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Under Section 1915(c) of the Social Security Act, Medicaid law authorizes the Secretary of the U.S. Department of Health and Human Services to waive certain Medicaid statutory requirements. These waivers enable States to cover a broad array of home and community-based services (HCBS) for targeted populations as an alternative to institutionalization. Waiver services may be optional State Plan services which either are not covered by a particular State or which enhance the State’s coverage. Waivers may also include services not covered through the State Plan such as respite care, environmental modifications, or family training.
The four basic types of 1915(c) HCBS waivers available for states based on the target population’s level of alternative long-term institutional care are:
intermediate care facility-mental retardation (ICF-MR) level of care for mentally retarded and/or developmentally disabled individuals;
chronic or rehabilitative hospital level of care for individuals who are medically fragile, chronically ill, or severely disabled;
psychiatric hospital level of care for individuals who are severely or chronically mentally ill; and
nursing facility level of care for individuals who are elderly, physically disabled, and/or cognitively impaired.
To be a waiver participant, an individual must be medically qualified, certified for the waiver’s institutional level of care, choose to enroll in the waiver as an alternative to institutionalization, cost Medicaid no more in the community under the waiver than he or she would have cost Medicaid in an institution, and be financially eligible based on their income and assets.
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Waiver Programs Overview |
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| Mentally Retarded/Developmentally Disabled Waiver | ||||
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The Home and Community-Based Services Waiver for Mentally Retarded/Developmentally Disabled Individuals, began in February of 1984, to provide services for developmentally disabled individuals, who meet an Intermediate Care Facility for the Mentally Retarded (ICF-MR) level of care, as an alternative to institutionalization in an ICF-MR. Covered services under the waiver include day habilitation, residential option services, respite care, services coordination, environmental modifications, assistive technology and adaptive equipment. This waiver is administered by the Developmental Disabilities Administration of the Maryland Department of Health and Mental Hygiene.
The Model Waiver began January of 1985. This waiver targets medically fragile individuals including technology dependent individuals who, before the age of 22, would otherwise be hospitalized and are certified as needing hospital or nursing home level of care. Through the waiver, services are provided to enable medically fragile children to live and be cared for at home rather than in a hospital. Model Waiver services includes case management, private duty nursing, shift home health aide assistance, physician participation in the Plan of Care development, and durable medical equipment and supplies. Individuals that would like to apply for Model Waiver Services must contact the Coordinating Center for Home and Community Care, Inc., a case management organization.
Since 1993, the Senior Assisted Housing Waiver has been giving eligible low-income adults a choice of receiving long term care services in a community-based setting rather than in a nursing facility. On July 1, 2000 the waiver was expanded statewide and the number of available slots increased from 135 up to 1,135. Effective January 2001 the minimum age was reduced from 62 years of age to 50 years of age, new services became available, and eligible participants can receive services in their homes or in large or small assisted living facilities. MDoA administers this waiver.
Effective July 1, 2001, the Maryland State Department of Education began administering the autism waiver, targeted to children ages 1 through the end of the school year that the child turns 21. As a part of determining eligibility, a child must be diagnosed with Autism Spectrum Disorder, meet an Intermediate Care Facility for the Mentally Retarded Level of Care, not be enrolled in any other waiver, and have an Individualized Educational Program (IEP) or Individualized Family Service Plan (IFSP) and receive at least 12 hours of special education and related services per week. The services provided under the Autism Waiver are intensive individual support services, therapeutic integration services, respite care, family training, environmental accessibility adaptations, supported employment, residential habilitation, and targeted case management.
Effective April 1, 2001, the Maryland Department of Human Resources began providing services for those eligible individuals that meet a nursing home level of care and are between the ages of 21 and 59 years of age. This waiver is designed to provide consumer-directed personal assistance services for adults with physical disabilities in their own homes. Waiver services include attendant care, administrative case management, family and/or consumer training, skilled nursing supervision, personal emergency response systems, environmental accessibility adaptations, and occupational and speech/language therapies. |
Medicaid waiver programs are offered by Medicaid to help in the medical assistance needs of long term care patients. These programs are especially formulated, and are being implemented to respond to the needs of individuals who are experiencing difficulty in putting up with their medical expenses
Medicaid waiver programs are introduced to the public on February of 1984 during a time when the United States medical statistics revealed the alarming increase in mentally retarded children. Originally, Medicaid thought of waiver programs to cater mostly to developmentally-disabled children. However, as time progressed and as health needs continued to arise, waiver programs were eventually extended to a wider set of patients and not only to a specific age bracket.
Now, Medicaid waiver programs are extended to waiver older adults (senior assisted housing waiver and waiver expansion), individuals with autism spectrum disorder, and individuals with physical disabilities. It is obvious that Medicaid has never abandoned its original advocacy of upholding the needs of disadvantaged, helpless children, although today, they also cater to adults and teens.
From services like day habilitation, respite care, services coordination, environmental modifications, residential option services and many others offered to mentally- and physically-challenged kids, more inclusive support are also being waived for older adults. These include the following: administrative care management, attendant care, family training, consumer training, environmental accessibility adaptations, occupational and speech therapies, and personal emergency response systems.
All the above-mentioned medical services could be waived if you are under Medicaid assistance. So if you are experiencing difficulties in conducting and maintaining your personal medical finances, you can start acquiring help from Medicaid anytime you like.
Medicaid Waiver Programs
http://www.gilbertguide.com/articles/medicaid-waiver-programs/
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