Service Coordination Overview

Service Coordination provides assistance to people with developmental disabilities in gaining access to necessary services and supports appropriate to their needs and life goals. It is provided by qualified service coordinators and uses a person centered process to develop, implement and maintain an Individualized Service Plan (ISP). Service Coordinators link their individuals with the most appropriate HCBS Waiver Services.

HCBS (Home and Community-Based Services) Waiver is the source for support and services that assists people with developmental disabilities to pursue their goals in life. HCBS waiver is the key that unlocks the doorway to more successful living in the community. The Person Centered Approach, and the person’s independence and inclusion in the community are primary concerns. Individuals possessing a developmental disability are eligible to live in an Intermediate Care Facility, a type of group home commonly inhabited by people with profound needs for assistance. These qualifying individuals may then waive this right, preferring to live in the community on their own, with family or other caregivers, or in an Individualized Residential Alternative (IRA). Hence the name “Waiver.”

Waiver Services include:

  1. Habilitation Services
    1. Day Habilitation
      An opportunity for individuals to achieve satisfying and rewarding connections and relationships within their communities. It offers myriad opportunities for socialization and activity.
    2. Residential Habilitation
      Provides the means, training and support for individuals who reside with their families or independently to gain social and personal skills necessary to lead an independent, fulfilling life.

      1. At-Home Residential Habilitation provides training in the person’s home.
      2. IRA Residential Habilitation is when individuals live in an Individualized Residential Alternative (IRA), sometimes called group homes. This heading also encompasses Supervised Apartments, which have staff present 24/7, and Supported Apartments, which have staff present some evenings and weekend hours.
      3. Family Care is when individuals reside in a private home with a family not their own, but where the family oversees the needs of the individuals.
    3. Supported Employment
      An opportunity for individuals to work in the community through the use of individual placement, mobile crew and enclave models. Intensive and ongoing support is provided at the work site by job coaches to assist participants in meeting the demands of their jobs.
    4. Prevocational Services
      An opportunity to enhance skills for work, the capacity to follow directions, productivity and worker/supervisor relationship management.
  2. Respite
    Designed to give families a rest in their caretaking duties, and creates a social opportunity for individuals.
  3. Environmental Modifications / Adaptive Devices
    This service provides specialized equipment, or changes to the living or work environment (for example, wheelchair ramps, lifts, handrails, communication boards), that enable people with physical disabilities or limited communication to lead more independent lives.
  4. Transitional Services
    A service to aid individuals who have been residing in a developmental center in transitioning to living in the community.
  5. Consolidated Support Services / Self-Determination
    A service enabling an individual to hire her/his own specific service providers that may lie outside the realm of existing services. This can be added to existing waiver programs provided there is not an overlap of services.
  6. Fiscal/Employer Agent
    This is in companion with Consolidated Support Services / Self-Determination as the agency overseeing the fiscal aspects of the program.
  7. Plan of Care Support Services
    In some cases, a person may not wish or need to have the level of support provided by an SC. There are also cases where home visits are not allowed by the parent(s) of an individual. As long as a person is receiving at least one Waiver service, an SC can help the person apply for Plan of Care Support Services. Instead of monthly contact, a person in PCSS need only meet with an SC two times a year, at the annual ISP meeting and semi-annual review.
  8. Family Education and Training
    This service is for parents / caregivers of individuals under the age of eighteen who were granted Medicaid with the understanding they would also maintain a Waiver service. Participating families are required to attend at least one two hour training session per year. This can be provided by a service coordinator in the family’s home as long as it is not also the monthly face-to-face contact.