# Presentation: 719819

## USE OF THE HOME AND COMMUNITY BASED WAIVER TO FUND HOME MODFICATIONS IN NEBRASKASECOND SYMPOSIUM ON HOUSING FOR PERSONS WITH DISABILITIESJUNE 30, 2004

## History

- June 1996	Task force established to study long term care services
- May 1997	Recommendations published in report
- Nebraska’s elderly more likely to be living in nursing homes than most other states
- Expand alternatives to include home modifications
- Need to match level of need to level of service

**Notes:**
86/1000 vs 57/1000 of those 65 and older

## History

- Jan 1998	Contract begins with Assistive Technology Partnership
- 	Guidelines and procedures developed on home modification service
- 		Function with greater independence 		and is necessary to keep the individual 	in their home.
- 		$5,000 Cap.
- July 1998	Aged and Disabled Waiver begins to pay for home modifications

## HCBS Aged and Disabled Waiver	Home Modifications by Type 	98-03

**Type****	****	****	****# of projects****	****Total Expended****	****Avg **
*Bathroom Mod**	**         *1,010	     $3,874,687		$3,836
*Ramp**	**	**	**	*454	     $1,340,758		$2,953* *
*Lift (Exterior)**	**	**	*267	     $1,192,669		$4,466
*Entrance Mod**	**	**	*193	        $561,057		$2,907
*Lift (Interior)**	**	**	**  *96	        $423,444		$4,410
*Other Home Mod**	**	*311	        $555,785		$1,787
*Kitchen Mod**	**	**	**    *9	          $27,107		$3,012
**Totals****	****	****	****         1,967****	****     $6,693,230****	****	****$3,403****	**

**Notes:**
The average cost of Exterior and Interior Lifts has gone down as we recycle used equipment to projects. All other costs continue to rise as construction and materials cost increase.

## HCBS Waiver 	Breakdown by age

- 3-17

- 18-20

- 21-54

- 85+

- 75-84

- 65-74

- 55-64

- Birth-3

- HCBS Waiver 	Breakdown by age

## What have we learned?

- Rural Service Delivery Issues
- Sparse population
- Long distance to services
- Lack of contractors
- Lack of alternative housing options
- Is it feasible?

## What are we doing?

- Spreading technical assistance cost across multiple programs
- Providing on-site assessments
- Providing awareness of a greater market for contractors

## What have we learned?

- Fragmented funding/unclear policies
- No single point of contact/tracking/coordination
- Funding was hit or miss
- No funding hierarchy

## What are we doing?

- Developed referral process and guidelines for Waiver home mods
- Using Service and Device Form to identify and coordinate funding
- Established funding hierarchy
- Leveraging funding

## Funding Coordination

- ATP Funding Coordinator
- Receives Service and Device Form
- Determines eligibility for other resources
- Puts together coordinated funding package

## Major Funding Sources for Home Modifications 98-02

- HCBS Medicaid Waiver	1,694		$4,835,907
- Federal HOME funds (MHA)	     60		   $724,300
- Vocational Rehabilitation	   345		   $325,531
- AABD	(State Supplement)	   125		   $249,548
- CDBG Funds			     35		   $120,438
- Veterans Fund	     		     51		   $103,272
- Child Welfare			     11		   $101,607
- DPFS (state program)		     41		     $85,730
- Disabled Childrens Program	     60	  	     $77,779
- Consumer Contribution	     50		     $61,810
**Total Funding****	****	****	****	****$6,685,922**

**Notes:**
An additional $1,119,175 of waiver funds was spent on home mods in 2003. Another $163,102 was leveraged on those projects for a total of $1,282,277. Just under $8 million was spent during a 5 1/2 year period on approximately 2,000 projects.

## What have we learned?

- Equitable Access to Services
- No assurance that needs were met-equipment being abandoned
- Lack of “qualified” contractors
- Lack of support for consumer
- Lack of support for Waiver Services Coordinator

## What are we doing?

- Statewide on-site technical assistance through Assistive Technology Partnership

## Technical Assistance

- Referral from Waiver Services Coordinator
- On-site assessment to develop solutions
- Draw plan/write specifications

## Technical Assistance

- Obtain approvals
- Obtain quotes
- Award the project and monitor construction
- Final Inspection

## What have we learned?

- Timeliness issues
- Finding funding
- Contractor scheduling
- Staff/Resources

## What are we doing?

- Established 30 day assessment timeline
- Established 60 day project completion timeline
- Increased efficiency of staff
- Repetition and specialization
- Training to increase skills

## What have we learned?

- Politics of funding
- Cuts threaten Medicaid every year

## What are we doing?

- Commitment by Nebraska HHSS
- Saving money
- Helping people stay in their homes and preventing institutionalization
- Providing appropriate and cost effective solutions
- Recycling
- Consumer Satisfaction

**Notes:**
$3million/year saved by preventing or delaying institutionalization
Recycling has lowered average cost of some home mods (exterior entrance lifts).
Difficult to determine cost of savings of appropriate/cost effective....but approx cutting cost in half.

## Consumer Satisfaction

-  97% feel they were included
-  97% feel their questions were answered
-  97% feel they were trained
-  98% are still using equipment

## Nebraska Assistive Technology Partnership

- All states and territories have AT Act projects
- To  find out about your state:
- http://www.resna.org/taproject/at/statecontacts.html
- Nebraska’s web site:
- http://www.nde.state.ne.us/ATP/
- Mark Schultz, Director
- _[mschultz](mailto:Mschultz@atp.state.ne.us)__[@atp.state.ne.us](mailto:Mschultz@atp.state.ne.us)_
- Phone: 402.471.0734