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EDCD Waiver - What Is It?

Medicaid Waiver programs for the disabled are changing in Virginia. One program that is not changing is the Elderly Disabled Consumer Directed Waiver (EDCD Waiver).

This program provides a range of services for disabled children and adults so they can remain living at home. Unlike the other Waiver programs there is no wait list for the EDCD Waiver.

For years EDCD was known as the Community Based Care (CBC) waiver. The reason for this was because this program was used solely by the elderly to obtain home based, as opposed to nursing home care. When Medicaid realized that it had no right to limit the program to elderly adults, the program was opened to the disabled general public.

Eligibility criteria is divided into two categories: financial eligibility criteria and non-financial eligibility criteria. Financial eligibility is often not an obstacle for the developmentally disabled because of their limited earning capacity. It's the non-financial criteria that presents a challenge.

The non-financial criteria for the ECDC waiver has three components: FUNCTIONAL CRITERIA, MEDICAL OR NURSING NEED CRITERIA, RISK OF MEDICAL OR NURSING PLACEMENT CRITERIA.

FUNCTIONAL CRITERIA is met when the applicant needs some degree of assistance to complete activities of daily living. If the applicant needs help with activities such as eating, bathing, dressing transferring, toileting, behavior, orientation, mobility, medication management this component is met.

MEDICAL OR NURSING NEED CRITERIA is met when there is a medical diagnosis or several diagnoses. A physician should document the medical needs and the need for medical supervision.

The applicant must be AT RISK OF MEDICAL OR NURSING PLACEMENT without the support of the EDCD or CBC services. This is the third component of ECDC criteria, which effectively reiterates the second. There is no need for an actual nursing home placement. There must however, be proof that that despite the parent/caregiver's best efforts the applicant's condition is worsening, or additional care is needed, to prevent the applicant's physical decline.

In Virginia, every county/city has a prescreening team that visits the applicant to make the non-financial assessment. However, the medical or nursing need and the at risk criteria are applied differently depending upon the county of application. This has caused much confusion for applicants.

In each application it is important that medical providers document the specific medical needs and the at risk component. Getting the right kind of advice is essential to get the application through.

Edward Zetlin Law is experienced in such issues. Don't hesitate to call if you face such an issue or if you have additional questions. Edward Zetlin Law would be happy to discuss. Please contact us at 703-379-0442 or e-mail at ed@zetlinlaw.com

Community Presentations in April for Ed Zetlin

Langston-Brown - April 8th at 1:00 pm How To Choose a Fiduciary, Arlington Center 55+ at Langston-Brown Community Center, 2121 N Culpeper St, Arlington, VA 22207.

Contact us at (703)379-0442; ed@zetlinlaw.com


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