Virginia Medicaid Resources:

• State Medicaid Website: Virginia
• Virginia Board for People with Disabilities Website
• The Arc of Virginia

Virginia Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 156,900 people with disabilities who are covered by Medicaid in Virginia. Virginia spent $13,775 for each Medicaid recipient with a disability in 2007.

18% of all people using Medicaid in Virginia have a disability, which is almost the same as the national percentage of Medicaid recipients who have a disability (15%).

Virginia spends 46% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

Medallion and Medallion II Programs:

Under these programs, children and adults with disabilities are covered for a variety of basic medical services. Services may differ depending on whether people live in intermediate care facilities, nursing facilities, or participate in an HCBS waiver.

Health: dental, durable medical equipment, disease management, early and periodic screening, diagnosis and treatment, family planning, hearing, immunization, hospital, mental health, laboratory, occupational therapy, substance abuse treatment, pharmacy, physical therapy, physician, podiatry, speech therapy, transportation, vision, ad x-ray

• Home: home health care
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to a PACE center to be eligible.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home health care, home and environmental modifications
• Social Services: social services

Non-Emergency Transportation Program:

This program can help pay for transportation to and from routine, scheduled doctor’s appointments and related medical errands. Some people who are also eligible for Medicare will not be covered.

• Community: health-related transportation

Intellectual Disability (ID) waiver:

This waiver covers people who have an intellectual disability or developmental delay. The person must be at risk of placement in an intermediate care facility.

Ages: 6 years old and under for developmental delay, 6 years old and older for intellectual disability. Children who do not have the needed diagnosis to continue on this waiver at age 6 should transfer to the IFDDS waiver.

Level of Care: intermediate

Option for Self-Direction: This waiver allows people to direct their own personal care, respite care, and companion services.

Restrictions: There are three kinds of waiting lists for this waiver: the Urgent list for people who need services now, the Non-Urgent waiting list for people who will need services within 30 days, and the Planning List for people who will need services sometime in the future. There are currently many people on each of these lists, and preference is given to people on the Urgent list as slots become available.

• Community: day support
• Health: assistive technology, skilled nursing services, therapeutic consultation, crisis services, personal emergency response systems
• Home: residential support services, personal care (with options for self-direction), respite (with options for self-direction), companion services (with options for self-direction), environmental modifications
• Social Services: support coordination
• Work: supported employment, prevocational services

Day Support waiver:

People on the Urgent and Non-Urgent waiting lists for the ID waiver who have an MR/ID diagnosis are eligible for these day services while they remain on those waiting lists.

• Community: day support
• Work: prevocational services, supported employment

Individual and Family Developmental Disabilities Support waiver (IFDDS waiver):

This waiver serves people 6 years old and older who have developmental disabilities but do not have an MR diagnosis (including people who transfer at age 6 from the ID waiver). This waiver will help pay for in-home services so that these children can live at home with their families instead of in institutions.

Ages: 6 years and older

Level of Care: intermediate

Option for Self-Direction: This waiver allows you to direct some of your own services, including companion services, personal care, and respite care.

• Community: day support
• Health: therapeutic consultation, skilled nursing services, crisis supervision, assistive technology, personal emergency response services
• Home: companion services (with options for self-direction), in-home residential support, personal care services (with options for self-direction), respite care (with options for self-direction), attendant services, family and caregiver training, environmental modifications
• Social Services: support coordination
• Work: supported employment, supported employment, prevocational services

Elderly or Disabled with Consumer Direction waiver:

This waiver serves people aged 65 or older, and people with disabilities of all ages. This waiver allows people to get care in the community rather than in a nursing home. People with disabilities can be served by this waiver while they are on the waiting list for other waivers, like the IFDDS waiver, and then transfer to the other waivers when slots become available.

Level of Care: nursing

Options for Self-Direction: This waiver allows you to direct your own personal care and respite care.

• Community: adult day care
• Health: help with medication, personal emergency response systems
• Home: personal care aide (with options for self-direction), respite care (with options for self-direction)

Technology Assisted (Tech) waiver:

This waiver serves people whose disabilities require intensive and ongoing care.

Ages: People under the age of 21 are eligible if they are dependent on technology to survive and have used up other resources for nursing care. People over the age of 21 are also eligible.

Level of Care: nursing

• Health: private duty nursing, assistive technology
• Home: personal care, respite care, environmental modifications