MEDICAID-IN HOME SUPPORT WAIVER FOR CHILDREN (ISHW-C)
Developmental Disabilities Services Division (DDSD)
Department of Human Services (DHS)
PURPOSE
The In-Home Support Waiver for Children (IHSW-C) provides services and support to Oklahoma residents with mental retardation. The waiver assists individuals in their goal to lead healthy, independent and productive lives in the community. Services and support offered are not otherwise covered through Oklahoma’s Medicaid State Plan (SoonerCare). In order to be eligible for the IHSW-C, an individual must reside in the home of a family member or friend, his or her own home and have needs that can be met through a combination of non-paid, non-waiver, SoonerCare and IHSW-C resources within the annual waiver limit. Services provided under the IHSW-C include assistive technology as well as other services which may relate to assistive technology including architectural modification and specialized medical supplies.
CONTACT
Paula Green, Program Manager
Oklahoma Department of Human Services
Developmental Disabilities Services Division
P. O. Box 25352
Oklahoma City, OK 73125
(405) 521-6274
FAX: (405) 522-0729
See Appendix B for Department of Human Services DDSD Area Offices.
FINANCIAL CRITERIA
• See “ELIGIBILITY”
ELIGIBILITY
• Individuals must meet SoonerCare financial eligbility requirements, which currently limit monthly countable income to $2,022, and a resource limit of $2,000. These figures are subject to change.
• Individuals may not be simultaneously enrolled in any other waiver program or receiving services in an institution including a hospital, rehabilitation facility, mental health facility, nursing facility, residential care facility or Intermediate Care Facility for persons with Mental Retardation (ICF-MR).
• Individuals must not be receiving DDSD state-funded services such as the Family Support Assistance Payment, Respite Voucher Program, sheltered workshop services, community integrated employment services or assisted living without waiver supports.
• Individuals must be age 3-17.
• Individuals must be determined to have a disability as determined by the Social Security Administration (SSA) or the Oklahoma Health Care Authority’s (OHCA) Level of Care Evaluation Unit and must also have a diagnosis of mental retardation.
• Individuals must be determined by the OHCA Level of Care Evaluation Unit to meet ICF-MR level of care requirements.
• Individuals must reside in the home of a family member or friend, his or her own home, an OKDHS Children and Family Services Division (CFSD) foster home, or a CFSD group home and have critical support needs that can be met through a combination of non-paid, non-Waiver and SoonerCare resources available to the individual and with waiver resources that are within the annual waiver limit.
AT SERVICES PROVIDED/COVERED
• Sign language interpreter services for people who are deaf
• Reader services
• Assessment for the need of assistive technology/auxiliary aids
• Training the service recipient/provider in the use and maintenance of equipment/auxiliary aids
• Repair of adaptive devices
AT DEVICES PROVIDED/COVERED
• Assistive devices for consumers who are deaf or hard of hearing. Examples include visual alarms, telecommunication devices (TDDs), telephone amplifying devices and other devices for protection of health and safety.
• Assistive devices for consumers who are blind or visually impaired. Examples includes tape recorders, talking calculators, lamps, magnifiers, braille writers, paper and talking computerized devices and other devices for protection of health and safety.
• Augmentative/alternative communication and learning aids such as language boards, electronic communication devices and competence based cause and effect systems.
• Mobility positioning devices such as wheelchairs, travel chairs, walkers, positioning systems, ramps, seating systems, lifts, bathing equipment, specialized beds and specialized chairs.
• Orthotic and prosthetic devices such as braces and prescribed modified shoes.
• Environmental controls such as devices to operate appliances, use telephones or open doors.
APPLICATION PROCESS
• Oklahoma’s Developmental Disabilities Services Division (DDSD) operates statewide with four offices in three areas of the state. To apply for waiver services, please contact the Area office nearest you.
APPEALS PROCESS
1. Anyone who applies for/or receives services from the Oklahoma Department of Human Services has a right to request the OKDHS Appeals Unit review an OKDHS action or delay action. This is called a Fair Hearing.
2. You have the right to request a Fair Hearing within 30 days after you have been notified of a decision with which you don’t agree or when there has been unusual delay by OKDHS in reaching a decision on your application or case.
3. If you want to request a hearing, contact the local OKDHS office that took the action or failure to act, that you disagree with. You will be asked to fill out a form that says exactly what you disagree with.
4. You may represent yourself or be represented by a lawyer.
5. The hearing decision will be made by the appeals committee, which is made up of the hearing officer and two OKDHS state office employees who were not involved in the action you are appealing. The appeals committee tries to get most cases decided within 30 days after the hearing. If the appeal is decided against you, you may ask the Director of OKDHS to review the hearing decision. The appeals committee letter will explain how to do this.
6. Please refer to the OKDHS website, www.okdhs.org, for further details related to Fair Hearings and Appeals.
7. For additional information regarding waiver eligbility, please refer to Oklahoma’s rules. These rules may be found in the Provider, Policies and Rules section at www.okhca.org, OAC 317:40-1-1.
PIECES OF THE PUZZLE
• Currently, there is a waiting list to receive services through the IHSW-C.
• There is a maximum dollar limit of services that an individual may receive through the IHSW-C during a 12 month period.
• Services provided through Oklahoma’s SoonerCare Child Health Services Program will not be covered by the IHSW-C. The SoonerCare Child Health Services Program lets children with SoonerCare, ages 0-20, get free medical, vision, hearing and dental checkups. If your child’s SoonerCare doctor finds a health problem during a health checkup, he or she may send you to another provider or another place for follow-up care. Services needed to take care of the problem will be covered through SoonerCare. For more information related to the SoonerCare Child Health Services Program visit www.okhca.org.
• All IHSW-C services are provided by agencies or individuals who have entered into contract agreements with the Oklahoma Health Care Authority.
• A DDSD Case Manager assists with the development of a plan of care which must be approved prior to all service delivery.
• DDSD Area Offices operate an Assistive Technology recycling program. Contact the Area Office closest to you for more information.
• Please refer to Oklahoma’s rules related to DDSD Assistive Technology (AT) devices and services. These rules may be viewed at www.okhca.org in the Provider, Policies and Rules section under OAC 317:40-5-100.
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