? Is it a special bike? 

>>Vivecca: I would expect. 

>>Heather: Yes. So this last one on this DBMD is adaptive aids. I think almost all of the waivers have adaptive aids. Correct me if I'm wrong, but I think most of them have it. This bike was actually ordered through the Deafblind waiver. I'm going to show you Orion cruising. Saturday night bike cruise. He's got his feet up on the handlebars and he's cruising. And good boy, he's wearing his helmet so he is safe. And he really enjoys this. This is a really great activity that he enjoys. He's a speed demon. He likes it when I go really fast on that bike. 

>>Vivecca: Is it side by side? 

>>Heather: Yes. This is a side by side tandem bike. The traditional bikes are, you know, front to back but this one is especially made side to side for us. Okay. So that is all for the Deafblind waiver. I'm going to go here to CLASS services. And so let Linda share about some of these CLASS services. 

>>Linda: Hi. I have a daughter on CLASS so I guess I'm a good fit for this one. The CLASS waiver provides things that help you be ready for your day and get through your day. And so it provides attendant care for bathing, dressing, feeding, bathroom and laundry, cleaning, shopping. And the more fun things: Arts and crafts, going and blowing, you know, all over the community. And it provides adaptive aids such as a wheelchair, a bath chair, a Hoyer lift. My daughter has had hand and foot splints and the bike. She had one slightly different that looked somewhat like a trike. And anyway, there's just lots of different things that you can have. And in general, first they ask your private insurance to pay and then they ask Medicaid acute care. And then when all that is lined up and nobody's paid, then the waiver pays. And that's pretty much in general across all the waivers. So CLASS is famous for having specialized therapy in a swimming pool, on a horse. That's what hippotherapy is. Hippotherapy -- my daughter was born without the ability to have sitting balance and that therapy helps you, because of, you know, the regular gait shifts you left and right on the horse. Music therapy, massage therapy, and recreational therapy. So my daughter's in her 30s and she looks forward every week to four hours of rec therapy. And you figure out the goals you want at the therapy and then you also figure out where you want to go and what you want to do. And so some years she was in college and the college would put everybody on a bus to get to a frat party or a sorority party, just because there was going to be drinking. So Amy would get her rec therapist to take her to the frat party and hang around and help her whenever she needed it. So that's, you know, that's how specialized it can be for you. But what she does now is she just goes around and works on outdoor traveling, you know, on the drag or somewhere that's got a lot of traffic. Or they just do a lot of things. They go to theater, whatever they pick to do to have a goal. It also pays for once in your lifetime $10,000 of home modification. Which is usually taking a bathtub out and putting a roll-in shower or ramps or something. What is not listed on here, she has supported employment. She works for parent to parent and that provides that person transports her to all the meetings she goes to, helps her set up her laptop. She can dictate to voice dictation but not when she's in a meeting or not when somebody has called her and she's giving advice. So she has to go back and forth between voice dictation to a computer and dictating to a person. Supported employment pays for that. Some of supported employment is also funded by Texas Workforce Commission. You'll be working with two people as you get with supported -- or get with employment. You'll be working with Texas Workforce Commission and your case manager in your waiver. I guess that's all about CLASS. And we can move on. 

>>Vivecca: I do see one question. 

>>Linda: Sure. 

>>Vivecca: In the chat. 

>>Heather: Oh, yeah. 

>>Vivecca: If a family received DBMD services, are they responsible for locating a professional to work with the individual receiving the services such as O&M/intervener, or is this provider responsible? Or is it a team effort? 

>>Linda: It can be both. 

>>Heather: Yeah, this is Hex here. We are going to get to a slide about that. So we will answer that. I'm looking at the time. We've got about 15 minutes left so I think we can get through some things quickly so we can get more information about that specific question. This is an example for MDCP services. That includes family support services. While I was researching this, I think it's pretty interesting, this is where you have a person with your loved one in a situation that is natural support. Like daycare or post-secondary program, something like that where they have natural supports in place. But if they have a criteria -- if that place has the criteria, maybe they are not able to have the specific skills that that person needs, they will cover that specific skill that's needed so that your loved one with go to those natural settings that they might want to go to. This one's great. And employment services, like Linda was just talking about, describing the employment services under CLASS. Minor home modifications are also on this one. And each waiver program has their own budget cap for those specific services and for the home modification. This one is $7500 lifetime limit. Adaptive aids and medical supplies, which might include a van lift, those special chairs like the tumble form chairs. Stair lifts and repairs. That one is a $4,000 for each year. Go ahead, Linda. 

>>Linda: Oh, sorry. It's easier to get on this waiver for children while you wait for the top three waivers: CLASS, HCS and DBMD. They have 190,000 children waiting and it takes a while to get through that list. This one has a much shorter waiting list so many people go to MDCP before they go to the others. Deafblind multiple disabilities, we have been able to convince legislators they should feel real sorry for a child who can't learn their world because they are deaf and blind and why don't they just take care of that waiting list. And so I think I've seen that happen twice over the last two dozen years. I'm very willing to help have that happen again. So anyway, MDCP is easier to get than many of the other waivers. But they have made it more stringent. It used to be that, gosh, if your child had autism and you were getting one therapy a week and you wanted two, you would go try to get them on MDCP. But now they're looking for more medical things like does your child have a ventilator? Do they have a trach, feeding tube? Things like that. Do they need nursing in the home? Significant amounts of nursing in the home. So I can't promise you that everybody here could be on MDCP. Like Vivecca, it was easy for her child to have it back then. But try anyway. You know, all they can do is not agree. But you won't know until you try. Okay. Next slide, please. 

>>Heather: Thanks, Linda. We'll come back to MDCP and soon. But this is where getting on the Texas Medicaid Waiver. This is very important. So getting your loved one on an interest list, that is the first column. The phone number is right there. It's also in the handout. So that phone number is an important one to have. You can also contact your LIDDA, HCS and Texas Home Living. You can contact your LIDDA, which is the Local Intellectual or Developmental Disability Authority, to get on those. So that is where you -- yes. You can go in and find your LIDDA. For example, I can show you really quickly when we hit that "contact" it takes me straight to the contact page on the Health and Human Services website. And when you see "find service offices," they have it right there. They've got that LIDDA right there and you would click "search for services." And you put your ZIP code in or your county. So I'm going to put in the ZIP code where we are now at TSBVI. 78756. And there you have the numbers that pop up. There's three that come up. Integral care. That's our LIDDA. But everywhere in Texas has their own LIDDA so you just put your ZIP code in and it will send you to your LIDDA. They can help you get on the interest list or also have a lot of other services. So you would find that. 

>>Kaycee: This is Kaycee. I have a question real quick. So we have the interest list phone number on the screen there. We have mostly professionals in the audience and so just thinking about how our professionals who are serving babies and young children who are blind, have low vision, or Deafblind that we want to support the families in getting on this list. Was wondering what do the families need to have knowledge of or need to have in front of them when they call this number to get on the list? What will they ask the family so we can help the families feel prepared to make this phone call? 

>>Linda: The child's name, the child's birth date. If the child has a Social Security number, I believe they need that. It's really very basic. It just gets you on the list and you will get a piece of paper in the mail confirming the date and minute you got on the list. 

>>Heather: Also, you have to provide a phone number and address as well. 

>>Linda: The next box says "check annually." That's because Texas lost a lot of contact with families when their home phones went to cell phones only. Some of the families didn't get the clue that they better call in and update. We have seen the list actually get lowered for that. And then people had to try to get back on it somehow. 

>>Vivecca: This is Vivecca. 

>>Linda: That's a good idea. Save it in your phone. 

>>Vivecca: Save it as a contact in your phone and share away and tell them don't wait. Just call. 

>>Linda: Many people are born with genetic disabilities and they call right away. And then other parents, it's hit or miss whether they hear it in ECI, in early childhood program at school. We probably get a call a month from a family who has somebody leaving high school and is not on the list. So just do it in case you need it some day. 

>>Heather: Yes. Absolutely. And like Vivecca is saying, if you're figuring out -- if they are still figuring out their child's disability and not sure which list might be the best. Maybe it would be this one or another one, you know, getting on all of them is a great idea. You can be on all of them simultaneously. Those of us with kids with multiple disabilities, we do get surprised new diagnoses sometimes as the kid is growing up and there's a new diagnosis. And so you never know what's going to come up. That's another great tip for families. You never know what's going to come up so getting on all the lists is a great idea. Then in that last column, it says when you get to the top of the list, what do you do? You have to respond! Yes. You open everything. You follow the instructions that they'll give you. It can feel really overwhelming, I will say that. What do we do now? Which agency? Which option, waiver services? But which agency provides the waiver services. And you have to go through all these different options. You can call each one and do your own phone interview, contacting friends and families who have experience with the agency, learning about their experiences with the different agencies can be really helpful. 

>>Linda: May I answer the question that just popped up, how do you convince a parent? Try to get them to think ahead. You know, what if they end up not married, by some horrible accident. Or think about when their child is finishing high school and the two parents are looking at each other trying to decide who is going to quit their job because their child's still on a waiting list. And it would be really good at that point to have signed up as early as you can to make that length of time after high school shorter before they get some help in the home. Thanks. 

>>Vivecca: This is Vivecca. I too was trying to not chime in too much. But I have tried to convince many people and people are like, oh, I don't want to ask for help. Oh, you know, whatever the reason is. So I try to say you don't know what the future may bring. You are not asking for a handout. Your child and your family -- and everybody pays taxes for this purpose to serve people that cannot serve themselves. You are not doing it for you. You are doing it for your child. You are doing it for the family member that will inherit your child when you cannot be there for them. Just call. That's the best advice I can give. Just call. Don't worry about what you need to have in front of you. You'll get it. Just call. Just dial the number. Just call. I'm telling you because you don't know. And I have people say, oh, my son's not that bad. They are not today. They might not need this today. You are not going to get the call that services are available today. I promise you that. Unfortunately, it might be ten years down the line but you will have saved your child and your family ten years of waiting if you just call now. I don't know how else to say it. Just call. And I know that's too easy but that's the truth. I didn't call. I didn't know. I lost years. Fortunately, we were in the DBMD when they did extend slots. So I am very thankful. And if people don't know what to do with it when they get the call that they have come up, please call a family support organization. We're here to help. 

>>Heather: Perfect. Covered that great. Fantastic answers. We're going to go to the next slide. Okay, Linda, I'm passing this to you. We do have four minutes left. 

>>Linda: Yes. Okay. There is legislation that says that if you really need MDCP now and not wait five years, you may -- there's a route and it's called Rider 28. Rider is a law and says you can go to a nursing home from one to 30 days. And upon release from the nursing home, you will qualify for a waiver, particularly MDCP waiver. And people just, you know, Vivecca did it. Her child was Deafblind. Boy, that used to be a shoe-in. But they have proposed new rules and the virtual and in-person comments period is going on right now. The meeting to hear the virtual is Thursday morning at 9:00. But we also have until April 23rd to comment in writing. It would really be good, even if you're not going to speak, to go in and listen. Because the new proposed rules are that you have to have two of the following things: A ventilator, a trach, renal dialysis, oxygen dependence, total nutrition via tube feeding, congenital heart disease requiring card ac-related unplanned hospitalization, or be in hospice. Nothing on there said DeafBlindness and that's a really serious omission. So I would recommend that we all start writing our letters and coming to speak on Thursday. And I will send Kaycee how to get signed up to speak on Thursday and all the language. Thank you. 

>>Heather: Thank you, Linda. Linda, it really helps getting that information to people here today so we can add that proposed rule, information about that, and a link we can put in the handout. I put that down as a note to myself so you all can look at the electronic version of the handout and you can see what Linda is talking about. I will add that as soon as I can. Okay. So I'm just going to say for this there is medical eligibility and not financial eligibility on the waiver. So the waiver waives the Medicaid eligibility so that it does not count the parents' income. They're only looking at the loved ones or the person who would be on this list, their assets and savings just have to be less than $2,000. So if it's over $2,000, then they don't qualify. 

>>Linda: They can own a car and a home. They're free from this. But the rest of it has to be under $2,000. If you have more, you go put it in an able account and that is an account that is not taxed. And you can use it on anything that has to do with disability. Including all your living expenses. 

>>Vivecca: Or you buy a bike. Whatever it takes. Just stay under $2,000. Next is CDS agency model. Let's answer that question. Oh, not yet. There we are. 

>>Heather: Just really quickly, I have to emphasize this one thing. Once you get to the top of the waiver, you have a Medicaid application and you can write a big thing on there that says MDCP. Sorry. That was an interpreter error. I forget what the E is for. Medicaid for the elderly and people with disabilities. That. It's just really important to emphasize that's what your Medicaid application is for because if it looks like a regular Medicaid application, it's going to mess it all up. I have to really emphasize this. This is for the waiver and you want to make that really clear on your application. MEPD is what it is. Sorry. Go ahead. 

>>Vivecca: I just wanted to cover the question. Sorry. CDS versus agency. Everyone has different experiences. The original intent is that CDS allows you to pay higher wages to the staff that work with your family member. Agency, the more responsibility is on the agency to provide all the service providers and the question specifically was: Do you find the O&M or do they? Typically, CDS means the family member is the -- a family member, a mom. I am the CDS employer, I find the people. But will my agency work with me? Yes. If it's an agency model and there's a family that knows other people, will they help? Yes. It's a team effort but technically CDS is the family's responsibility. Agency is the agency's responsibility. Just to cover that question. But there's so much more we could say. Do you have some key points you want to say? I have many things I would say but it has been a little bit challenging lately, I will say that, with CDS. Because there's been some denials and some concerns and people have been stuck. Typically the way it's supposed to work is CDS puts the time sheet and review submission on the family and the agency model puts the -- they handle that. 

>>Linda: The reasons why many people choose CDS, one it pays a little higher to the attendant. You can get better-quality attendants. But the other ones were -- my daughter was in Girl Scouts and youth group at church. And they want to know who's around all their kids. They want people they trust. So they would rather you pick the attendant, somebody that's known to Girl Scouting or known to youth groups, known to the church. And that's another reason. And the third reason is some of the providers don't allow their employees to drive you anywhere. And when you're doing CDS, you make the decisions. You decide if your kid can drive in their car or they can drive your vehicles. In our case, we have Ramp vans, they of course are going to be driving our vehicles. That's why we chose CDS. 

>>Vivecca: Sorry. 

>>Heather: Go ahead. 

>>Vivecca: I was going to say it would be dreamy if an agency person could provide all the service providers my child needs. That would be dreamy. Just doesn't really exist. Go ahead. 

>>Heather: Agreed. I'm going to go to the last slide. We're flying through this. This is also in your handout of just the regular actions that you have to do quarterly, annually, and when your loved one is in the hospital. It's very important you have to let the case manager know any time there is a hospitalization. Resources. These are also in the handout. It has the LIDDA link. It has the phone number for any concerns or if you need help problem solving, really specific things to the MDCP and the DBMD waiver. They have an escalation line. There's an omnibus office for managed care. Ombudsman for managed care. So, you know, managed care for health is a concern. There's also family to family connections. PTFK is a fantastic Facebook page. DBMAT. Again, I go to DBMAT for any questions. What doctors are good? Waivers, where do I go? And also Texas Chargers are in there. Thank you so much for letting us race through this complex topic together. I think -- 

>>Vivecca: May I close with a positive in that we're fortunate to live in Texas. We're fortunate to have these waivers. They are federally funded, partially, and facilitated by Health and Human Services here in Texas. It is a lifeline for families, especially when they're no longer in school. If you can help them get connected with that interest list number, with CFC, which is Community First Choice, first services, prior to getting on to a waiver, it could help the health of a family drastically. Today or later. If they're not ready for it, they don't have to be. But just get on the interest list so that when the time comes -- because by the time they're pulling their hair out, it's a little -- I don't want to say too late but they could have saved themselves years. We're fortunate to be in Texas. Let's make use of these services.