autism

In honor of Autism Month, Autism Housing Pathways described ways to develop a housing strategy based on MassHealth’s Adult Family Care/Adult Foster Care program. The outline was issued as a series of daily Tweets in April. Here they are, in a single post. Bear in mind, this strategy is specific to Massachusetts.

It’s Autism Month. Let’s look at developing a housing plan, one Tweet at a time.
The Adult Family Care (AFC) program can pay you to provide support to your adult child who lives with you.
AFC is a program of MassHealth. MassHealth is Medicaid. Changes to Medicaid could endanger AFC.
To qualify for AFC, your child must need prompting with 1 or more activities of daily living. You can’t be the guardian.
Consider saving the AFC stipend (not in your child’s name). It’s yours, and it’s tax free.
Get your child on the Section 8 waiting list at 18 (or NOW, if they’re over 18). Go to www.18section8.org to learn how.
It may be a 10 year wait to get a Section 8 voucher. Work on living skills while you wait. http://bit.ly/1Nak9zm
Are you saving the AFC stipend? If your family member waits 10 years for Sec. 8, that’s a $90K nest egg.
Section 8 is a part of HUD. A 13% cut in the HUD budget is proposed. The wait for a voucher could get longer.
Your child is at the top of the Sec. 8 list! What’s your plan? You’ve only got 60 days (120 w/extension) to use the voucher.
One option: your child could rent a two bedroom apt. w/ Sec. 8. An Adult Foster Care provider could move in, too.
You could add a 2 bedroom accessory unit to your house for your child and an Adult Foster Care provider.
How to pay to add on the accessory unit? You saved the Adult Family Care stipend, right? It’s a start.
You could supplement what you saved from AFC with up to $30K from the Home Modification Loan Program. http://bit.ly/2lrSpJX
Need some more? Consider a home equity loan. Assume construction costs of at least $200/sq. ft.
Make sure local zoning permits accessory units (possibly via a special permit). Otherwise, you may need to move first.
S. 729 would allow accessory units for a disabled family member as of right on lots of 5,000+ sq. ft. http://bit.ly/2nUD7mg
Or you could buy a condo for your child with space for an Adult Foster Care provider, using the AFC savings for a down payment.
Need a mortgage? Fannie Mae lets you get a 5% down mortgage to buy a home for a disabled adult child. http://bit.ly/1njEW6v
Your child uses Sec. 8 to pay you rent; you use the rent to pay the mortgage.
Can’t carry (or qualify) for two mortgages? One option is to sell your house and buy a duplex.
Or you could consider buying a three-family, and using the rent from the third unit for respite, maintenance, etc.
Or you could buy that three family with another family; the kids live together with an Adult Foster Care provider.
Whatever you do, try to get individual support hours from DDS to help your child work on skills and get into the community.
Look into assistive technology to help increase your child’s independence. http://mahousingthinktank.org/technology/
If eligible, apply for the DDS Adult Supports waiver, to help secure ongoing access to supports. http://www.mass.gov/eohhs/docs/dmr/waiver/adult-waiver-app.pdf
For those on a DDS waiver, ½ of costs are paid by Medicaid. Does your child go to Day Hab? That’s Medicaid, too.
If Congress block grants Medicaid, that could end the entitlement to AFC, PCA, and Day Hab.
The Devil is in the details. Come to a daylong housing workshop. http://bit.ly/2nmYpnL
Consider individualized housing counseling. http://autismhousingpathways.org/services/training-and-outreach/#FamilyConsultation

In April, Autism Housing Pathways posted a series of Tweet length “Autism Month Housing Thoughts of the Day”. They comprised a mini-tutorial on housing for individuals with autism and other developmental disabilities, including housing subsidies and supportive services. They are updated and republished here, with three additional comments to add information on Medicaid waivers. Acronyms are spelled out here, as they were not in the original Tweets. To learn more about many of the services mentioned, check out our Turning 18 checklist.

Of those with family involvement, only about 12% will be both eligible and prioritized for Community Based Residential Services through the Department of Developmental Services (DDS) at age 22.
It frequently takes 5-10 years to plan and implement a housing strategy; start at 18 if the goal is independent living by 30.
The housing equation is: bricks & mortar + food + services = housing. There are subsidies for all, but not all can be combined.
Supplemental Security Income (SSI)* can be used for any part of the housing equation. People can apply based on their own income at 18.
SSI has asset and income caps; other income can reduce benefits. Try to avoid assets in the person’s own name.
SSI makes someone automatically eligible for MassHealth (Medicaid). Medicaid is the main way to pay for services.
Social Security Disability Insurance (SSDI)* can be used for any part of the housing equation. Assets and unearned income do not affect benefits.
SSDI makes you eligible for Medicare (not Medicaid) after 2 years. Medicare can’t be used for long-term services.
For those disabled before 22, SSDI can be based on their own income or a parent’s, once the parent retires.
Try not to retire until your child receives SSI as an adult. Otherwise, they may not qualify for MassHealth.
Those who don’t qualify for MassHealth can qualify for CommonHealth if they work 40 hours/month.
People can also qualify for CommonHealth by meeting a one-time spend-down.
The most important housing subsidy is Section 8. Apply at age 18. Go to www.18section8.org to learn how.
The wait for a Sec. 8 voucher can be up to 12 years. Apply at 18.
A family member can be the Sec. 8 landlord for a person with a disability. But they can’t live in the same unit.
Someone who needs a live-in aide can get a 2-bedroom Sec. 8 voucher. But the aide can’t be immediate family.
Food stamps and Sec. 8 will not result in a reduction of SSI benefits. People usually qualify for food stamps at age 22.
The food stamp recipient needs to buy and prepare food “substantially separately” from the rest of the household.
MassHealth State Plan Services are the main way to pay for long-term services and supports.[Addendum: other than Medicaid waivers — waivers are addressed below.]
MassHealth State Plan Services are entitlements. There are no waiting lists if you qualify.
Adult Foster/Family Care (AFC), Personal Care Attendant (PCA), and Group AFC (GAFC) are state plan services.
You can’t combine AFC, PCA, and GAFC. Pick one.
AFC pays a stipend to a caregiver who lives with the person. A parent who is not a guardian can be a caregiver.
Consider saving the AFC stipend while waiting for a Sec. 8 voucher. It goes a long way toward a down-payment.
AFC generally can’t be combined with food stamps.
GAFC can only be used in assisted living or subsidized housing – not with a mobile Sec. 8 voucher.
DDS individual support hours can be used with AFC, PCA, or GAFC.
DDS housing dollars can only be used in settings with 5 people or less under one roof.
Families can borrow from the Home Modification Loan Fund to help create an accessory apartment. A bill in the state senate (S2132) would make creating accessory units a by-right zoning use.
Housing + Living Skills = Independent Living: http://autismhousingpathways.org/independent-living-skills-the-horse-that-pulls-the-housing-cart/
Bonus day: Our “Learning about housing” webinar is archived at https://www.fuzemeeting.com/replay_meeting/325491df/7944610

Addendum — Medicaid waivers:

Those receiving services from DDS can apply for a Medicaid waiver. The feds reimburse the state for half the cost of waiver services.
Waiver services are portable, meaning the dollars are attached to the person on the waiver, and can move with the person.
There are three kinds of waivers: Intensive Supports, Community Living, and Adult Supports. http://www.mass.gov/eohhs/docs/dmr/hcsis/hcbs-brief.pdf

* Emergency Aid to the Elderly, Disabled, and Children (EAEDC) is a cash benefit available to some Massachusetts residents who do not qualify for SSI or SSDI.

Developing a housing strategy using AFC (our 2017 Autism Month housing Tweets)

Housing, in a month’s worth of Tweets