What Is A Medicaid Waiver?

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Medicaid Waivers help provide services to people who would otherwise be in a nursing home or hospital to receive long-term care in the community. Although there are waivers for many conditions, our focus is towards waivers for people who have intellectual disabilities, developmental disabilities, and autism.


Waiver Eligibility

Many people who qualify for waiver services are not even aware that they exist. Families struggle alone, to provide care- creating economic, physical, and emotional strain. States do not educate people about these programs, and it is often only through crisis that people realize help is available.

The waiting period to get onto a waiver program, can be many years, and varies by state. Unfortunately, waiver eligibility does not transfer from state to state. This is a huge problem for families who wish to move to another state. It also unfairly distributes the federally matched dollars among states because each state determines it's own budget.

Institutions vs Waivers

There are still people living in state institutions today. And, it has been questioned as to whether states violate the Americans with Disabilities Act (ADA) when they limit the number of participants to home and community based waiver programs. However, states chose to participate in these programs. Our best hope is to get statutes changed at the federal level.

The 1915(c) waiver is known as the “home and community-based services waiver” (HCBS) because it allows states to treat certain Medicaid populations in home or other community based settings rather than in institutional or long-term care facilities such as hospitals or nursing homes.

Which States Have Medicaid Waivers

Forty-four (44) states and the District of Columbia have received waivers to provide home- and community-based services to people with developmental disabilities (DD). Depending on each state's DD definition, these waivers may cover services to people with autism.

Before you Move.

If you are receiving Medicaid Waiver services, your waiver services will not transfer other states. You will still be eligible for Medicaid State Plan services after establishing residency, but waiver services do not transfer from state to state. If you decide to move to another state, you should know that many states have thousands of individuals on a list already waiting to receive waiver services. In most cases, you will not be placed in line in front of these other individuals, so it would be best to consider what services you currently have in place and decide if you can do without them if you move. In some states, it will most likely be several years before services would begin.

Waivers For Autism

Colorado, Indiana, Maryland, and Wisconsin have waivers specifically addressing autism. They all limit waiver services to children. The first three states' waivers are only for children with autism. Wisconsin provides intensive in-home autism treatment under two broader waivers, one for children with DD and the other for children with social and emotional disorders. In Indiana and Wisconsin, children eligible for autism-specific services are also eligible for services under other Medicaid waivers.

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Interesting Facts

-Nationwide, there are 268,000 people on waiting lists for home and community-based services. People on wait lists for Medicaid Waivers for Developmentally Disabled (MR/DD) programs, with an average wait time of almost 3 years. Some states have waiting lists in excess of ten years.

-President Obama signed a law in 2010 mandating Federal statutes will no longer use the term “mental retardation”. The replacement phrase is “intellectual disability.” This law is S. 2781 or “Rosa’s Law.

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For insurance coverage starting in 2018, the proposed Open Enrollment Period is November 1, 2017–December 15, 2017. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. Learn More About The Deadline and Find Out If Any Exemptions Or Tax Credits Apply To You.

Waivers & demonstration projects:

Prior to 1991, the Federal Medicaid program paid for services only if a person lived in an institution. The approval of Federal Medicaid Waiver programs allowed states to provide services to consumers in their homes and in their communities.

  • Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.
  • Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit people’s choice of providers.
  • Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.
  • Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.
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