AAS | DASA | CA | DDS | ESA | JRA | MAA | MHD | DVR
Aging and Adult Services
The Aging and Disability Services Administration (ADSA) includes
Aging and Adult Services (AAS) and Developmental Disability Services
(DDS). Aging and Adult Services serves frail elderly persons, as well as
functionally disabled people over 17 years of age. AAS provides
assistance with activities of daily living such as housework, shopping,
and money management as well as with life functions such as self-care,
eating, and medication management. Components of the long-term care
system include: Community services provided through AAS field service
offices; Community services provided through Area Agencies on Aging;
Nursing home quality assurance, regulation, and funding.
Adult Family Homes: Small group care
settings supply room, board, and laundry services for as many as six
adults who cannot live alone, but do not need 24-hour skilled nursing
supervision. AFH Personal Care assists residents with the activities of
daily living. AFH residents are not related to the provider. AFHs are
either COPES, State-only, or Title XIX funded. Services include Medicaid
Personal Care, state-funded Personal Care, and AFH-Aids Special Care
Services.
Adult Residential Care: Licensed boarding
facilities for disabled adults offer 24-hour supervision of, and help
with, the following: planning medical care, taking medications, and the
handling of financial matters when necessary. ARC services also include
a Personal Care element assisting residents with the activities of daily
living. ARC residence is either COPES, State-only, or Title XIX funded.
Assisted Living: Services provided in
licensed boarding facilities for adults requiring assistance with
self-care tasks but who otherwise can remain in a community residential
setting. Facilities allow for a private living unit and a private
bathroom. Services are available 24 hours a day and include limited
nursing care, assistance with activities of daily living, limited
supervision, and housekeeping. Clients pay a participation fee
(non-exempt income above the Medically Needy Income Level) and AAS pays
the remainder.
In-Home Services: These include both Chore
and Personal Care services delivered in the client?s home.
Chore is state-funded and provides in-home personal care services to non-Medicaid eligible, low-income, disabled or very frail adults who still live in their own homes. This group includes all contracted agency and individual provider services as well as provider meal reimbursements and travel costs.
Personal Care employs individuals and contracted agencies to assist
low-income disabled or frail adults with the activities of daily living,
allowing clients to remain in their own homes. Included are Title XIX
funded Personal Care services and transportation for Medicaid-eligible
clients as well as Community Options Program Entry System (COPES) funded
in-home Personal Care reimbursements. In addition to Personal Care,
COPES pays for the following ancillary services: Environmental
Modification (necessary physical adaptations to the client?s home),
Personal Emergency Response System equipment installation and
monitoring, Adult Day Care, Transportation, Home-Delivered Meals,
Special Medical Equipment, and Skilled Nursing.
Nursing Homes: In these residential
facilities, staff perform an array of services for disabled persons who
require daily nursing care as well as with medication, eating, dressing,
walking, or other personal needs.
Additional Services (AAS Misc): Services
that are small or unlike others are included in this category. Client
counts and expenditures for the following services appear in the program
total only. 1) Nursing Home Discharge Allowance, 2) Foster
Grandparents--AAS pays a small amount of money to elderly participants
for their work in the community or in schools for mentally retarded, 3)
Private Duty Nursing--AAS funds special, 24-hour intensive nursing
services, generally for younger clients with traumatic brain injuries,
and 4) Adult Day Health Services.
Not in this Report: Adult Protective Services; Respite
Services; Some AAA Services; Comprehensive Assessments; COPES Nurse
Oversight; COPES Participation Reimbursements; Nursing Facility
Placement; Nursing Home Nurses Aid Training; Caregiver Training and
Continuing Education for Individual Providers; Audit Settlements and
Recoupments; OASI Refund.
Alcohol and Substance Abuse
The Division of Alcohol and Substance Abuse (DASA) provides
alcohol and drug related services to help people recover from alcoholism
and drug addiction. DASA contracts with counties and service agencies to
provide services to clients who cannot pay for the full cost of
treatment.
ADATSA Assessments: The Alcohol and Drug
Addiction Treatment and Support Act (ADATSA) establishes a discrete mode
of treatment for indigent, unemployable alcoholics and drug addicts as a
constructive alternative to maintaining these persons on the public
assistance rolls. Clients determined both financially indigent and
clinically eligible may receive ADATSA Assessment services from
contracted assessment centers. An assessment includes a diagnostic
evaluation of alcohol or other drug addiction; a determination of
employability; and, if the applicant elects treatment, a determination
of the proper access point to the continuum and course of treatment for
that client.
Detoxification: Detoxification is a
short-term residential service for persons withdrawing from the effects
of excessive or prolonged alcohol or drug consumption. Services continue
only until the client recovers from the transitory effects of acute
intoxication. Detoxification always includes supervision, and may also
include counseling and/or medical care. Some counties provide
detoxification in specialized freestanding facilities. In other
counties, community hospitals provide detoxification. .
Opiate Substitution Treatment: Contracted
Opiate Substitution Treatment agencies provide outpatient services for
both Medicaid eligible and non-Medicaid eligible clients addicted to
heroin or other opiates. Opiate Substitution Treatment includes
counseling and daily, or near daily, administration of methadone or
other approved substitute drugs.
Outpatient Assessment: Counties contract
with private agencies to provide a variety of diagnostic services in a
non-residential setting. Outpatient Assessment patients include Medical
Assistance-eligible and low-income adults and adolescents. Outpatient
Assessment services also include assessment activities provided through
Group Care Enhancement contracts with JRA Group Homes. Specialized
assessment services are also provided to targeted client groups
including DCFS-referred adults, pregnant and parenting women, youth,
Native Americans, and TANF participants.
Outpatient Treatment: Counties contract
with private agencies to provide a variety of diagnostic services in a
non-residential setting. Outpatient Assessment patients include Medical
Assistance-eligible and low-income adults and adolescents. Outpatient
Assessment services also include assessment activities provided through
Group Care Enhancement contracts with JRA Group Homes. Specialized
assessment services are also provided to targeted client groups
including DCFS-referred adults, pregnant and parenting women, youth,
Native Americans, and TANF participants.
Residential Treatment: DASA contracts
directly with private agencies to provide the following services:
Intensive Inpatient Treatment, Long-term Residential Drug Treatment, and
Recovery House Care. Specialized Residential Care is provided for
populations with co-occurring disorders (mental health issues).
Residential Treatment also includes Involuntary Chemical Dependency
Treatment (ICDT) provided at the Pioneer North facility. Residential
facilities provide treatment to both ADATSA and regular DASA clients,
pregnant and parenting women, and youth.
Additional Services (DASA Misc): Additional
Services (DASA Misc): Services that are small or unlike others are
included in this category. Client counts and expenditures for the
following services appear in the program total only. 1) Parenting
Education services for Pregnant and Parenting Women, 2) Miscellaneous
services for Pregnant and Parenting Women, 3) DASA Therapeutic Child
Care--the Childhaven agency provides child care for children affected by
alcohol and/or drugs during their mother?s pregnancy; DASA Therapeutic
Child Care is provided while the mother is in outpatient treatment, 4)
DASA Child Care--DASA also pays for non-therapeutic Child Care while the
mother is in outpatient treatment, 5) Case Management for
Medicaid-eligible Youth, 6) Intensive Case Management for
Medicaid-eligible Youth, 7) Stipend payments for ADATSA clients to cover
food and housing costs while in outpatient treatment or a small
personal/incidental grant while in residential treatment, 8)
Transitional Housing--DASA contracts with private agencies to provide
individual or group living for Parenting Women in a drug free
environment, 9) Urinalysis--DASA pays for screening of Medical
Assistance-eligible clients.
Not in this Report: Not in this Report: Most DASA Child Care,
Interagency Prevention Services, Community Outreach and Prevention
Services, Support Services, Some Special Projects.
Children's Services
Children?s Administration (CA) promotes families and seeks to
ensure the safety and protection of children. CA both provides direct
services and works in partnership with community-based public and
private organizations.
Adoption Services: Children?s Administration
provides both Adoption Services and Adoption Support. Adoption Services
provide opportunities to permanently place in families children in DSHS
custody. Services include permanency planning, adoption preparation,
placement supervision, and some limited post-adoption services. Adoption
Support encourages adoption of hard-to-place children from DSHS foster
care and adoption of children who, because of age, race, physical
condition, or emotional health, would not otherwise be placed for
adoption. This service eliminates barriers to the adoption of such
children by providing financial assistance; medical and counseling
services; and assistance with legal fees for adoption finalization.
Behavioral Rehabilitation Services-Emergent:
Behavioral Rehabilitation Services-Emergent: The Behavioral
Rehabilitation Services (BRS) program uses intensive resources to create
an environment in which supervised group and/or family living are
integrated into a set of comprehensive services where positive
behavioral support methods and environmental structure are provided for
children with mental, developmental, emotional, and/or behavioral
difficulties that exceed the service or supervision capacity of regular
foster care families. Clients may be sexually aggressive,
self-injurious, high risk, behaviorally or emotionally disordered,
developmentally disabled, autistic or medically fragile.
BRS can be categorized as Emergent or Ongoing. Emergent BRS are
short-term, assessment and interim care services.
Behavioral Rehabilitation Services-Ongoing:
The Behavioral Rehabilitation Services (BRS) program uses intensive
resources to create an environment in which supervised group and/or
family living are integrated into a set of comprehensive services where
positive behavioral support methods and environmental structure are
provided for children with mental, developmental, emotional, and/or
behavioral difficulties that exceed the service or supervision capacity
of regular foster care families. Clients may be sexually aggressive,
self-injurious, high risk, behaviorally or emotionally disordered,
developmentally disabled, autistic or medically fragile.
BRS can be categorized as Emergent or Ongoing. Ongoing BRS are
long-term, continuing therapeutic services.
Child Care Services: Child Care Services:
Children?s Administration provides child care subsidies to support
children and their families engaged in various programs and services
offered by the administration. This includes: Adoption Support Child
Care, Employed Foster Parent Child Care, and CPS/CWS Child Care (the
latter for children at risk of child abuse and/or neglect).
Children whose families are in need of child care support services receive CPS/CWS and Employed Foster Parent Child Care subsidies. Adoption Support Child Care is provided to hard-to-place children who, because of age, race, physical condition, or emotional health, would not otherwise be placed for adoption.
Note: CSDB Child Care counts include both the children being served
and their adult, primary caregivers.
Child Protective Services Case Management:
Child Protective Services Case Management: CPS workers provide family
services to reduce risk and to maintain children in their own homes. CPS
cases are accepted for investigation based on a risk assessment which
includes a sufficiency screen for new referrals, an initial risk
assignment and response designation, and collateral contacts with key
witnesses or information sources. CPS cases receive 24-hour intake,
assessment, and emergency intervention services. Ongoing CPS includes
direct treatment, coordination and development of community services,
legal intervention, and case monitoring.
Child Welfare Services Case Management: CWS
services are designed to strengthen, supplement, or substitute for
parental care and supervision. CWS Services may involve substitute care
such as Foster Care or Adoption placements.
Crisis Care Services: Children?s
Administration provides emergency placement resources for children
pending family reunification or out-of-home placement to longer-term
Family Foster Care or Group Care. Crisis Care includes Crisis Counseling
and/or placement in Crisis Residential Centers (CRC). Two types of CRCs
are utilized: Group and Family facilities. Crisis Care also includes
costs associated with clothing or personal incidentals purchased for
children placed in CRCs.
Family Reconciliation Services: FRS helps
adolescents, 13-17 years of age and their families, in instances where
the adolescent has run away and/or is in conflict with his/her family.
FRS involves three components: (1) Intake; (2) Family Assessment; and
(3) Crisis Counseling provided by county-contracted counselors.
Family-Focused Services: Children?s
Administration provides individualized services to help families who are
at risk of child placement or are in need of reunification.
Family-Focused Services may include traditional child welfare services,
such as parent aides or counselors, and/or support centered around basic
needs, such as clothing, shelter, employment, and transportation.
Family-Focused Services also include in-home family preservation
services and intensive family preservation services that are provided by
contract agencies.
Foster Care Placement Services: Foster Care
Placement Services: Foster Care Placement Services: Foster Care
Placement Services are provided when children need short-term or
temporary protection because they are abused, neglected, and/or involved
in family conflict. The goal of Foster Care Placement Services is to
return children to their homes or to find another permanent home as
early as possible. Children here are served in out-of-home placements
exclusively. Placement types include traditional Foster Care Placements
as well as placements in Family Receiving Homes.
Notes: (1) CSDB client counts for Foster Care Placement Services
include only the children being served, not their families. (2) Children
receiving Foster Care Placement Services are served exclusively in
out-of-home settings. (3) Foster Care Placement Services may be provided
without prior Child Protective Services (CPS) involvement.
Foster Care Support Services: Foster Care
Support Services are provided to children and families who need
short-term or temporary protection because they are abused, neglected,
and/or involved in family conflict. The goal of Foster Care Support
Services is to return children to their homes or to find another
permanent home as early as possible. Children are served either in their
own homes or in out-of-home placements. Also included are support
services received by children while in foster care: clothing and
personal incidentals, psychological evaluation and treatment, personal
care services, transportation, and payments made to foster parents for
respite and for additional supervision for special activities.
Notes: (1) CSDB client counts for Foster Care Support Services
include both the children being served and their families. (2) Children
receiving Foster Care Support Services may be served in their own homes
as well as in out-of-home placements. (3) Foster Care Support Services
may be provided without prior Child Protective Services (CPS)
involvement.
Other Intensive Services: These services are
alternatives to the regular contracted Behavioral Rehabilitation
Services. They include the following: Children?s Hospitalization
Alternatives Program (CHAP), this service may occur in either the
child?s own home or a treatment foster home; treatment foster home
services that are not CHAP; After Care services, these services may
occur in the youth?s own home, a relative?s home, or a foster home, they
are intended to help youth transition to their permanent placement from
the more intense Behavioral Rehabilitation Services; Child-specific
placement services, these structured individualized services are for
youth that exhibit behaviors, disorders, and disabilities so extreme
they require placement and services above and beyond the normal BRS;
exceptional clothing and personal incidentals; exceptional
transportation.
Additional Services (CA Misc): Services that
are small or unlike others are included in this category. Client counts
and expenditures for the following services appear in the program total
only. 1) Personal Care - Nurse Oversight-- Authorizations for Title XIX
Personal Care Nurse Oversight services for children with special needs,
2) Child Care Registration--payment of a fee to register a child in a
licensed Child Care facility, 3) Child Care Registration - Infant
Bonus--payment of a $250 infant bonus to a licensed or certified Child
Care provider, 4) Independent Living Skills (ILS) Support--payment for
enhanced non-maintenance services for children 16 or older living in a
CA-paid placement who are not receiving contracted ILS services.
Changes from Prior Year: Group Treatment Care as reported in
CSDB for SFY02 has been relabeled and redefined in CSDB for SFY03. This
service category is now referred to as Other Intensive Services.
Not in this Report: Referrals Not Accepted (did not pass
sufficiency screening); Accepted Referrals where no caseworker was
assigned; Child Care Training; Regional Crisis Residential Centers (CRCs);
Secure Crisis Residential Centers (CRCs); Miscellaneous Adoption
Services; Payments to assure availability of beds (e.g. CRC slot
payments); Public Health Nurses; Street Youth.
Developmental Disabilities Services
DDS provides support services and opportunities for the personal
growth and development of persons with developmental disabilities
resulting from mental retardation, epilepsy, cerebral palsy, autism or
similar neurological conditions that originated before adulthood. DDS
clients? disabilities are lifelong and constitute a substantial handicap
to everyday functioning. Additionally, children under age 6 may receive
services if they have Down Syndrome or have developmental delays of 25%
or more below children of the same age. CSDB obtains service and
expenditure information for some clients who do not appear in DDS
information systems due to the inclusion of additional source
information systems (e.g. the Medicaid Management Information System).
DDS also typically reports point in time counts rather than annual
counts. For these reasons, CSDB client counts and dollar sums may differ
from those reported by DDS.
Case Management: Case Management: Case
managers perform intake, eligibility determinations, and reviews, and
provide information and referral services to applicants and eligible
clients. Case managers help eligible DDS clients and their families
assess needs; develop and review individual service plans; authorize
services; and link clients with needed medical, social, educational or
other services, as well as provide support and assistance in handling
life crises. Case management service is not provided to clients living
in state institutions. A Habilitation Plan Administrator (HPA) at the
institution monitors these clients. While CSDB includes expenditures for
all clients receiving assessments and ongoing case management, counts
are reported only for those clients who are determined eligible for
ongoing Case Management services.
Community Residential Services: DDS clients
who require assistance with daily living may receive facility based or
non-facility based Community Residential Services. Clients receiving
facility based services live in contracted Intermediate Care Facilities
for the Mentally Retarded (ICF/MRs), Adult Residential Centers (ARCs),
Group Homes, or Adult Family Homes (AFHs) where staff provide support
and training. Clients receiving non-facility based services live in
their own homes, either alone or with a roommate; contracted agencies
provide the necessary support in homes owned or rented by the client.
Non-facility based services include Alternative Living, Medical/Dental
services (for clients who are not Medicaid-eligible), Supportive Living,
State Operated Living Alternatives (SOLAs), Tenant Support, and Other
Residential Support. Other Residential Support may include summer
recreational activities, specialized aids or equipment purchases,
reimbursement for activity fees, client transportation, interpreters,
and other community supports such as client allowances or temporary
additional staff when needed.
County Services: DDS contracts with county
governments to provide services to both adults and children.
Adult-oriented services include: (1) Individual Supported Employment
which helps clients find and keep jobs in the community, (2) Group
Supported Employment which enables clients to work in groups or enclaves
at local businesses, (3) Prevocational Employment / Specialized
Industries which provides employment in training centers, and (4)
Community Access, Person-to-Person, Individual & Family Assistance, and
Adult Day Health services which emphasize development of personal
relationships within the individual?s local community. DDS also funds
Child Development services through county contracts. These services
provide specialized therapeutic or educational services for infants and
toddlers and their families in order to maximize the child?s development
and to enhance parental support of the child.
Note: Expenditures for County administration of these services are
not included.
Family Support Services: These services
enable families to keep children with developmental disabilities at
home. Family Support Services include Respite Care, Attendant Care, and
Transportation for attendants or family members. Some clients receiving
Family Support Services also receive the following services: Nursing
Care, Physical Therapy, Occupational Therapy, Instructional Therapy,
Behavioral Therapy, Communication Therapy, and Counseling.
Personal Care Services: DDS provides
Personal Care Services to Medicaid-eligible children and adults. The
major difference between children?s and adult?s Personal Care is in the
interpretation of the level of need for specific Personal Care tasks.
This service enables eligible individuals to remain in their community
residences through the provision of semi-skilled maintenance or
supportive services. These services can be provided in the person?s own
home, a licensed Adult Family Home (AFH), or an Adult Residential Center
(ARC).
Professional Support Services: DDS funds the
following Professional Support Services for adult DDS clients supported
by Community Residential Services: Medical and Dental services (for
clients Medicaid-eligible), Psychological Services (used to determine
eligibility), Professional Evaluations (required by the criminal
courts), Counseling, Nursing Care, Behavioral Therapy, Communication
Therapy, Physical Therapy, Occupational Therapy, Instructional Therapy,
and Other Therapies approved by exception. DDS also funds Professional
Support Services for persons with developmental disabilities who live
with their families.
Note: CSDB counts for Medical/Dental services include only those
clients whose treatment was paid for by DDS. DDS does not typically
report on Medical/Dental services, so counts and cost will be higher
than reported by DDS. Those clients whose treatment was paid for by the
Medical Assistance Administration are included in the MAA counts.
RHCs and Nursing Facilities: The following
state Residential Habilitation Centers (RHCs) provide residential and
habilitation services to persons with developmental disabilities either
under Intermediate Care Facilities for the Mentally Retarded (ICF/MR) or
Nursing Facility (NF) regulations: Rainier School and the Frances Haddon
Morgan Center have only ICF/MR beds; Fircrest and Lakeland Village have
both ICF/MR and NF beds; all beds at Yakima Valley are NF. Respite care
services, not identified as such in the data, are included making CSDB
counts higher than DDS reports.
Voluntary Placement-Children: A family may
ask for out-of-home placement for their child under 18 due solely to the
child?s disability. Under certain circumstances, the child may be placed
in licensed out-of-home care.
Additional Services (DDS Misc): Services
that are small or unlike others are included in this category. Client
counts and expenditures for the services that follow appear in the
program totals only. Infant Toddler Early Intervention Program: ITEIP
provides early intervention services, including family resources
coordination, for eligible children from birth to age 3 and their
families. Only a portion of ITEIP services are reported here. ITEIP
services provided by other departments are not included. Child
Development services, coordinated through DDS, are reported under County
Services. Complete ITEIP data are available from DDS in the ITEIP Data
Management System.
Changes from Prior Year: Was listed as Division of
Developmental Disabilities (DDD).
Not in this Report: Training; Payments for DDS Group Home
vacancies; Respite Care for RHC and SOLA residents; Adult Day Care; and
Authorized Employment and Day Services (only the Provided services are
reported).
Economic Services
The Economic Services Administration (ESA) administers welfare
grants, related employment training, and child care to low-income
persons in the following groups: disabled and unemployable persons,
persons who have children under age 18, and pregnant women. In addition,
ESA administers services that promote economic independence and
self-sufficiency for refugees through the effective use of financial,
medical, and social services. ESA also administers food assistance
services.
Basic Food Program: Federal Food Stamp
Program (FSP) benefits are available to households with income below
130% of the federal poverty level and resources below federal limits.
Legal immigrants who are ineligible for the federal FSP but meet FSP
income and resource limits receive food assistance through a
state-funded food assistance program. Food assistance benefits are
generally available to all low-income households regardless of factors
such as age, incapacity, and dependency. Certain Able-Bodied Adults
Without Dependents (ABAWDs) are limited to no more than 3 months of
benefits during a 36-month period unless they either work at least 20
hours a week or participate in Food Stamp Employment and Training.
Recipients receive debit cards redeemable for food at participating food
stores.
Consolidated Emergency Assistance: ESA
provides for specific emergent needs such as food, shelter, clothing,
minor medical, household maintenance, job-related transportation or
clothing, and transportation for foster care-bound children. Payment is
limited to specified maximums for individual emergent need items or the
Temporary Assistance for Needy Families (TANF) Payment Standard,
whichever is lower. Benefit payments are authorized for only 30 days in
any 12 consecutive month period. CEAP is available to the following
persons: (1) pregnant women in any stage of pregnancy or (2) families
with dependent children. Prior to January 2000, clients could be
eligible for CEAP benefits while receiving ongoing cash assistance.
Beginning January 1, 2000, clients must be ineligible for TANF, State
Family Assistance (SFA), Refugee Cash Assistance (RCA), or Diversion
Cash Assistance (DCA) to receive CEAP benefits. This policy change
restricting eligibility accounts for the significant decline in numbers
served between SFY99 and SFY00.
Diversion Cash Assistance: Diversion Cash
Assistance: ESA provides one-time DCA grants to low-income families with
temporary emergent needs who are not likely to need continued assistance
if those needs are met. DCA grants are limited to $1500 once per year.
DCA payments may be used to cover emergent needs for shelter,
transportation, child care, food, medical care, and employment-related
expenses. Recipients must meet TANF or SFA eligibility criteria to
receive a DCA grant. If the family or assistance unit goes on TANF or
SFA assistance within 12 months of receiving a DCA grant, a
proportionate amount of the DCA payment must be repaid.
General Assistance (GA-ABD, GA-I, GA-U, and GA-X):
ESA provides GA-A/B/D, GA-I, GA-U, and GA-X cash grants to clients who
are poor and unable to work due to a physically or mentally
incapacitating medical condition. GA-A/B/D benefits are paid to the
aged, blind, and/or disabled. GA-I benefits are paid to clients residing
in institutional facilities. GA-U benefits are paid to those with
medical conditions that are not severe or long-term enough to meet
federal disability criteria. GA-X benefits are paid to clients who are
awaiting SSI determination (GA-X).
Refugee Grants: Refugees who meet state
income and grant standards, but do not qualify for TANF or SSI, receive
federal Refugee Cash Assistance (RCA) for their first eight months in
the United States. In general, RCA recipients are single persons and
married couples without children.
Supplemental Security Income-State (SSI):
SSI is a national benefit service for individuals and couples who are
age 65 or older or who are blind or disabled as determined by the Social
Security Administration. SSI State Supplement Payments are Washington
State funded grants which supplement federal SSI payments. SSI state
supplement payments are made to individuals and couples who have
countable income below a combined state and federal income standard and
meet one of the following criteria:
- a grandfathered SSI recipient;
- an individual with an ineligible spouse;
- age 65 or older;
- blind;
- determined eligible for SSP by the Division of Developmental Disabilities; or
- determined eligible under specific criteria set by the Children?s Administration.
Note: Changes in the administration and eligibility of SSI have resulted in totals that are not comparable across time. What follows is a brief explanation of those changes.
The SSI dollars in CSDB include only the state's portion, which is known as the State Supplemental Program (SSP). Federal dollars have never been included. No dollars are reported for 1999.
Administration Changes Affect Counts
The state began administering SSP July 2002, at the beginning of state fiscal year 2003. Prior to then, SSP was federally administered and all recipients were considered ESA clients.
Under the state, administration of the funds was further de-centralized. ESA administers SSP for MIL (Mandatory Income Level), for individuals with an ineligible spouse, and for aged and blind. So the clients and dollars CSDB reports for ESA SSI are only for these services. However, during FY2003, SSP was not paid to aged and blind.
Starting in FY 2003, Funds for recipients with developmental disabilities go through the Division of Developmental Disabilities. Children's Administration administers the program for foster care recipients. SSP for these people are not reported separately in CSDB but rather are included in other service groupings.
SSI Eligibility Changes for SFY 2003
ESA aged and blind were not paid SSP during state fiscal year 2003 (July 2002-June 2003). These recipients were reinstated and back payments were made during SFY 2004.
TANF and State Family Assistance: TANF and
State Family Assistance: ESA provides TANF cash grants to the following
financially needy client groups: (1) children under age 18, (2) children
under age 19 attending high school or working towards a GED full-time,
(3) parents or caretaker relatives of these children, (4) unmarried teen
parents under the age of 18, and (5) pregnant women. Eligibility for
TANF cash grants is limited to a 5-year period during which adult
members of the family or assistance unit are expected to participate in
WorkFirst. In addition to ongoing TANF cash grants, families may receive
a special one-time Additional Requirements for Emergent Needs (AREN)
cash payment to meet emergency housing or utility needs. ESA also
provides SFA cash grants to certain persons meeting Washington State
residency requirements who are not eligible for TANF assistance and who
are (1) qualified aliens and have been in the United States for less
than five years, (2) aliens who are permanently residing in the US under
color of law (PRUCOL), (3) nineteen or twenty year-old students meeting
certain education requirements (i.e. receiving a special education due
to their disability or participating full-time in secondary education or
vocational training), or (4) pregnant women who have been convicted of
either misrepresenting their residence in order to receive benefits from
two or more states at the same time or of a drug-related felony.
Work First: Persons age 16 or older who are
part of a TANF family or assistance unit are required to participate in
WorkFirst (WF). WorkFirst services include job search, basic education
(including high school/GED completion, remedial education, and English
language proficiency), jobs skills training, customized job skills
training, subsidized community jobs, one year of post-secondary
education (career counseling as well as limited academic education and
vocational instruction), and on-the-job training. In order to receive
food assistance, a TANF/WF client must participate fully in WF
activities. Sanctioned TANF/WF clients must register for the Food Stamp
Employment and Training (FS E&T) program and participate in job search,
employment and training activities, and/or attend General Education
Development or English as a Second Language classes.
Working Connections Child Care: Working
Connections Child Care: ESA provides child care assistance to: (1)
eligible TANF families who require child care to participate in approved
WorkFirst activities, job search, employment, or training and (2) non-TANF
families who require child care to maintain employment or to attend
approved training. Clients receiving WC Child Care must pass an economic
means test.
Note: CSDB Child Care counts include both the children being served
and their adult primary caregivers.
Additional Services (ESA Misc): Additional
Services (ESA Misc): Services that are small or unlike others are
included in this category. Client counts and expenditures for the
following services appear in the program total only. Categories are as
follows: 1) SSI Facilitation--ESA provides assistance with the
completion and monitoring of SSA Title II or Title XVI applications to
the following client groups: GA-U recipients, TANF recipients, and
ADATSA shelter residents, 2) Protective Payee Fees, 3) Eligibility
Determination--ESA staff perform assessment, evaluation, and
documentation of incapacity for applicants or recipients, 4) General
Assistance-Legal Guardian (GH-H) payments--ESA provides cash grants for
the basic needs of children who live with court-appointed legal
guardians or permanent legal custodians. Beginning in July 2000, this
service was integrated with TANF, 5) Refugee and Immigrant Assistance (RIA)
coordinates a variety of contracted services including English as a
Second Language (ESL) Training, Health Screening, Self-Sufficiency
Assessments, Citizenship Training, Planning, Employment Services, Foster
Care, Mental Health and other Social Services and referrals to medical
services. All RIA Services are provided to refugees and immigrants
through private non-profit and government contractors. ESL Training
assists refugees and immigrants to overcome communication problems and
to obtain the necessary language skills to find employment. Employment
Services include assessment, job development, job placement,
on-the-job-training, trial employment, and follow-up to ensure job
retention, 6) Refugee Unaccompanied Minors--RIA administers foster care
contracts for children who have been identified as Unaccompanied Minors
by the Office of Refugee Resettlement. The contracting agencies provide
services that include recruiting, training and/or licensing foster
families, placement, and casework services. These agencies also provide
emancipation training and cultural preservation activities.
Not in this Report: Telephone Assistance (Washington Telephone
Assistance Program); Non-Assistance Support Collection; Public
Assistance Recoveries (which offset ESA expenditures); Refugee Health
Screening.
Juvenile Rehabilitation
The Juvenile Rehabilitation Administration serves youth who have
been adjudicated in Juvenile Court and sentenced for a minimum and
maximum term. CSDB reports data for JRA youth in residential placements,
or who have been in residential placement and moved out on parole.
Learning and Life Skills Services and Consolidated Juvenile Services
which JRA funds are not included. Specialized Mental Health, Substance
Abuse, and/or Sex Offender treatment services are provided to all JRA
youth as necessary in its Institutional, Youth Camp, Community, and
Parole placements.
Community Placement: JRA clients are housed
in the following types of small group facilities while working and/or
attending schools in the community: JRA-operated Community Facilities;
Contracted Community Facilities; and Short Term Transitional Program.
Institutions, Youth Camps, and Basic Training:
All JRA institutions and youth camps provide treatment, education,
and/or work experience in a secure facility. JRA Institutions include
Green Hill, Maple Lane and Echo Glen; JRA Youth Camps include Naselle
and Mission Creek; JRA also operates JRA Basic Training camps.
Parole: Parole counselors supervise juvenile
offenders released to parole status. Counselors provide structure,
supervision, family and client support, and access to needed community
services. Several distinct types of Parole are provided: Regular;
Intensive; Sex Offender; and Basic Training Camp Aftercare.
Additional Services (JRA Misc): Services
that are small or unlike others are included in this category. Client
counts and expenditures for the following services appear in the program
total only. 1) Special Sex Offender Disposition Alternative (SSODA)
services are designed for first-time juvenile sex offenders allowing for
community supervision and treatment as an alternative to institutional
confinement, 2) Chemical Dependency Disposition Alternative (CDDA)
services are designed for substance-abusing juvenile offenders allowing
for community supervision and treatment as an alternative to
institutional confinement.
Changes from Prior Year: The JRA Youth Camp, Mission Creek, was
closed.
Not in this Report: Learning and Life Skills Services;
Consolidated Juvenile Services.
Medical Assistance
The Medical Assistance Administration (MAA) assures that necessary
medical care is available to income assistance and other eligible low
income persons. Medical Assistance-paid services include fee-for-service
payments and managed health care premiums. Medical Assistance-paid
services also include primary care case management clients, regardless
of whether they received fee-for-service services. Through the provision
of Medicaid services, MAA uses both federal and state funds to pay for
services to Categorically Needy clients, those meeting categorical and
income eligibility requirements set by the federal government for income
assistance services; and to Medically Needy clients, those meeting
categorical eligibility requirements but with assets and/or incomes
slightly higher than the allowable limits. Included in Categorically
Needy clients are pregnant women in Washington State who are at or below
185 percent of the federal poverty level as well as Medicaid eligible
children under the age of 19 with family incomes at or below 200 percent
of the federal poverty level. Under the Refugee Act of 1980, the federal
government pays for services provided to refugees in their first 8
months in the United States. In addition to federally-funded services,
Washington State covers the cost of services to non-Medicaid eligible
children under the age of 18 with family incomes below 100 percent of
the federal poverty level and to non-Medicaid eligible clients receiving
GA-U.
Dental Services: These include diagnostic,
preventive, or corrective services provided by or under the supervision
of an individual licensed to practice dentistry or dental surgery.
Hospital Inpatient Care: Hospital Inpatient
Care includes care and treatment to clients admitted to stay at a
facility under the direction of a physician or dentist. A licensed or
formally approved hospital furnishes these services. This program
includes emergency room services to clients admitted through the
emergency room to an inpatient stay. Hospital Inpatient Care includes
room and board and possibly other ancillary services such as drugs,
laboratory, and radiology.
Hospital Outpatient Care: A licensed or
formally approved hospital provides Hospital Outpatient Care to clients
treated, but not admitted to stay, at the facility.
Managed Health Care: Managed Health Care
Payments are fixed monthly premiums paid on a per client basis to
managed health care providers. In return for the payment, a managed
health care provider makes a range of services available to the client.
The one-time payment is independent of the client?s use of those
services and replaces the traditional fee-for-service arrangement.
Health maintenance organizations, (which provide services through staff
physicians) or health insuring organizations (which contract with
primary care physicians to provide services) administer managed health
care plans.
Medically Eligible Clients (T19): Clients
who are eligible to receive medical services for which the state
receives federal Title XIX matching funds. Title XIX of the Social
Security Act funds: (1) medical assistance on behalf of families with
dependent children and of aged, blind, or disabled individuals, whose
income and resources are insufficient to meet the costs of necessary
medical services, and (2) rehabilitation and other services to help such
families and individuals attain or retain capability for independence or
self-care.
Medically Eligible Clients (not T19):
Medically Eligible Clients (not T19): Clients who are eligible to
receive medical services which are not Title XIX funded.
Other Medical Services: Other Medical
Services include laboratory tests and x-rays, durable medical equipment,
home health care, optometrists/opticians/ eyeglasses, chiropractic care,
Indian Health, rural health facilities, and a variety of other services
that represent a small proportion of MAA expenditures.
Physician Services: A provider of Physician
Services is, or is under the personal supervision of, an individual
licensed to practice medicine or osteopathy. Providers furnish Physician
Services in the physician's office, the client's home, a hospital, a
nursing home, or a clinic. Physician Services include primary care case
management.
Prescription Drugs: These include simple or
compound substances or mixtures prescribed by a physician or other
licensed practitioner and dispensed by licensed pharmacists or other
authorized practitioners, with no adjustment for drug rebate.
Not in this Report: Audit Settlements; Family Planning; HIV
Insurance; Kidney Disease Programs; Medicare Premium Payments;
Transportation; Disproportionate Share; Drug Rebates.
Special Notes: Client counts and dollar amounts reported from
CSDB may differ to some extent from those reported by MAA for the
following reasons: CSDB obtains its medical information from the MMIS
Billing/Warrants File, while MAA reports are based on its Extended Data
Base (EDB); Medthodological differences between CSDB and EDB in terms of
how client counts are calculated; Classification differences between
CSDB and EDB in terms of how services are categorized; Methodological
differences between CSDB and EDB in terms of how dollar amounts are
calculated. CSDB does not include payment adjustments that are not
attributable to individual clients; EDB includes certain adjustments.
Mental Health Services
The Mental Health Division administers treatment services for
adults and children who are severely and/or chronically mentally ill.
MHD administers services through three channels. (1) MHD directly
operates state mental hospitals, which deliver services to clients with
severe mental disorders. (2) Single counties or groups of counties
administer Regional Support Networks (RSNs), which contract with
licensed community mental health providers to supply mental health
services. RSNs coordinate crisis response, community support,
residential and resource management services. MHD funds services to
Medical Assistance-eligible consumers within an RSN through capitated
Prepaid Health Plans (PHPs). (3) Community Evaluation and Treatment
facilities include general hospitals and psychiatric hospitals that
deliver inpatient psychiatric treatment, both voluntary and involuntary,
to consumers authorized by the RSNs. For involuntary admissions, either
general or psychiatric hospitals in the community serve as
hospital-based Evaluation and Treatment (E&T) facilities that provide
services during emergency situations for the initial 72-hour detention
and for an additional 14 days of commitment if necessary. E&Ts may also
be free-standing residential treatment facilities.
Child Study and Treatment Center: Child
Study and Treatment Center: MHD operates a state hospital for children
who are psychiatrically disturbed. Inpatient services are provided on
the grounds of Western State Hospital.
Note: Dollar amounts for CSTC may be overestimated since client
counts for other Children?s Long-term InPatient (CLIP) facilities are
not included.
Community Inpatient Evaluation and Treatment:
Community Inpatient Evaluation and Treatment: Community general
hospitals, psychiatric hospitals, and free-standing residential
treatment facilities provide services to clients who are voluntarily
admitted for inpatient care. In addition, the Involuntary Treatment Act
(ITA) authorizes involuntary admissions to these community facilities.
Notes: (1) According to MHD staff, oxygen claims from community
hospitals were incorrectly coded and included as Community Inpatient
services for SFY01. These claims were erroneously charged to involuntary
mental health inpatient services. This problem was identified early in
SFY00 and it is expected that data for these claims will be correctly
reported starting in April 2001. (2) Also according to MHD staff, the
number of clients receiving Community Inpatient services in SFY01 is
understated due to Pierce RSN authorizing and paying for these services
outside the Medicaid Management Information System (MMIS). No automated
data for these transactions were made available for collection by CSDB.
Community Services: Community mental health
providers deliver Individual Therapy, Group Therapy, Day Treatment, and
Medication Management on an outpatient basis in both emergent and
non-emergent situations. Also included here are Day Treatment services
provided on an outpatient basis at the Child Study and Treatment Center
at Western State Hospital. Expenditures for RSN Administration are not
included.
Note: All outpatient services reported to the MHD are used in
estimating Outpatient costs, including Residential, 24-hour Crisis, and
Crisis Hotline.
State Hospitals (State Institutions): MHD
operates two state hospitals, Eastern State Hospital and Western State
Hospital. State Hospitals provide inpatient services to both voluntary
and involuntary clients. Services offered at Western State Hospital also
include the Program for Adaptive Living Skills (PALS).
Not in this Report: Children's Long-term Inpatient/CLIP (no facilities
reported, except CSTC); Community Residential Transitional Services;
Group Housing; Adult Residential Treatment Facilities (no facilities
reported except the E & Ts); Special Commitment Center; services
contracted directly with Tribal governments by the federal Indian Health
Service.
Vocational Rehabilitation
The Division of Vocational Rehabilitation (DVR) serves persons who
want to work but have difficulty obtaining and/or maintaining employment
due to a physical, sensory, and/or mental disability. DVR provides
vocational assistance, independent living, and job support services.
Independent Living Case Management: Independent
Living Case Management, Expenditures, and Part B includes evaluations
and social services that assist persons in dealing with life issues that
get in the way of rehabilitation and employment goals. Case managers
help clients to access community resources and develop self-advocacy,
money management, and personal organization skills.
Medical and Psychological Services: Agencies
contracted by DVR provide medical or psychological evaluations needed to
identify work potential and/or enhance job accessibility. Medical and
Psychological Services include the purchase of adaptive devices,
prostheses, eye glasses, and job site re-engineering.
Personal Support Services: DVR funds
services associated with the completion of a rehabilitation plan and
with finding employment. Personal Support Services include payments for
transportation, day care, independent living services, and vehicle
modifications necessary to accommodate a disability.
Placement Support (Work Support): DVR funds
services associated with job placement. Placement Support Services
includes the purchase of work clothing, books, tools or equipment
necessary for job placement; assistance with resumes, job applications,
business licenses and fees; and job placement fees.
Training, Education, and Supplies: DVR funds
the direct costs of post-secondary Training. DVR also assists clients
with Education and Supplies including tuition, school books and
equipment, interpreter or reader services, and lab fees.
Vocational Assessments (Job Skills):
Agencies contracted by DVR identify clients? interests, readiness for
employment, work skills, and job opportunities in the community.
Vocational Rehabilitation Case Management:
Vocational Rehabilitation services help participants assess job skills
and find suitable employment. Case managers assist a small segment of
clients who are severely disabled. To maintain employment, these clients
require ongoing follow-up and post-employment services. Other agencies
provide long-term follow-up and employment services.
Source: Washington State Department of Social and Health
Services, Research and Data Analaysis, Client Services Database, June
2002-July 2003. January 2004.
