Champions for Children with Disabilities
PACER’s Family-to-Family Health Information Center (F2F HIC) provides a central source for families of children and young adults with disabilities to obtain support, advocacy, and information about the health care system. PACER promotes family-centered care and family and professional collaboration at all levels of health care. The F2F HIC also has a strong commitment to promote and support the needs of families from racially, culturally, and linguistically diverse communities.
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What are the funding sources?
Once parents and their son or daughter with a disability have visualized their “dream” home, the next step is to explore how much can be spent on housing. It is essential to look at possible income, Medicaid, SSI, SSDI, work income, and family contributions. Administered by states, in Minnesota Medicaid is called “Medical Assistance” or “MA.” Creating a list of expenses is essential. There are no easy answers when it comes to obtaining payment for housing. Eligibility criteria for your son or daughter’s specific disability will become a determining factor for most funding.
FEDERAL MEDICAID FUNDING COMES FROM BOTH THE FEDERAL AND STATE GOVERNMENT
FEDERAL MEDICAID pays for medical services for individuals with disabilities and families with low incomes, including children, pregnant women, and people over the age of 65. The federal Centers for Medicare and Medicaid Services (CMS) administers Medicaid nationwide, provides funding, approves state plans, and ensures compliance with federal regulations. In Minnesota, the Department of Human Services oversees the Medicaid (Medical Assistance) program, administered locally by counties.
MEDICAID HOME AND COMMUNITY-BASED SERVICE (HCBS) is a program that pays for support services so people can live in the community. Minnesotans with disabilities or chronic illnesses who need certain levels of care may qualify for the state’s HCBS, known as “waivered services.” HCBS waivers allow states the flexibility to develop and implement creative alternatives to placing Medicaid-eligible individuals in hospitals, nursing facilities, or Intermediate Care Facilities for Persons with Developmental Disabilities (ICF/DD).
HCBS waivers also allow states to combine different service options that are not available under regular Medical Assistance. These service options are available to consumers in addition to services covered by Medical Assistance. Because each of the waiver programs was written to meet federal guidelines, each program includes eligibility requirements specific to the type of disability, funding parameters and limits, and separate county and/or state policies. Waiver funds cannot be used to pay for, or supplement, room and board costs, but they can be used to pay for additional supports so an individual can live in the community.
Home and community-based waiver programs available to people who meet the eligibility criteria include:
- Developmental Disabilities (DD) Waiver for people with developmental disabilities or a related condition who need the level of care provided in an ICF/DD.
- Community Alternative Care (CAC) Waiver for chronically ill individuals who need the level of care provided in a hospital.
- Community Access for Disability Inclusion Waiver
The Community Access for Disability Inclusion (CADI) Waiver provides funding for home and community-based services for children and adults, who would otherwise require the level of care provided in a nursing facility
- Brain Injury (BI) Waiver for persons with acquired or traumatic brain injuries who need the level of care provided in a nursing facility that provides specialized (cognitive and behavioral supports) services for persons with brain injury or neurobehavioral hospital level of care
Each of the waiver programs was written to meet federal guidelines, and program eligibility requirements specific to the type of disability, funding parameters and limits, for state policies. For more information on these waivers and supports, contact your county social services department or refer to the Department of Human Services section on Minnesota's home and community-based waivers.
CONSUMER DIRECTED COMMUNITY SUPPORTS SERVICE is a unique service option that gives people more flexibility and responsibility for directing their services and supports, including hiring and managing direct care staff. CDCS may include services, support, and/or items currently available through the Medical Assistance waivers, as well as additional allowable services that provide needed support. CDCS is a service option under several Home and Community-Based programs. CDCS is available as a statewide service for people enrolled in one of these programs: DD Waiver, CAC Waiver, CADI Waiver, or BI Waiver.
PERSONAL CARE ASSISTANCE (PCA) provides services to people who need help with day-to-day activities to allow them be more independent in their own home. A personal care assistant is an individual trained to help people with activities of daily living if they have a physical, emotional, or mental disability, a chronic illness, or an injury. PCA service is available to people able to direct their own care.
SUPPLEMENTAL SECURITY INCOME (SSI) is a social entitlement program, based on financial need, that provides monthly payments to children and adults who have disabilities, low income, and limited resources.
SOCIAL SECURITY DISABILITY INSURANCE (SSDI) is a social insurance program that workers and employers pay for with their Social Security taxes. Eligibility for these disability benefits is based on work history, and the amount of benefit is based on an individual’s earnings.
GROUP RESIDENTIAL HOUSING (GRH) funding is an individual income supplement to SSI that pays for room and board costs in specified licensed or registered settings to those who qualify. Individuals who receive this service must first be eligible for SSI. Financial eligibility for this option is the same as SSI.
MINNESOTA SUPPLEMENTAL AID (MSA) is a state-funded supplement for people who receive SSI.
MINNESOTA SUPPLEMENTAL AID (MSA) HOUSING ASSISTANCE is an additional cash supplement to MSA recipients under 65 years of age who have total housing costs that are more than 40 percent of their total income. To be eligible recipients must:
- Be relocating into the community from an institution or an intensive residential mental health treatment program OR
- Be eligible for Medical Assistance (MA) personal care assistance (PCA) services and have the ability (or have a parent or legal guardian with authority) to hire, fire, supervise and manage the PCA, OR
- Be getting services through an MA home and community-based waiver and be living in your own home or apartment.
MOVING HOME MINNESOTA is a new Medicaid demonstration project to help people transition from an institution to community living. Moving Home Minnesota provides services to help with the planning process; the transition, including moving expenses, security deposits and furnishings; and extra services and supports for up to one year after the move. For more information call the MN Department of Human Services at: 651-431-3951 or 888-240-4756.
GENERAL ASSISTANCE (GA) is a state program that provides payment to individuals with no income and minimal assets. GA is determined at the county level, pending eligibility for SSI.
HOUSING ACCESS COORDINATION (HAC) is a service covered by the waiver that allows an authorized consultant to provide assistance in a wide variety of areas, such as locating and finding housing, obtaining financing, and constructing a home. For more information on these waivers and supports, contact your county social worker or refer to the DHS website section on Waiver Services.
FUNDING FOR MENTAL HEALTH
The DHS Mental Health Division provides state and federal funding for mental health treatment and grants to counties to provide infrastructure to ensure that programs and services are available throughout Minnesota.
In Minnesota, the county is responsible for providing publicly- funded mental health services with federal, state, and county funding. In many parts of the state, counties contract with providers to deliver mental health services. A person who qualifies under the Severe and Persistent Mental Illness (SPMI) label (Rule 79) qualifies for supports and services similar to the supports and services an individual would receive if he or she were qualified under the developmental disabilities category.
There are a number of community-based programs serving people with mental illness, developmental disabilities (dual diagnosis), chemical dependency, and brain injury. Intensive Residential Treatment Services (IRTS) are time-limited mental health services provided in a residential setting to recipients in need of more restrictive settings (versus community settings) and at risk of significant functional deterioration if they do not receive these services. IRTS are designed to develop and enhance psychiatric stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more independent setting.
For more information on the Adult Mental Health System in Minnesota go to the DHS website section on mental health services.
SUBSIDIZED HOUSING AND THE SECTION 8 PROGRAM
Subsidized Housing is a federal rental assistance housing program where the government pays a percentage of the rent for people with low and moderate incomes. The percentage is based on income limits established by the government and varies with different programs. The most commonly available type of subsidized housing is the Section 8 program. Two kinds of assistance are provided: project-based and tenant-based. Project-based assistance is designated Section 8 buildings that are primarily privately owned but have been built with federal funds. A list of these buildings is available through your local public housing agency. Tenant-based assistance is provided through “vouchers” or “certificates.” Some apartments and houses in various communities may accept Section 8 vouchers or certificates, which are funded by the U.S. Department of Housing and Urban Development (HUD). With Section 8 certificates or vouchers, one generally pays one-third of his or her income for rent. These certificates and vouchers are portable, meaning an individual can use them in any community in any state.
Virtually all people with disabilities receiving SSI benefits are eligible because their incomes are well below 50 percent of median income. Citizens and non-citizens are eligible who meet HUD’s definition of “household,” which includes one or more adults with disabilities, as well as elderly and family households. Because the availability can vary widely, it is common for new applicants to be placed on waiting lists. More important, housing authorities may only take applications at announced times.
PUBLIC HOUSING AGENCIES (PHAS)
The Section 8 program is governed by rules established through federal law and regulations. Additional Section 8 policies are determined by the state and local agencies known as Public Housing Agencies (PHAs) that receive funding from HUD to administer the program. On average, there are more than 50 PHAs per state, which can make Section 8 difficult to understand. There are three types of PHAs. The most common and well-known are the local public housing authorities. The others are state housing agencies and nonprofit organizations.
To locate your PHA go to the HousingLink section on Public Housing here.
VOUCHERS AND CERTIFICATES
Non-Elderly Displacement Voucers (NED) & Mainstream vouchers enable families having a person with disabilities to lease affordable private housing of their choice. Mainstream program vouchers also assist persons with disabilities who often face difficulties in locating suitable and accessible housing on the private market. Families apply to the local PHA that administers this program. When an eligible family with a disabled person comes to the top of the PHAs housing choice voucher waiting list, the PHA issues a housing choice voucher to the family.
For more information, visit the Technical Assistance Collaborative Inc. (TAC) website and see New HUD Vouchers for People with Disabilities, Data Base.
Using all available data from HUD and the Federal Register, TAC has developed a comprehensive up-to-date database of vouchers for people with disabilities and other special needs.
The Technical Assistance Collaborative Inc. (TAC) and the Consortium for Citizens with Disabilities Housing Task Force (CCD) recently led a successful effort to modernize the Section 811 program. The enactment of the Frank Melville Supportive Housing Investment Act of 2010 reforms and reinvigorates Section 811 - the only HUD program authorized to create permanent supportive housing for people with significant and long-term disabilities who are living unnecessarily in an institution or other restrictive setting, are homeless, or are at risk of these conditions.
For more information, visit the Technical Assistance Collaborative Inc. (TAC) website and see “New HUD Vouchers for People with Disabilities, Data Base.” Using all available data from HUD and the Federal Register, TAC has developed a comprehensive, up-to-date database of vouchers for people with disabilities and other special needs. Certificates from the Bridges Program provide a rental subsidy for people with serious and persistent mental illness who are eligible, or can become eligible, to receive a Section 8 Housing Choice Voucher. Their eligibility is based on successful participation in the Bridges Program and whether they are currently on Section 8 waiting lists. The program is administered by the local housing organizations and referral to the program must be made by a mental health professional.
Go To hud.gov 811 supportive housing for more information
On Jan. 4, 2011, President Barack Obama signed the Frank Melville Supportive Housing Investment Act of 2010 into law. This groundbreaking legislation will reinvigorate and modernize the Section 811 Supportive Housing for Persons with Disabilities program. By leveraging other sources of capital funding, such as federal Low-Income Housing Tax Credits, the reformed Section 811 program will now develop thousands more units of supportive housing every year and – for the first time – create integrated supportive housing units within affordable housing properties.
Bridges certificates provide a rental subsidy for people with serious and persistent mental illness who are eligible or can become eligible to receive a Section 8 Housing Choice Voucher, based on successful participation in the Bridges Program, and who are currently on Section 8 waiting lists. The program is administered by local housing organizations, and referral to the program must be made by a mental health professional.
See mnhousing.gov - Bridges Program for more information.