What is a CL Waiver?
A community living (CL) waiver, previously known as an intellectual disability (ID) waiver, is designed to provide individuals with intellectual and developmental disabilities access to support and services in their area.
CL waiver services include:
- workplace assistance
- community coaching
- in-home support
- skilled nursing services
- assistive technology
In general, a CL waiver is intended to provide holders with a complete and full range of behavioral, medical and non-medical support services. It allows the person a wide range of flexibility in choosing the services that best meet their individual needs. It also provides their caregivers access to respite help.
If not for a CL waiver many of these individuals would only be eligible to receive such services in a long-term care facility.
How to Obtain a CL Waiver
The process to obtain a CL waiver can seem complex and hard to navigate.
In order to make it simpler, here’s an overview of the tests required to qualify for a waiver, and the process for actually getting a waiver once the three eligibility tests are met.
3 Eligibility Tests for a CL Waiver
The evaluation process for obtaining a CL waiver involves three different eligibility tests, administered by the Department of Medical Assistance (DMAS) in conjunction with the Department of Behavioral Health and Developmental Services (DBHDS).
1. Diagnostic Eligibility
The CL waiver program is designed to help those with life-impacting intellectual and developmental disabilities, and one of the eligibility criteria looks at the specific diagnosis of the applicant.
Those individuals with intellectual disabilities must demonstrate a proper diagnosis issued by a qualified medical professional.
All persons over the age of six must have undergone a psychological evaluation that outlines the intellectual disability, the age at which the disability onset, and the individual’s current functional level.
For those under six years old, a psychological or developmental evaluation which shows a diagnosis or a developmental risk of a diagnosis is necessary.
For developmental disabilities, those over the age of three have to demonstrate a severe and chronic disability due to mental or physical impairment. The disability must be caused by factors other than mental illness as shown by school, psychological or medical records created by a properly credentialed professional.
To meet diagnostic eligibility, several key factors must apply:
- The impairment must have occurred before the age of 22.
- The limitations resulting from the impairment must be likely to carry on indefinitely.
- The resulting limitations must affect at least three key life areas in a significant way, including self-care, mobility, self-direction, expressive and receptive language, independent living ability, economic self-sufficiency, and learning.
2. Functional Eligibility
Local Community Service Boards (CSBs) conduct functional screenings as part of the qualification process for the CL waiver.
All individuals applying for a waiver will need to complete the Virginia Individual DD Eligibility Survey (VIDES).
There are three different types of VIDES depending on the age of the applicant:
- adult version for those over 18
- child version for those between the ages of three and 18
- infant version for those under two years of age
The survey results must show that the applicant meets the Intermediate Care Facility — Intellectual Disability (ICF-ID) level of care. This standard is met by demonstrating dependency level requirements on the survey. Minors must qualify under two areas, while adults must qualify under three categories.
While on the waiting list for a CL waiver, a renewed VIDES is required on an annual basis to maintain or move up in priority level.
3. Financial Eligibility
The final eligibility test looks at financial resources.
In general, in order to qualify for a CL waiver, an individual must meet Medicaid’s general financial guidelines. Although there are some instances where those not typically qualified financially for Medicaid services may meet the CL waiver financial eligibility test.
In most cases, adults have a maximum monthly income threshold of $2,205. Children are assessed based on their own financial resources; any income or other financial assets of their parents are not considered.
Keep in mind that this financial test is ongoing, and in order to maintain eligibility for a CL waiver, an individual must stay under this maximum income limit.
Securing a CL Waiver
Once an individual (or their family) has proven their eligibility by meeting the three eligibility tests, they qualify to receive a waiver. However, a CL waiver is not immediately granted.
Instead, the individual is classified by priority level, ranging from Priority One (those who are deemed to need services within a year) to Priority Three (those who are determined not to need services for at least five years).
As slots become available–typically in July of each year–those in Priority One are granted a CL waiver according to the urgency of need, with any remaining slots going to Priority Two and Priority Three candidates in turn.
Unfortunately, the number of CL waivers is limited, and not everyone who meets the three eligibility tests will receive a waiver in a short time frame.
As of February 2018, more than 12,000 people were on the waiting list for a waiver.
Keep in mind that those classified as a lower priority level can move up on the priority lists if their needs change.
If you (or an individual under your care) does undergo a change in condition as a result of medical circumstances, you can request a priority level review. Otherwise, reviews are performed every two years for minors and every three years for adults.