The New Opportunities Waiver (NOW) began in April 2003, replacing the Mentally Retarded and Developmentally Disabled Waiver (MRDD Waiver). The mission of the NOW is to utilize the principles of self-determination to supplement the family and/or community supports while supporting dignity, quality of life, and security in the everyday lives of people while maintaining the Recipient in the community.
The NOW is only appropriate for those individuals whose health and welfare can be assured via an Individual Support Plan and for whom home and community-based waiver services represent a least restrictive treatment alternative. The NOW is intended to provide specific, activity focused services rather than continuous custodial care.
To qualify for the New Opportunities Waiver, a person must:
• Meet Medicaid Eligibility AND
• Be 3 years of age or older AND
• Have an OCDD Statement of approval
• Meet the Louisiana definition of Developmental Disability per Revised Statue 25:451.2 Paragraph (11)
• Meet Intermediate Care Facility-Intellectual Disability (ICF-ID) Level of Care Criteria
• Have needs that cannot be met by another OCDD Waiver
Additionally, interested persons must meet the following financial criteria:
Income limits (also known as Special Income Limit (SIL)) are $2,250 for an individual, and $4500 for a couple (when both spouses need long-term care).
However, there is a “waiver Spend-down” option which allows your eligibility to be considered even if your income is over the limit. Waiver Spend-down has a standard $20 income deduction. Additionally, $65 and 1/2 of the remainder is deducted from all earned income.
After the income deductions are applied, the average monthly waiver rate and other allowable incurred medical expenses are used to “spend-down” an individual’s excess income, qualifying the individual for Waiver.
Allowable incurred medical expenses include Medicare and private health insurance premiums, deductibles, coinsurance, or copayment charges, and medical/remedial care expenses incurred by an individual that are not subject to payment by a third party.
The individual’s liability is based on their income after the income deductions are applied. All individuals are allowed to retain a basic needs allowance from his/her income which is equal to $2,250 and the amount of incurred medical expenses not paid by a third party. Any remainder will be the individual’s liability for the cost of care in Waiver Spend-down.
Individuals who have a need for services should contact their local Human Services District/Authority in order to go through the eligibility determination process. Once a person is eligible for OCDD services, they may ask to be added to the Developmental Disability Request for Services Registry (RFSR).
OCDD maintains a Developmental Disability RSFSR of individuals who have a need for waiver services along with the date the person initially requested waiver services.
As each individual is added to the RSFSR, the individual is screened to determine their urgency of the need for services. An Individual, who meets the eligibility criteria, is in the highest urgency priority category(s) being served based on funding and has the earliest RSFSR date will be offered the next available OCDD waiver opportunity that meets their needs.
The application process does not begin until a waiver slot becomes available. At that time, medical and financial determinations will be completed simultaneously to verify that the person has a developmental disability and meets the financial and medical/psychological requirements for an Intermediate Care Facility for the Intellectually Disabled (ICF/ID).