Divorce, Custody, and Child Support for Parents of Children with Special Needs: Medicaid Waivers (Part II)
This is the second in a series of blogs Curran Moher Weis attorneys will be publishing on divorce and child support involving children with special needs. Please see Part I for the first blog on this important topic.
Medicaid waivers can be a critical element in the care plan for a physically and/or intellectually challenged child. Parents going through custody and child support disputes need to be aware of the benefits available to them under various Medicaid waivers, how they may affect their support obligations and what to be aware of when negotiating a support agreement.
Virginia established a new Medicaid waiver program in 2017—the Commonwealth Coordinated Care Plus (CCC+) program. The CCC+ program provides managed long-term service and support programs designed to offer a comprehensive set of services that address all of the Medicaid participating enrollee health care needs. The program provides care management, care coordination and person-centered care through an integrated and interdisciplinary team approach.
There is an eligibility screening for the CCC+ Waiver. Fortunately for families with intellectually and physically challenged minors, only the child’s income is counted, not the combined family income. This opens up the program to middle and high income families that otherwise might otherwise go bankrupt providing care for their severely physically and/or intellectually challenged child. Virginia’s CCC+ person-centric assessment and interdisciplinary plan of care determination essentially identifies the appropriate mix of clinical and social services needed for the child.
While the Medicaid-based CCC+ multidisciplinary person-centered clinical assessment and plan of care can help support the evaluation of private health care insurance coverage determinations, such determinations are independent of Medicaid findings. The CCC+ program requirements recognizing the availability of third-party (private insurance) liability (coverage and payment) on behalf of a child continue to be a function of communication between the CCC+ program, the parents, the insurance company, and the child’s case management officials. The availability of private insurance coverage for a service will not disqualify a child from the program so long there are other needs of the child not covered by private insurance.
Under Virginia law, responsibility for unreimbursed medical expenses is by default, apportioned pro rata to the parents according to income shares. Parents going through custody or support litigation may dispute what is reasonable and necessary. If a child is enrolled in the CCC + program, the appropriate level of service determinations now rests with the program’s professional case management team, which is primarily responsible for defining the level of care that is considered adequate, appropriate, reasonable and necessary.
For example, a child can be approved for 12 hours of Licensed Practical Nurse (LPN) care per day provided. If a parent wanted 24 hours of LPN care, they would not be able to “double up” on the service and pay out-of-pocket as the child would then lose those 12 hours allotted to them. That is because the professional case management team has already determined that 12 hours of LPN care per day is what is reasonable and necessary. Parents negotiating settlement agreements for the care of their intellectually or physically challenged child need to be aware of this condition so as to not contract for providing the same type of care beyond what has been established by the program. Doing so risks losing the service altogether.
Part I of this blog series defined the attendant and respite care services that are available to children under the program. Attendant and respite care are not nursing services, so the hours provided for these care giving services would be in addition to any nursing hours.
However, the program pays a set rate for attendant and respite caregivers depending on whether the child is located in Northern Virginia or the rest of the Commonwealth. The parent cannot subsidize the rate of the caregiver or insist on the same caregiver each time; otherwise, they can also lose the benefit entirely. This poses a challenge in higher-cost-of-living areas if a parent wants a high quality and more consistent caregiver who may demand a higher hourly rate. A court can deem respite and attendant are reasonable and necessary independent of the approval of such care by the program.
When negotiating agreements on the allocation of reasonable and necessary expenses for physically and intellectually challenged children, the parties should clearly define whether or not they consider respite and attendant care to reasonable and necessary. If they do, they should consider whether they agree to accept whatever amount of services the program may provide for, or if they go outside the program, a cap at the amount the higher payor parent would be liable for.
These issues are highly complex and distressing to parents. We at Curran Moher Weis are here to ease that burden. Contact us today to meet with an experienced family law attorney who can help guide you through a divorce or custody issues pertaining to your and your child’s needs.