2009/12/31/Josh emails

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This is an email from the supervisor (whom I will refer to as "CB") of Josh's case manager, and my reply to it. (The case manager herself is off work for the holidays, so CB has been handling her work.)


from CB to us

Hello Nick and Sandy,

I wanted to make sure that you have all the information you need in order to make a sound decision regarding the services available for your son. I have emailed you a recent service definition from the state of NC regarding what services he would be eligible for under the CAP waiver. After we spoke earlier this week, Nick mentioned that he may be moving into another home, so I wanted to find out for sure exactly what service(s) he would be eligible for if he moves into another home and has CAP services. As it turns out, he cannot receive funding from state Medicaid for both out-of-home residential services and CAP waiver services to pay for the care/supports in that home. This is what is explained in the state memo I sent in the separate email.

There are two options available for you:

In order for your son to receive the CAP supports waiver slot, he will have to continue to live at home, but he will be eligible for the CAP waiver services explained in the forms I gave to Nick. (CAP services up to $17,500/yr.)

If the state of NC pays for him to live in another home through Therapeutic foster care, or any another home or group home in which funding is paid by the state, he will not be able to use the CAP supports waiver slot.

I know this is a lot to ponder, but please feel free to email or call me for clarification.

I absolutely want you to have all the information you need to make the decision which will work best for your family.

Please let me know what you decide and we can work together, along with Yolanda to continue the next steps in the CAP supports waiver option, or the residential option.


Manager of Durham Support Brokerage
Community Partnerships, Inc.

from me to CB

Hi [first name],

I had wondered about that, since my understanding was that one of the main differences between Supports and Comprehensive was the residential services.

Josh absolutely needs out-of-home care; we have not been able to think of any way that our home could possibly be retrofitted to make caring for him manageable.

Just last night, for instance, he tried to cook himself some bacon -- in the toaster oven. We were upstairs reading to the younger kids, I smelled smoke, and came down to find the toaster oven with a nice little fire inside it and the kitchen totally filled with smoke. This is the first time he has ever tried to use the toaster oven, but it is not the first time he has managed to fill the kitchen with smoke; on at least two or three prior occasions when he has tried to reheat food for himself in the microwave (at which he is usually successful), he has punched in one too many digits, and ended up with a melted plastic plate and a lump of blackened charcoaled goo that used to be chicken.

Josh does not pose a direct danger to himself or others, but he needs to be in an environment where he can't unintentionally do something dangerous -- in our house, he does pose a danger to himself and others. He needs a home with a lockable kitchen, lockable areas/rooms for securing any breakables when he is not being closely supervised, and all outside doors lockable with keyed deadbolts. He needs to be in a situation where his needs and habits don't conflict with the needs of other children and adults sharing the same space. He needs caregivers who are capable of dealing with his intensive needs on a day- in, day-out basis.

So it looks like we will have to pass up the Supports waiver, as useful as it might be during times when Josh is staying with us.

On the positive side, I presume this means that he will retain the same priority rating for a Comprehensive waiver. He was #17 in line last I knew, and since three Comprehensive slots have now been awarded he should be somewhere around #14 or possibly better if others have dropped off the list.

Can you confirm what his current place is on the waiting list?

Can you also confirm that his waiting list ranking takes into account the fact that he does need constant supervision and a properly secured environment in order not to be a danger?

Thanks for checking into the Supports details.


Nick (and Sandy)