NH Developmental Disabilities Waiver Explained

If you are caring for a loved one with a developmental disability in New Hampshire, you may be wondering if there is any financial assistance available to help you with the costs and challenges of caregiving. The answer is yes, there is a Medicaid program that can provide you with various services and supports, and even pay you for the care you provide. This program is called the Developmental Disabilities Waiver (DDW).

Here, we explore the DDW, who can qualify for it, its benefits, and how it can compensate family caregivers. 

Overview of Developmental Disabilities Waiver

The DDW is a Medicaid program that provides home and community-based services (HCBS) to individuals with autism, intellectual disabilities, or developmental disabilities of any age who meet an intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care 1. The DDW is designed to help these individuals live independently in their homes or other community settings rather than in institutions.

The DDW is administered by the New Hampshire Department of Health and Human Services (DHHS) and Bureau of Developmental Services (BDS) in collaboration with 10 area agencies that serve as local points of contact for applicants and participants. The DDW operates under a federal waiver authority that allows the state to customize its Medicaid services and eligibility criteria to meet the specific needs of its target population.

The DDW serves about 4,000 individuals in New Hampshire and has an annual budget of about $300 million. 

The DDW recently underwent some amendments that took effect on July 1, 2023. These amendments include updated language regarding compliance with federal regulations related to conflict-free case management and direct billing requirements, updated language surrounding the ability to bill via the organized health care delivery system (OHCDS) for certain services, and updated cost of care language.

Eligibility Requirements

To be eligible for the DDW, an individual must meet the following requirements:

• Be a resident of New Hampshire
• Qualify for Medicaid under one of the following categories: Supplemental Security Income (SSI), Katie Beckett option, Medically Needy with Spend Down option, or 300% of SSI option
• Have a diagnosis of autism, intellectual disability, or developmental disability that occurred before age 22 and is expected to last indefinitely. 
• Have substantial functional limitations in three or more areas of major life activities, such as self-care, learning, mobility, communication, self-direction, capacity for independent living, or economic self-sufficiency
• Meet an ICF/IID level of care, which means that the individual requires active treatment and 24-hour supervision due to their disability
• Have an individual service agreement (ISA) that outlines the services and supports needed by the individual and is approved by BDS
• Choose to receive HCBS rather than institutional care

Services and Supports

The DDW offers various services and supports to help individuals with developmental disabilities achieve their personal goals and enhance their quality of life. Some of the services and supports available under the DDW are:

• Community participation services: These are services that help individuals participate in meaningful activities in their communities, such as volunteering, education, recreation, or socialization. Examples include adult day services, day habilitation, prevocational, and supported employment services.
• Residential habilitation: This service assists with daily living skills, personal care, health and safety needs, behavioral support, and community integration in a residential setting. Examples include group homes, shared living arrangements, foster care homes, supported living apartments, or individual homes 1.
• Respite: This service provides temporary relief to unpaid caregivers responsible for the primary care of an individual with a developmental disability. Respite can be provided in various settings, such as the individual’s home, a respite provider’s home, or a licensed facility.
• Service coordination: This service helps individuals access and coordinate their waiver services and other resources. The area agencies assign service coordinators and work with individuals and their families to develop their ISAs, monitor their service delivery and outcomes, advocate for their rights and preferences, and assist them with any issues or concerns.
• Assistive technology: This service provides devices, equipment, or software that help individuals with developmental disabilities perform tasks that they would otherwise be unable to do or have difficulty doing. Examples include communication devices, mobility aids, environmental controls, or adaptive equipment.
• Community integration services: These are services that help individuals with developmental disabilities develop and maintain relationships with others in their communities, such as friends, neighbors, or co-workers. Examples include social skills training, peer support, mentoring, or coaching.
• Community support services: These are services that help individuals with developmental disabilities live independently in their own homes or other community settings. Examples include personal care, homemaker, chore, companion, or transportation services.
• Crisis response services: These provide immediate intervention and support to individuals with developmental disabilities experiencing a behavioral or psychiatric crisis that poses a risk to themselves or others. Examples include crisis stabilization, mobile crisis response, or crisis respite.
• Environmental and vehicle modification services: These provide physical adaptations to an individual’s home or vehicle that are necessary to ensure their health, safety, or independence. Examples include ramps, lifts, grab bars, or hand controls.
• Individual goods and services: These provide items or activities not covered by Medicaid or other sources but necessary to address an individual’s needs and goals. Examples include clothing, furniture, personal hygiene items, or recreational activities.
• Non-medical transportation: This service provides transportation to and from waiver services or other community activities for individuals who do not have access to other means of transportation.
• Personal emergency response system (PERS): This service provides an electronic device that enables individuals with developmental disabilities to secure help in an emergency. The device is connected to a 24-hour response center that can dispatch emergency personnel or contact a designated caregiver.
• Removable prosthodontic services: These services provide dentures or partial dentures for individuals with developmental disabilities who have missing teeth and need them for functional reasons.
• Specialty services: These provide specialized interventions or therapies for individuals with developmental disabilities with complex needs that other waiver services cannot meet. Examples include applied behavior analysis (ABA), music therapy, art therapy, or massage therapy.
• Wellness coaching services: These are services that provide guidance and support to individuals with developmental disabilities who want to improve their physical and mental health. Examples include nutrition counseling, fitness training, stress management, or smoking cessation.

Compensation for Caregivers

One of the most attractive features of the DDW is that it allows individuals with developmental disabilities to choose their providers for certain waiver services through the participant-directed and managed services (PDMS) option. PDMS gives individuals more control and flexibility over their waiver services, including hiring, training, supervising, and dismissing providers.

However, PDMS does not allow individuals to hire family members as caregivers. Family members are defined as spouses, parents of minor children, legal guardians of minor children, stepparents of minor children, adoptive parents of minor children, foster parents of minor children, grandparents of minor children, siblings of minor children, adult children of participants age 65 or older who live in the same household as the participant, and spouses of adult children of participants age 65 or older who live in the same household as the participant.

Therefore, if you are a family caregiver who falls under any of these categories, you cannot get paid by the DDW for the care you provide to your loved one. However, you can still get financial assistance from other sources. There may be other programs or benefits that can help you with the costs and challenges of caregiving.

A Note from Givers

If you want to find out if you are eligible for the DDW or any other program that can pay you for caregiving, please fill out this form, and we will get back to you as soon as possible. We are here to help you get the support you deserve.