Through years of research and collaboration with individuals with developmental disabilities, families, providers and community organizations, the Louisiana Department of Health has ended the 25-year-old waiting list for specialized home and community-based services.
In its place, the Department has developed an innovative approach for providing these services to people with developmental disabilities that will prioritize the needs of people instead of the date they applied for services.
The new plan, or Tiered Waiver, means that individuals with a greater urgency of need will now be prioritized for receiving the most appropriate home and community-based services.
Over two years ago, LDH’s Office for Citizens with Developmental Disabilities began a screening process to evaluate the needs of the more than 10,000 individuals who were on a waiting list for services. As of today, all of the people on this waiting list who have an urgent or emergent need for waiver services have received a waiver opportunity.
The screening, using a nationally accepted best practice, considered what services and supports were already in place, whether or not the person was eligible for Medicaid, the severity or complexity of the person’s disabilities, what additional supports may be needed and any changes in an individual’s life or living situation.
Urgency of Need is not solely based on the severity/complexity of a person’s disability. It identifies supports in place, supports needed and consideration is given overall to changes in a person’s life and living situation. For example, when considering the urgency of need, the person conducting the screening will ask questions about supports that are now in place, the ability of a caregiver to provide supports, eligibility/availability of various types of supports. If something is changing in that individual’s life, such as a caregiver no longer able to provide the same level of supports for reasons such as life-changing illness, a physical disability of the caregiver, etc. then this would change the urgency/priority of the need.
This is just one example of an area that might be considered when evaluating the urgency of need. There are four (4) areas that are considered during the screening to identify each person’s urgency of need:
- · Change in Caregiver Status
- · Change in Individual’s Needs/Circumstances
- · Change in Availability/Eligibility Status
- · Change in External Factors
Each case was given a Screening for Urgency of Need (SUN) Score to determine the urgency of need for waiver services. Five levels of need, or tiers, were created. Everyone in Tiers 3 and 4 will be offered the most appropriate services and supports.
- 4-Emergent: Supports will be needed in the next 90 days. (7% of the individuals requiring services)
- 3-Urgent: Supports will be needed in the next 3-12 months. (8%)
- 2-Critical: Supports will be needed in the next 1-2 years. (22%)
- 1-Planning: Supports will be needed in the next 3-5 years. (23%)
- 0-Currently no unmet needs (40%)
While the Department will continue to maintain a registry of individuals, today, the registry reflects that those with needs are receiving the services necessary to continue living in a home or community environment. The registry allows the department to plan for and to be responsive to individuals if their needs change, becoming urgent or emergent.
Prior to this change, it would have cost the state $832 million in new state and federal dollars to address the needs of all of the individuals on the waiting list. However, with this approach, meeting the needs of individuals with disabilities is resolved with a $43 million investment (passed by the Legislature in 2018) which includes state funds and a federal match.
For additional information or frequently asked questions regarding Tiered Waivers, click here.