AAS 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: Adult Family Homes (AFH) are small group care
residential settings licensed to care for up to 6 (six) adults who
cannot live alone but do not need 24-hour skilled nursing supervision;
AFH residents are not related to the provider, AFHs encourage maximum
resident independence and involvement. They provide a range of daily
activities tailored to resident preferences. AFHs provide room, board,
laundry, supervision, assistance with activities of daily living, and
personal care; some provide nursing or other special care and some AFHs
provide transportation.
Room and board, care and services vary depending on provider
qualifications. Providers are required to adequately staff each AFH to
meet the needs of their residents.
AFHs may be funded through an individual's private resources, Medicaid,
the COPES (Community Options Program Entry System ) Waiver, or the
Medically Needy Residential Waiver.
Adult Residential Care: Licensed boarding facilities for
disabled adults offer 24-hour supervision in a Boarding Home (BH) in a
community setting. The home provides housing, meal services and assumes
general responsibility for the safety and well-being of the residents
and helps with the following: planning medical care, managing
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. Residents may need/receive limited
supervision. ARC residence is either COPES (Community Options Program
Entry System ), State-only, or Title XIX funded.
Boarding Homes allow residents to live an independent lifestyle in a
community setting while receiving necessary services from staff. BH can
vary in size and ownership from a family operated 7-bed facility to a
150-bed facility operated by a large national corporation. Some
specialize in serving people with mental health problems, developmental
disabilities, or dementia.
Enhanced Adult Residential Care (EARC) provides help with medication
administration and personal care. No more than two people will share a
room and Intermittent nursing care must be provided.
Payment for services is provided by the individual (in the majority of
cases), or through COPES, Medicaid, the Medically Needy Residential
Waiver or State funds.
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. Assisted Living
facilities are boarding homes with an emphasis on privacy, independence
and personal choice.
Generally these are private apartments, with a private living unit and
private bathroom and intermittent nursing services and assistance with
medication administration and personal care. 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 through the COPES waiver
or the Medically Needy Residential Waiver.
In-Home Services: These include both Chore and Personal Care services
delivered in the client's home, as well as some ancillary services,
provided off site, essential to seniors safely living in their own
homes.
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,
such as bathing, dressing and grooming, meal preparation and household
chores, allowing clients to safely 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: Adult Day Care and Adult Day Health,
Environmental Modification (necessary physical adaptations to the
client's home), Home Health treatments, Home Health Aides, Health
Screening, Hospice, Information and Assistance, Minor Home Repairs,
Personal Emergency Response System equipment installation and
monitoring, Senior Centers, Senior Meals, including Home-Delivered
Meals and meals in group settings, Special Medical Equipment, Skilled
Nursing and Transportation.
Nursing Facilities: A nursing facility (NF), or nursing home,
provides 24-hour supervised nursing care, personal care, therapy,
nutrition management, organized activities, social services, room,
board, and laundry.
NF residents have the right to exercise reasonable control over life
decisions in a safe, clean, comfortable, and homelike environment. They
have a right to choice, participation, privacy, and the opportunity to
engage in religious, political, civic, recreational, and other social
activities that foster self-worth and enhance quality of life.
In these residential facilities, staff perform an array of services for
disabled persons who require daily nursing care as well as assistance
with medication, eating, dressing, walking, or other personal needs.
Payment for services may be made through the client's resources,
Medicaid or Medicare and, for Veterans, through the Veterans
Administration.
Additional Services (AAS Miscellaneous):
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.
Nursing Home Discharge Allowance,
Foster Grandparents--AAS
pays a small amount of money to elderly participants for their work in
the community or in schools for mentally retarded,
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
DASA provides alcohol and drug related services to help people
recover from alcoholism and drug addiction. DASA contracts with
counties, tribes, and service agencies to provide services to clients
who cannot pay for the full cost of treatment.
DASA pays counties and tribes to provide Assessments and Outpatient
Treatment. DASA pays counties or hospitals to provide detoxification
services. The amount paid to individual counties is based on an
allocation formula which takes into account demographic factors
associated with the incidence of substance abuse. The counties either
provide the services directly or contract with private agencies to
provide services.
DASA also contracts directly with service agencies to provide
Residential Treatment services. DASA does not provide any direct client
services.
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 entities.
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.
Assessments--General: Counties either provide the service directly or
contract with private agencies to provide a variety of diagnostic
services in a non-residential setting. Tribes provide the services at
tribal facilities. General assessment patients include Medical
Assistance-eligible and low-income adults and adolescents. General
Assessment services also include assessment activities provided through
Group Care Enhancement contracts with JRA and Mental Health 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.
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. Most 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 Treatment: Counties either provide the service
directly or contract with private agencies to provide a variety of
treatment services in a non-residential setting according to a
prescribed treatment plan. Tribes provide the services at tribal
facilities. Outpatient Treatment patients include ADATSA, Medical
Assistance-eligible, and low-income adults and adolescents. Outpatient
treatment for ADATSA clients includes vocational counseling and other
efforts to help clients regain employment. Outpatient Treatment services
also include treatment activities provided through Group Care
Enhancement contracts with JRA and Mental Health Group Homes.
Specialized treatment is 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 chemical dependency services:
Intensive Inpatient Treatment, Long-term Residential Treatment, and
Recovery House Care. Specialized Residential Care is provided for
populations with co-occurring disorders (mental health issues in
combination with substance use disorders). Residential Treatment also
includes Involuntary Chemical Dependency Treatment (ICDT) provided at
the Pioneer North and Pioneer East facilities. Residential facilities
provide treatment to both ADATSA and regular DASA clients, pregnant and
parenting women, and youth.
Additional Services: 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.
Parenting
Education services for Pregnant and Parenting Women,
Miscellaneous
services for Pregnant and Parenting Women,
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 and
in residential treatment agencies in which the child resides with the
parent,
DASA Child Care--DASA also pays for non-therapeutic Child
Care while the mother is in outpatient treatment,
Case Management,
Living Stipend payments for ADATSA clients to cover food and housing
costs while in outpatient,
Housing Support Services--DASA contracts
with private agencies to provide individual or group living support
services for Parenting Women in a drug free environment,
Urinalysis--DASA
pays for screening of a limited number of Medical Assistance-eligible
clients.
Changes from Prior Year: The report group Outpatient Assessments
was changed to Assessments-General to more accurately reflect the
services in this category.
Not in this Report: Most DASA Child Care, Interagency
Prevention Services, Community Outreach and Prevention Services, Support
Services, and some special projects.
Children's Services
Children's Administration 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 and Adoption Support: 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:
This program provides comprehensive services for children with mental,
developmental, emotional and/or behavioral difficulties that exceed
the care capacity of regular foster families. Clients may be sexually
aggressive, self-injurious, high risk, behaviorally or emotionally
disordered, developmentally disabled, autistic or medically fragile.
Supervised group and/or family living are integrated into a set of
comprehensive services where positive behavioral support methods and
environmental structure are provided.
BRS can be categorized as Emergent or Ongoing. Emergent BRS are
short-term, assessment and interim care services. Ongoing BRS are
long-term, continuing therapeutic 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 (CPS) 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: CA 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): Family Reconciliation
Services help 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:
Intake;
Family Assessment; and
Crisis Counseling provided by county-contracted counselors.
Family-Focused Services: CA 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
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:
CSDB client counts for Foster Care Placement Services include only
the children being served, not their families.
Children receiving Foster Care Placement Services are served
exclusively in out-of-home settings.
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:
CSDB client counts for Foster Care Support Services include both
the children being served and their families.
Children receiving Foster Care Support Services may be served in
their own homes as well as in out-of-home placements.
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 in Program Total: Some services are small and unlike
others are included in this category. Client counts and expenditures for
the following services appear in the program total only:
Personal Care - Nurse Oversight: Authorizations for Title XIX
Personal Care Nurse Oversight services for children with special needs.
Child Care Registration: Payment of a fee to register a child in a
licensed Child Care facility.
Child Care Registration - Infant Bonus: Payment of a $250 infant
bonus to a licensed or certified Child Care provider.
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: Employment Child Care which was previously
reported in Children's Services is now reported as part of ESA Child
Care under the Economic Services Administration.
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 and Victim's Assistance, Domestic Violence,
State Domestic Violence Hotline, Sexual Assault Victim Services,
Employment Child Care (now reported in ESA), DLR Child Protective
Services Case Management.
Developmental Disabilities Services
DDD 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. DDD
clients' disabilities are lifelong and constitute a substantial handicap
to everyday functioning. Additional, 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 DDD
information systems due to the inclusion of additional source
information systems (e.g. the Medicaid Management Information System).
DDD 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 DDD.
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:
Individual Supported Employment which helps clients find and keep
jobs in the community,
Group Supported Employment which enables
clients to work in groups or enclaves at local businesses,
Prevocational Employment / Specialized Industries which provides
employment in training centers, and
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 three, and their families. Only a
portion of ITEIP services are reported here. ITEIP administrative costs
and services provided by non-DSHS agencies 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: None.
Not in this Report: Training, Payments for DDD Group Home
vacancies, Respite Care for RHC and SOLA residents, and
Authorization for Employment and Day Services (only the Provided
services are reported).
Economic Services
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 the state-funded
Food Assistance Program (FAP) for Legal Immigrants. Food assistance
benefits are generally available to all low-income households regardless
of factors such as age, incapacity, and dependency. Certain students of
higher education, Able-Bodied Adults Without Dependents (ABAWDs), and
families participating in the food distribution program on or near
Indian reservations are not eligible for benefits. In addition, those
ABAWDs who are eligible may receive 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 activities.
Recipients receive Electronic Benefit Transfer (EBT) cards to purchase
food at participating food stores.
Child Support:
ESA’s Division of Child Support (DCS) provides services to establish
paternity; locate non-custodial parents; and the establishment,
modification, and enforcement of child support orders (financial and
medical). DCS provides services under Title IV-D of the Social
Security Act as well as those required by Washington family support
orders. Services are provided for families in Washington and DCS also
coordinates services through the agencies of other states and nations
when necessary. The primary beneficiaries of collections from the
non-custodial parents are the children through their custodial
parents.
Clients who were part of a Child Support case were reported for the
first time in the CSDB Annual Reports in SFY2004, although these
clients were present in the DSHS caseload in prior years. Over 550,000
Child Support clients receive only child support services -- and no
other services -- from DSHS. These clients include custodial parents,
non-custodial parents, and children. The inclusion of Child Support
clients in the CSDB Annual Reports causes the total number of clients
receiving DSHS services, especially Economic Services, to appear much
higher in SFY2004 and subsequent years compared to previous years.
Unlike most other DSHS clients, many Child Support clients live
outside of Washington State due to their connection with clients who
are state residents.
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:
pregnant women in any stage of pregnancy or
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 by ESA between SFY99 and SFY00. In SFY 2000, part of
the funding for the CEAP program was transferred to the Department of
Community, Trade and Economic Development.
Diversion Cash Assistance: ESA provides
one-time DCA grants to low-income families with temporary emergent
needs who are not likely to need TANF assistance if those needs are
met. DCA grants are limited to $1,500 once per year. DCA payments may
be used to cover emergent needs for shelter, transportation, child
care, food, medical care, and employment-related expenses. Payments
are usually paid directly to vendors. 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 through a deduction from the monthly TANF/SFA cash grant.
ESA Child Care: ESA provides child care
assistance through the Working Connections Child Care Program 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. In addition, ESA provides child care
through the Seasonal Child Care Program to families that are
seasonally employed in agriculturally related work. Clients receiving
ESA Child Care must pass an economic means test. Clients receiving
subsidized childcare through ESA’s Homeless Child Care program are not
included in this report. A small number of families receiving child
care through the Refugee Child Care program are included in these
counts.
Note: CSDB Child Care counts represent an unduplicated count of all
children being served and one parent or guardian associated with those
children.
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, do not have dependent children and are unable to work
because of the effects of a physical or mental disorder. 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.
SSI clients who meet the SSP criteria are only eligible for one SSP
payment per month.
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
TANF and State Family Assistance: ESA
provides TANF cash grants to the following financially needy client
groups:
children under age 18,
children under age 19 attending high school or working towards a
GED full-time,
parents or caretaker relatives of these children,
unmarried teen parents under the age of 18, and
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
qualified aliens and have been in the United States for less than
five years,
aliens who are permanently residing in the US under color of law (PRUCOL),
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
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.
WorkFirst: Persons age 16 or older who
receive TANF cash aid must participate in WorkFirst. WorkFirst
services include case management (such as orientation, screening,
evaluation, assessment, referrals and case staffing), support services
(such as money to pay for transportation or other work-related
expenses), job preparation, employment services, education and
training (including high school/GED completion), help with resolving
issues that interfere with employment (such as chemical dependency,
disability, and family violence), specialized services for persons
with limited-English proficiency or for pregnant women/parents of
infants, subsidized community jobs, unpaid work and on-the-job
training. People who refuse to participate as required in WorkFirst
activities are sanctioned and receive a reduced TANF grant. Once
sanctioned, they may also lose food assistance unless they are exempt
under federal food assistance rules or meet the Food Stamp Employment
and Training (FS E&T) registration and participation (such as job
search or training) requirements.
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:
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,
Protective Payee Fees,
Eligibility Determination--ESA staff perform assessment,
evaluation, and documentation of incapacity for applicants or
recipients,
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,
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.
Changes from Prior Year: Changes in the administration and
eligibility of SSI and the inclusion of Child Support clients in
annual reports have resulted in totals that are not comparable across
time. See notes above. The Office of Refugee and Immigrant Assistance
(ORIA) changed to Refugee and Immigrant Assistance (RIA) and moved to
the Additional Services report group in FY2004. Working Connections
Child Care was changed to ESA Child Care. Child Support is reported
for the first time in CSDB.
Not in this Report: Telephone Assistance (Washington Telephone
Assistance Program); Non-Assistance Support Collection; Public
Assistance Recoveries (which offset ESA expenditures); Refugee Health
Screening.
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
Services
JRA 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.
Dispositional Alternatives: Dispositional Alternatives include the
following services:
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.
Disposition Alternative Community Commitment (DACC) places limits on
the amount of time that a juvenile can spend in secure county detention
and sets out other placement alternatives, such as home detention,
electronic home monitoring, county group care, and day or evening
reporting.
Mental Health Disposition Alternative (MHDA) services are designed
for offenders with a diagnosis consistent with the American psychiatry
association diagnostic and statistical manual of mental disorders
allowing for community supervision and treatment as an alternative to
institutional confinement,
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, and
Suspended Disposition Alternative (SDA) services are designed for
offenders subject to a standard range disposition involving confinement
by the department and allowing for community supervision and treatment
as an alternative to institutional confinement.
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; JRA also operates Camp
Outlook Basic Training Camp.
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: Intensive, Sex Offender,
Enhanced, Transition, and Basic Training Camp Aftercare.
Changes from Prior Year: The report group JRA Miscellaneous was changed
to Dispositional Alternatives as this title more accurately reflects the
services in this category.
Not in this Report: Learning and Life Skills Services;
Consolidated Juvenile Services.
Medical Assistance
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: Dental Services include diagnostic, preventive,
or corrective services provided by or under the supervision of an
individual licensed to practice dentistry or dental surgery.
First Steps: This program provides low-income pregnant women
with medical coverage and social services to increase the chances of
healthy birth outcomes and includes full medical, vision and dental
coverage for the mother from enrollment during her pregnancy through two
months post-delivery. Post-delivery, the mother is eligible for Family
Planning Services for another 10 months. Newborns receive full medical
coverage until the first birthday.
Hospital Inpatient Care: These services include 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 other ancillary
services such as drugs, laboratory, and radiology.
Hospital Outpatient: A licensed or approved hospital provides
Hospital Outpatient Care to clients treated, but not admitted to stay,
at the facility.
Managed Health Care Payments: 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 (Title XIX): 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:
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
Rehabilitation and other services to help such families and
individuals attain or retain capability for independence or self-care.
Medically Eligible Clients (non-Title XIX):
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.
Changes from Prior Year: State Only coverage of children who were not
eligible for federally supported medical assistance programs was dropped
in FY 2004. The Medically Indigent program was also terminated by the
Legislature effective FY 2004. First Steps reporting was added to CSDB.
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); methodological 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
MHD administers treatment services for adults and children who are
severely and/or chronically mentally ill. MHD administers services
through three channels:
MHD directly operates state mental
hospitals, which deliver services to clients with severe mental
disorders.
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 Medicaid eligible consumers within an
RSN through capitated Prepaid Inpatient Health Plans (PIHPs) and funds
services to non Medicaid eligible consumers within an RSN through state
grant.
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 (CSTC): MHD operates a state
hospital for children who are psychiatrically disturbed. Inpatient
services are provided on the grounds of Western State Hospital.
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.
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.
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).
Changes from Prior Year:
Residential services are reported as encounter data from the RSN. The
service hours are included in the outpatient services.
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 include 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 include 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.
Changes from Prior Year: None.
Source: Washington State Department of Social and Health
Services, Research and Data Analysis, Client Services Database, June
2003-July 2004. January 2006.
For more ways to get in touch with the Department of Social
and Health Services, go to
the DSHS Contact
Information Web page. Technical Site Comments: DSHS Webmaster.
Copyright 2004 Washington State Department of Social and Health Services.
