History of the Medicaid Waiver
On July 31, 2003, Susan Taney, MSN, ANP, became Taggie's legal guardian, replacing long-time guardian and key caregiver, Matt Nowakowski. As legal guardian, Mrs. Taney is responsible for decisions regarding Taggie's care and well-being. In October, she approached Jeannine Hawkins, BS, Developmental Services Supervisor for Northeast Kingdom Human Services, to begin the process of obtaining a Medicaid waiver for Taggie, which was granted. With this waiver and permission from the federal government, the state of Vermont provides substantial funding, about $65,000 annually, for Taggie's care. These monies are provided on a federal and state level. The Medicaid waiver thus provides the majority of the required annual financial support.
Jeannine Hawkins recognized that the Developmental Home Care Provider model would be a good choice for Taggie's ongoing care, with some adjustments, initially and the hope that with continued progress he could be transitioned into a family centered model of the shared living provider program. She knew it would need to be set up a little differently at first, based on Taggie's specific needs and history of "high-intensity" care requirements. She also wanted to keep as much as possible what had been established and for Taggie to be able to continue to live at BPB some days each week. This has evolved over the few years it has been in place and will continue to have additional services provided in the area of speech and communication development, social and athletic activities and perhaps soon trying to further transition into some workplace activities.
The Medicaid waiver went through two processes: a local review board and a state-wide review board. The review board consists of all the directors of all the mental health agencies in Vermont and all of the coordinators of the developmental delay programs in the state. The proposed waiver met all of the criteria and was granted the maximum amount allowed for the Developmental Home Care Provider Program.
An important ground for granting the waiver was that Taggie had lost all funding for his care and had no funding of his own. Although Taggie receives Social Security Disability income (SSD), it does not approach the cost of the care he needs. Because of that, he was viewed as being at risk for becoming homeless. Also, Ms. Hawkins knew the progress that caregivers had made with Taggie and saw the value of maintaining the care model that had so benefited him with an eye on progressing his care model and adding services as appropriate. She worked very hard to express all of the details of Taggie's history, care and progress to the review boards.
Petitions for Medicaid Waiver are usually one page long; Taggie's was three. The review board approved the petition very quickly. The 30-member board agreed to provide support for Taggie and granted the Medicaid Waiver. They asked only one question: Will Taggie be able to maintain contact with the meditation community and his culture?