MN Waiver System: What Parents Should Know

In Minnesota in order to be eligible for a waiver, you have to qualify for Medical Assistance.  This all depends on your income.  You may have to pay a parental fee if your income is too high, otherwise known as TEFRA.  You can apply through the MNSure process online here:   MNSure Link.

Contact your county's social worker to let them know you've started the process.  They should also help you determine if you qualify for straight MA of TEFRA.  

You also need to have your child determined as someone with a disability through the state medical review team. 

Here are some: TEFRA FAQ's

When contacting your county's social worker, request a MNChoice Assessment.  The outcome of this assessment will determine what, if any, waiver you qualify for.   It is FREE, occurs in your home, and should take place within 20 days of your request. 

IT IS IMPORTANT TO BE DETAILED IN DESCRIBING THE NEEDS OF YOUR CHILD.  I can't emphasize this enough.

Although the MNCHoice Assessment is standardized, meaning the same questions for every child, the responses you give will ultimately impact their "score."  Be truthful, but be thorough.  It's easy to overlook something because you do it every day.  Be sure to think about everything you do for your child when answering questions. The assessment is essentially looking at the amount of support your child needs for his/her Activities of Daily Living (ADL's) compared to a same age peer.  This is one reason why the current system, in my opinion, is not sufficient.  It can be challenging to get infants to qualify for support because typical babies are 100% dependent on adults for all things.    Thus, there is not a huge discrepancy in babies with brain injuries and neurotypical ones. Nevertheless, this is the current way eligibility is determined.  

After they leave, they will  summarize the results. They will get back to you with what type, if any, services you qualify for. They have 40 days to provide a written plan of options based on the assessment results. 

Here is the link to the handout re: MnChoiceAssessment from DHS 

Here is the general link about MNChoice from DHS' site:  DHS MNChoice

There are several waivers that your child may qualify for.  Please know each one is different, so you want to ensure you have all the information before deciding.  You may qualify for two more more, so knowing which one is most appropriate for you is important.  The budgets are often different.  These are the 3 types you will most likely be eligible for:  

• CAC- Community Alternative Care Waiver.  This one is for children requiring hospital level care.  This is for children that are chronically ill and frequently in the hospital.  Ask yourself, "if something happened to me would my child have to be hospitalized in order for them to be taken care of?" This comes with the highest budget is intended to help fund and hire staff.

                    It's also important to know that many counties require a private duty nursing                     assessment (PDN) to be eligible for this waiver.  Please see next section for more information. 

                   Here is the link for the CAC Fact Sheet., as well as the link on DHS' site.

• CADI- Community Access for Disability Inclusion.  This is for children who require nursing level care.  CADI and CAC are the two that most often get confused, but are the most appropriate for medically complex kids. 

                    Here is the link for the CADI Fact Sheet, as well as the CADI info on DHS' site.

• DD- Developmental Delay.  This is for children with developmental delays and related conditions.  It's important to make a distinction between developmental delay and medically complex.  If your child is like Karter, we are both.  However, children with delays may eventually reach a developmentally milestone.  It just make take them longer to achieve it; hence "delay."  For Karter, there are certain milestones he will likely  never achieve.  We will modify and do everything we can to help him, but his brain injury and condition is severe.  Thus, CAC is the most appropriate waiver for us.  

                   Here is the link for the DD Fact Sheet, as well as the DD info on DHS' site.

The implementation of the state waiver programs varies greatly depending on where you live. This should NOT be the case, but its the reality right now.  There is lots of misinformation out there, sometimes by well-intentioned county workers that are the ones there to help you.    Be weary if you hear...

• "Your child won't qualify for the CAC waiver unless he/she has a trach...." NOT true. I know so many children who don't have trachs that qualify.

• Your child won't qualify until age [insert random number].  That also is NOT true.  Eligibility should be determined by needs, not age.  Keep in mind, however, eligibility IS determined by the discrepancy of ADL's and typical peers.  Often times as kids get older that discrepancy gets wider, so services and budgets will increase.  Still, Karter qualified for CAC at age 2, so age isn't an automatic disqualification.

• Please also know CAC eligibility often requires a Private Duty Nursing Assessment (PDN).  This can be obtained by asking your primary care physician for a referral to a nursing agency for an assessment.  Depending on your insurance or MA, it should be covered.   We made the mistake of paying out of pocket for this.  It certainly expedited the process, but it is something that should be provided to you.

• Some families have been lucky enough to qualify for CAC WITHOUT a PDN.  Others have asked their physician to certify them as needing hospital level care.  Please see this form:  Physicians Certification for Homecare.  It may be worth trying this before seeking a PDN.  It shouldn't be this way, but in our experience it depends on the county.  

If you qualify for a waiver, the vast majority of people choose the Consumer Directed  Community Supports (CDCS).  This allows you, the parent, to determine how your budget is spent.  In doing so, you will work with your county social worker to develop a support plan.  The services and supports you opt to include in your budget must support these goals. 

You will  also need to hire a support planner- your county worker can refer you to someone.  The support planner will work with you and your county social worker to allocate your budget to supports and services your child needs most.  YOU decide how they are spent.   Once your budget plan is written, you submit it to your county social worker for approval. He/she will review it and determine which things are approved, pended, or denied.

One great thing about the CAC waiver under CDCS is you can opt to hire staff or even pay yourself.  The state of Minnesota recognizes that parents like us often have to give up their jobs to take care of their child.  That's exactly what happened to me.  Finding staff is a huge challenge, too.  Often times, families can't.  So they have to stay home and be the caretaker.  The "paid parent" option allows you to recoup some of the loss of income.  

It's also important to know your plan isn't written in stone.  It's flexible, and you can revise as you need to.  For example, if insurance denies a piece of equipment your child needs, you may be able to use your waiver to pay for it.  Typically the county requires a copy of the denial letter.  Please know any time you make a revision request they have 30 days to review and respond.  If they deny your request, you always have the option to appeal. In our experience, your county worker will work with you to determine the necessary documentation to get the support or service approved.

Of course there are limitations to what you can include in your budget.  Please see the Washginton County Expenditure Guide for an example of what our county allows.  

Here is the link to the CDCS information on DHS' site.

Once your budget is approved you will need to find a Fiscal Management Service (FMS).  They will function as your "human resource department" and finance manager.  If you opt to pay yourself or hire staff they will ensure you've completed all the necessary steps and paperwork, and will function as the place who's "hired" you/staff.  They are responsible for reimbursing you for any approved purchase you pay for out of pocket.  You will be responsible for filling out timesheets , expense forms, and adhereing to their policies.  They will also oversee your budget and ensure it is accurate and updated as waiver dollars are spent. 

It is important to know they will charge a certain percentage of your overall waiver budget for their service.  Each place will have their own rates, so be sure you "shop" around.  They will make your life easier.