TERMS AND DEFINITIONS

Beneficiary

is the person benefitting from a trust.

Activities of Daily Living - ADLs

are daily, routine skills an individual needs in order to function.  Examples include:  eating, bathing, moving, toileting and grooming.

Day Training & Habilitation Program - DT&H

is a licensed organization that assists individuals with disabilities to develop and maintain life skills, participate in community life, and engage in activities of their own choosing.

Department of Human Resources - DHS

provides health care, economic assistance and other essential services for those who do not have the resources to meet their basic needs and are least able to help themselves.

Developmental Disability - DD

is a mental and/or physical condition that manifests before age 22, substantially affects functioning in several major life activities, and usually lasts through life.

Employment Network - EN

is an entity that contracts with the Social Security Administration (SSA) that provides and coordinates the delivery of necessary services to Social Security disability beneficiaries participating in the Ticket to Work program.

Formal Supports

are community supports for individuals with disabilities that are provided by services and programs.

Global Developmental Delay

is a significant lag in meeting important developmental milestones, including:  physical, cognitive, behavioral and social development.

Informal Supports

are community supports for individuals with disabilities that are provided by family, friends and social network groups.

Instrumental Activities of Daily Living - ADLs

are basic skills an individual needs in order to function.  Examples include:  shopping, managing fnances, essential household chores, planning and preparing meals.

Intermediate Care Facility for Persons with Developmental Disabilities - ICF DD

is a residential facility or licensed health care institution that provides health and rehabilitatiave services for persons with developmental disabilities or related conditinos who require active treatment.

Irrevocable Trust

is a trust that cannot be changed or cancelled after it has been created.

Medical Assistance - MA

is a publicly funded health care program for individuals who meet certain income and other criteria, including persons with disabilities.

Minnesota Department of Health - MDH

is a state agency whose mission is to protect, maintain and improve the health of all Minnesotans.

Nursing Facility - NF

is a facility or part of a facility licensed to provide nursing care for persons who are unable to properly care for themselves.

Parental Fee

is a monthly amount paid by parents of children under 18 accessing TEFRA.  It is based on family income and size.

Personal Care Assistant/Assistance - PCA

provides day-to-day assistance and support to individuals with disablities to help them be more independent in their homes and in the community.

Plan for Achieving Self Support - PASS

is a Supplemental Security Income (SSI) work initiative that lets individuals with disabilities set aside money and other assets for items or services to reach specific work goals.

Related Condition

is a condition closely related to a developmental disability that is severe, chronic, results in impairment of general intellectual functioning or adaptive behavior, requires treatment or services similar to those required for persons with developmental disabilities, manifests before age 22, is likely to continue indefinitely, is not attributable to mental illness, and results in substantial functioning limitations.

Revocable Trust

is a trust that can be changed or cancelled after it has been created.

Social Security Administration - SSA

is a federal agency that administers Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs.  These two major programs provide cash benefits to persons with disabilities.

Social Security Disability Income - SSDI

is a program under Retirement, Survivor and Disablity Insurance (RSDI) that provides cash benefits to individuals who have a disabilty and have worked a certain number of quarters or had a parent or spouse who worked a certain number of quarters and have paid into the Social Security System.  SSDI helps offset the costs of food, clothing and shelter with monthly benefits.

Spenddown

is an amount of money that a person enrolled in a Minnesota Health Care Program (MHCP) is required to pay before they are eligble for Medical Assistance (MA).

State Medical Review Team - SMRT

is a division of the Department of Human Services (DHS) that makes disability determinations using criteria from the Social Security Administration (SSA).

Supplemental Security Income - SSI

is a federal needs-based program for children and adults who have been been able to work or have not worked enough to pay into the Social Security System.  SSI helps to offset the costs of food, clothing and shelter with monthly benefit payments.

Tax Equity Fairness and Responsibility Act - TEFRA

is a component of Medical Assistance (MA) that helps cover health care costs for children with disabiilties.  Only the child's income is used to determine eligibility; however there may be parental fees, depending on family income and size.

Trustee

is the person or entity responsible for the management and distribution of the assets of a trust.

Waivered Services

Waivered services is a federally-funded program that allow states to “waive” traditional Medicaid guidelines, allowing individuals to receive services in their homes and community instead of receiving these services in institutions, nursing homes or medical facilities.  Waivers are cost effective and allow individuals with disabilities to live where they choose.Definitions of terminology highlighted in Green Italics can be found in the right sidebar.

History:

During a press conference in November of 1981, then President Ronald Reagan explained the story of a 3-year-old girl, named Katie Beckett, who had been in a hospital for more than two years. The family's insurance had run out and Medicaid was paying to keep her in the hospital.  Medicaid is a government health care program that covers people who have low income and children or have disabilities.  Doctors agreed that Katie could do well at home with proper supports, but Medicaid would only cover expenses in the hospital, even though the monthly cost for home care would be much less than care in the hospital setting.  Seeing the error in government regulation, President Reagan changed the Medicaid rules, allowing Katie to return home and still receive Medicaid coverage.   This was the beginning of the Katie Beckett Waiver or Waivered Services.   Katie Beckett died on May 18, 2012 at the age of 34.

There are a variety of waivers that provide support to individuals with differing needs: Community Alternative Care Waiver (CAC), Community Alternatives for Disabled Individuals Waiver (CADI), Developmental Disabilities Waiver (DD), and Traumatic Brain Injury Waiver (TBI). Waiver budgets are flexible and are based on individual needs determined by an assessment. The waivers described here are exclusively for people with disabilities.

The Department of Human Services (DHS)states services provided by waivered services must ensure the recipient’s health, welfare and safety and must not be covered by other funding sources. Other options must be assessed, and the cost of services must be considered reasonable and customary.

Waivered Services are not entitlement programs and Washington County has a certain number of waiver “slots” that determine how many people can receive services at one time.   Contact your Washington County Developmental Disabilities Social Worker for assessment information.

Community Alternative Care Waiver (CAC)

NOTE:  It is recommended that if the criteria for eligibility is met and there is a need for the services available through the CAC Waiver , to contact Washington County at 651-430-6484 for more information.

The Community Alternative Care (CAC) Waiver is for children and adults who are chronically ill or medically fragile and would require the level of care provided in a hospital. Services are provided in a home setting.

DHS Eligibility Criteria - Must meet all

  • Be eligible for Medical Assistance (MA) 
  • Be certified as disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). 
  • Be under age 65 at the time of the application
  • Have a written support plan assuring health and safety and outlining service needs
  • Be provided informed choice, meaning the individual chooses community-based services instead of services in a hospital setting
  • Need skilled assessment and intervention multiple times during a 24-hour period to maintain health and prevent deterioration
  • Due to a health condition, has both predictable health needs and the potential for status changes that could lead to rapid deterioration or life-threatening episodes
  • Requires a 24-hour plan of care that includes a back-up plan that reasonably assures health and safety in the community
  • Without the CADI Waiver services would require frequent or continuous care in a hospital

DHS defined services available through the CAC Waiver include:

  • Case management
  • Consumer Directed Community Supports (CDCS)
  • Extended home health aide and nursing services
  • Extended personal care assistance (PCA) services
  • Extended prescribed medication
  • Extended supplies and equipment
  • Family counseling and training
  • Foster care services
  • Homemaker services
  • Modifications to the home or vehicle
  • Respite care

Need more information?

More information on the CAC Waiver can be found here.

Community Alternatives for Disabled Individuals Waiver (CADI)

NOTE:  It is recommended that if the criteria for eligibility is met and there is a need for the services available through the CADI Waiver, to contact Washington County at 651-430-6484 for more information.

The Community Alternatives for Disabled Individuals (CADI) Waiver is mainly for children and adults with physical disabilities or serious mental health needs that require the level of care provided in a Nursing Facility (NF).  CADI Waivers are funded as an alternative to institutional care.  Eligible persons do not need to have a diagnosis of developmental disability or related condition.

DHS Eligibility Criteria – Must meet all

  • Be eligible for Medical Assistance (MA)
  • Be certified as disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT).
  • Be under age 65 at the time of the application
  • Have a written support plan assuring health and safety, and outlining service needs
  • Be provided informed choice, meaning the individual chooses community-based services instead of services in a nursing care facility
  • Must demonstrate need in one or more of the following:
              Restorative and rehabilitative or other special treatment
              Unstable health
              Complex care management
              Functional limitations
              Existence of complicating conditions
              Cognitive or behavioral conditions
              Frailty or vulnerability

DHS defined services available through the CADI Waiver include: 

  • Adult day care
  • Assisted living services
  • Case management and case aide services
  • Extended home health aide and nursing services
  • Extended home health therapies
  • Extended personal care assistance (PCA) services
  • Extended supplies and equipment
  • Extended transportation services
  • Family counseling and training
  • Foster care services
  • Homemaker services
  • Home-delivered meals
  • Independent living skills
  • Modifications to home or vehicle
  • Prevocational services
  • Residential care services
  • Respite care
  • Supported employment services

Need more information?

More information on the CADI Waiver can be found here.

Developmental Disabilities Waiver (DD)

IMPORTANT:  The following program is not an entitlement program.  This means eligibility does not guarantee funding due to a possible waiting list.  It is recommended that eligible persons get on the waiting list for a future available slot.

The Developmental Disabilities Waiver is for persons with developmental disabilities or related conditions that require the level of care provided in an Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD). There are no age limits.

DHS Eligibility Criteria – Must meet all

    • Be eligible for Medical Assistance (MA)

  • Be certified as disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
  • Have a written support plan assuring health and safety, and outlining service needs
  • Be provided informed choice, meaning the individual chooses community-based services instead of  services in a ICF/DD services
  • Have a diagnosis of developmental disability or related condition
  • The county screening team determines the person would be placed in an intermediate care facility for persons with developmental disabilities (ICF/DD) if home and community services were not provided, or the person lives in an ICF/DD facility and continues to require that level of care
  • Requires daily interventions and service needs specified in a 24-hour plan of care.  Persons must need active treatment  which includes:  daily intervention, assistance, supervision and on-going habilitation to learn necessary skills and assure health and well-being

DHS defined services available through the Developmental Disabilities (DD) Waiver include:

  • Adult day care
  • Assistive technology
  • Caregiver training and education
  • Case management
  • Chore services
  • Consumer training and education
  • Consumer-directed community supports (CDCS)
  • Crisis services
  • 24-hour emergency assistance
  • Extended personal care assistance services (PCA)
  • Extended transportation services
  • Homemaker services
  • Housing access coordination
  • In-home family support services
  • Live-in personal caregiver expenses
  • Modification to the home or vehicle
  • Personal support
  • Respite care
  • Specialist services
  • Supported employment services
  • Supported living services
  • Training and habilitation services

Need more information?

More information on the DD Waiver can be found here.

Brain Injury Waiver (BI)

NOTE:  It is recommended that if the criteria for eligibility is met and there is a need for the services available through the BI Waiver, to contact Washington County at 651-430-6484 for more information.

The Brain Injury Waiver (BI) is for persons with an acquired or traumatic brain injury or related neurologic condition that is not congenital and has resulted in significant cognitive and significant behavioral impairment.  Services are provided in a home environment, board and lodging facility, or assisted living facility. 

Note: It is first determined if an individual's needs can be met through the CADI Waiver.  If not, then additional BI screening questions are done to determine if a BI Waiver is justified.

DHS Eligibility Criteria – Must meet all

  • Be eligible for Medical Assistance (MA)
  • Be certified as disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
  • Be under age 65 at the time of application
  • Be determined to need the level of care available in a Nursing Facility (NF) or neurobehavioral hospital
  • Be provided informed choice, meaning the individual chooses community-based services instead of a nursing facility or neurobehavioral hospital
  • Have a documented diagnosis of traumatic or acquired brain injury or an acquired or degenerative disease diagnosis where cognitive impairment is present, provided the diagnosis is not congenital
  • Experience significant/severe behavioral and cognitive problems related to the injury
  • Be assessed at Level IV or above on the Rancho Los Amigos Levels of Cognitive Functioning Scale

DHS defined services available through the Brain Injury (BI) Waiver include:

  • Adult day care services
  • Assisted living services
  • Behavior programming by professionals
  • Case management and case aide services
  • Chore services
  • Extended cognitive rehabilitation therapy
  • Extended home health aide and nursing services
  • Extended home health therapies
  • Extended personal care assistant services
  • Extended supplies and equipment
  • Extended transportation services
  • Family counseling and training
  • Foster care
  • Home-delivered meals
  • Homemaker services
  • Independent living skills and independent living therapies
  • Mental health testing
  • Modifications to home or vehicle
  • Night supervision services
  • Prevocational services
  • Respite care
  • Structured day program services
  • Supported employment services

Need more information?

More information on the BI Waiver can be found here.