Medicaid – In-Home Supports Waiver For Adults

Purpose

The In-Home Supports Waiver for Adults (IHSW-A) provides services and support to Oklahoma residents with specific types of intellectual disabilities.  The waiver assists individuals in their goal to lead healthy, independent and productive lives in the community.  Services offered are not otherwise covered through Oklahoma’s Medicaid State Plan (SoonerCare).  Services provided under the IHSW-A include assistive technology, as well as, other services, which may relate to assistive technology including adaptive equipment, audiology, dental, nutrition, occupational therapy, physical therapy, speech therapy, architectural modification and specialized medical supplies.

Contact

Oklahoma Department of Human Services
Developmental Disabilities Services
4345 N. Lincoln Blvd.
Oklahoma City, OK 73125
(405) 522-7300
https://oklahoma.gov/ohca/individuals/in-home-supports-for-adults.html

Financial Criteria

  • See “Eligibility”

Eligibility

  • An individual must be age 18 or older;
  • meet SoonerCare financial eligibility requirements, which currently limit monthly countable income to $2,205, and a resource limit of $2,000. These figures are subject to change;
  • 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 Intellectual/Developmental Disabilities (ICF-IDD);
  • not be receiving DDS state-funded services such as the Respite Voucher Program, sheltered workshop services, community-integrated employment services or assisted living without waiver supports;
  • 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 an intellectual disability and meet ICF-MR level of care requirements;
  • reside in the home of a family member or friend, his or her own home, an OKDHS Children and Family Services (CFS) foster home, or a CFS 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; and
  • for additional information regarding waiver eligibility, 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.

AT Services Provided/Covered

  • 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
  • Interpreter services
  • Reader services

AT Devices Provided/ Covered

  •  Aids for Hearing Impaired
  • Mobility/Seating & Positioning
  • Speech Communication
  • Environmental Adaptations
  • Aids for Vision Impaired

Application Process

  •  Oklahoma’s Developmental Disabilities Services (DDS) operates statewide with four offices in the state.  To apply for waiver services, please contact the area office nearest you.

Dispute Resolution 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 to 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.
  4. You will be asked to fill out a form that says exactly what you disagree with.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.

Pieces of the Puzzle

  • Currently, there is a waiting list to receive services through the IHSW-A.
  • There is a maximum dollar limit of services that an individual may receive through the IHSW-A during a 12 month period.
  • Services provided through Oklahoma SoonerCare will not be covered by the IHSW-A.  Individuals ages 18-20 will receive services through SoonerCare Child Health Services Program. IHSW-A will not cover any services provided through that program. For more information related to the SoonerCare Program visit www.okhca.org.
  • All IHSW-A services are provided by agencies or individuals who have entered into contract agreements with the Oklahoma Health Care Authority.
  • A DDS Case Manager assists with the development of a plan of care, which must be approved prior to all service delivery.  The Case Manager also assist with locating, securing and coordination of needed services.
  • DDS Area Offices operate an assistive technology reuse program.  Contact the area office closest to you for more information.
  • Please refer to Oklahoma’s rules related to DDS 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.
  • Self-Directed Services (SDS) is an option for IHSW-A members that provides the opportunity to exercise choice and control in identifying, accessing, and managing specific waiver services and supports in accordance with their needs and personal preferences. SDS are waiver services DDS specifies that may be directed by the member or a representative using both employer and budget authority. IHSW-A members are not required to utilize the SDS option.