Q&A: Changes to Individual & Family Services

We understand that change can be difficult, but if there’s one thing we know for sure, it’s that change in big systems is inevitable; it also offers new opportunities. If you have a question that’s not address below, please email us with your question. We will track down an answer for you.

When does the change happen?
If the IFS waiver application is approved by the Center for Medicare and Medicaid Services (CMS), the new program will begin in late spring of 2015. If the person is already SSI eligible, transition will automatically occur when the waiver is approved. However, most individuals and families will be moved to the new waiver during the month of their annual assessment, so if that’s a year from now, then that’s when they will transition. Until they transition, they will continue to use the current IFS program.

Are the funding levels different?
No. They are the same as the current IFS program, ranging from $1,200 to $3,600. And just like with the state-only IFS program, you can use that funding in a flexible way, depending on your needs. The cost for all waiver services will be deducted from your annual allotment.

Are the services different?
Every effort has been made to make the new waiver cover the same services that are currently available on the state-only funded IFS program. However, there are some federal rules that must be followed, such as not being able to cover co-pays for medical expenses, or be reimbursed for expenses incurred by the family. Other changes include the requirement to use qualified providers, and also to insure that all services are in integrated settings. The new waiver will not be able to pay for the cost of recreational opportunities in the same way that it does with the state-only IFS program; however, the state is proposing to use support for recreational experiences, such as summer camp, as respite.

Will I be reimbursed for medical co-pays?
No. Unlike the current state-only program, this is not an allowed service under the waiver. However, because this is a Medicaid-funded waiver, individuals on the IFS waiver will be eligible for Apple Health (Medicaid). If your child is covered under private health insurance, and your provider accepts Apple Health, then Apple Health can be used as a secondary insurance.

Can I be reimbursed for out-of-pocket expenses?
No. The IFS waiver program will only cover services by qualified providers. If you currently rely on reimbursable services, activities or items, this will be a significant change for you. If you prefer the current flexibility of IFS and you qualify for SSI, an alternative to IFS is the State Supplemental Payment (SSP) program, a cash benefit program for DDA clients with low income who are assessed to be eligible for IFS. With this program, you can spend the cash as you wish, but must be willing to count the amount against income ceilings.

What does qualified provider mean? Can I still hire a relative for respite care?
A qualified provider is an individual, agency or organization that is contracted with DSHS to provide a specific service. Some providers for services such as respite, may require training. They will be paid by the state directly. Friends and relatives can provide respite only if they become a contracted provider. If not, then the answer is no, you cannot use your funding to hire them. Waiver funds can only be paid to individuals who are contracted with DSHS.

How do I find out who qualified providers are?
Your case manager will be able to give you the names of qualified providers for the services or equipment you wish to purchase with your IFS allotment.

Will the new IFS program pay for summer camp?
Not in the way that it currently pays for camp tuition; however, DDA is working with the Centers for Medicare and Medicaid Services (CMS) to pay for camp as a respite service as long as the camp program is contracted with DSHS as a respite provider. It will take some sorting out on a case-by-case basis. Families whose annual IFS assessments are not due until next September or beyond, will still be operating under the current IFS program, so it’s less of a concern for the summer of 2015. However, families whose assessments are due sometime between May and August 2015 will need to start talking to their case managers in late spring when more will be known about the contracting process.

What are the new benefits available under the IFS waiver?
Some of the new services available under that IFS waiver include: community guide/integration (providing the waiver participant with support to access the community), person centered plan facilitation, supported parenting, and peer mentoring for individuals and their families.

How does my local parks and recreation program get approved?
The first step will be to fill out contracting paperwork with DDA contracts staff. You or your Parks and Recreation personnel can contact your local DDA office and ask to be connected to contracting staff who will help you start the process.

Will mileage be covered?
Transportation (which includes mileage) is covered if it’s to and from a waiver service.

I heard that I need a monthly service in order to stay on the waiver, but what if I only need IFS for occasional respite or summer programs?

It’s true that if you want to remain on the waiver, you must use a waiver service every month. If the services you use are intermittent, your DDA Case Resource Manager will do monthly monitoring calls or records reviews to fulfill this requirement.


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