Medwaiver Program How the Waiver Can Help Your Child

A smiling child with Down syndrome is featured on this Medicaid Waiver Program graphic.

Parents of special needs children today have many options available for help. One such option is the Medicaid Waiver Program. While not for everyone, and while it may differ from state to state, the goal of the program is to provide home and community-based services.

In this article, we will examine the Medicaid Waiver Program and answer some commonly asked questions. We will also provide you with links to resources that can help you identify programs in your community.

Purpose of the Medicaid Waiver Program

The primary purpose of the Medicaid Waiver Program is to help people stay in their homes and receive services they would have otherwise received in a nursing home or other medical institution.

For parents, that means getting the help needed to keep their child in the home. The program is designed for children at risk of being placed in a medical facility because the care required at home is more than the parents can provide.

The federal government provides waivers so that individuals who may not qualify for Medicaid services due to income could receive help.

How Does the Medicaid Waiver Program Work?

The Medicaid waiver allows the government to waive certain Medicaid rules so that the states can create programs to bring specific services to people who may not have qualified for coverage under Medicaid.

In some instances, a person may only have access to specific care if in a long-term

medical institution and not at home. The Medicaid Waiver Program allows for those services to be provided in the home.

There are different types of waivers, with the Section 1915(c) waiver – the Home and Community-Based Services (HCBS) waivers is the one we will discuss today.

How Is the Medicaid Waiver Program Funded?

Medicaid is a federal program that provides funds directly to the states to use as they decide. That also allows the states to opt-out of new funding and requirements of the Medicaid program.

The states determine what programs they will fund with their Medicaid dollars, and they will dictate the eligibility requirements for their various programs.

Unlike Medicare, a federal health care program for individuals over age 65, as well as those under 65 who have disabilities, Medicaid is for individuals with limited income and resources.

What Does the HCBS Waiver Program Provide?

The HCBS Waiver Program provides for services that include both medical and non-medical care based on individual needs and state guidelines. Each state creates its programs and what it will fund. These services may include, but are not limited to:

Personal care and supervision
Nursing and medical treatment
Home health aides
Meal delivery
Medical equipment and supplies
Counseling services
Home and vehicle modifications, including safety rails and ramps
Case management and support
Home services such as cleaning, shopping, laundry
Primary caregiver relief via respite care
Medical and non-medical transportation services

How Do You Obtain Services Through the Medicaid Waiver Program?

Eligibility for a Medicaid Waiver varies from state to state. Since most states also have more than one type of HCBS program, you will need to check and see what is available where you live. The state will determine the program names and who is eligible.

Most states offer some form of HCBS waivers to children with developmental disabilities or those diagnosed as medically fragile requiring extensive medical equipment or life support.

In most cases, the individual must meet the medical criteria that would require living in a nursing home or other facility if they could not receive in-home or community care. Remember, the purpose of the HCBS waiver is specifically to keep individuals living in their homes rather than in a facility.

Is it income-based?

Although the individual does not have to be a Medicaid recipient, most states require it or place a cap on earnings or financial assets.

Waiver programs such as this base eligibility on the child’s income rather than the parents. That helps them qualify for Medicaid to receive services.

How to Apply for the Medicaid Waiver Program

The first step you must take is typically applying for Medicaid. Each state is different, and you will need to check the eligibility factors for your household at the state level. Be prepared to provide information about your personal assets, family size, and your child’s disabilities. You can visit healthcare.gov for more details.

You can apply for Medicaid at any time – you do not need to wait for an open enrollment period. You will create your account through the Health Insurance Marketplace. If you qualify for Medicaid, the Marketplace will forward the information to your state’s Medicaid agency. That agency will then contact you about enrollment, benefits, and anything else you need to know.

Another option available is to contact and apply directly with your state’s Medicaid agency. An agent will guide you through the process of applying for coverage.

Once approved for Medicaid, you will need to apply for the HCBS waiver through your state Medicaid office. To find contact information specific to your state, visit the Centers for Medicare & Medicaid Services website. Information for applying for the HCBS waiver will be there.

Medicaid Waiver Program Waiting List Details

Please know that the states limit how many people can receive services under each HCBS waiver program. There are long waiting lists in many states, and it may take years before application approval and receipt of benefits. Some states offer priority designations in extreme situations.

If your state has a waiting list, put your child’s name on it immediately. Do not delay, as that may further extend the waiting time. For example, in Texas, the wait can be 3 to 10 years before entering the waiver program. You do not need to prove eligibility to get on a waitlist. That can come later.

If your child requires more assistance than you can provide in the home, let your local Medicaid office know. There may be additional assistance available if they know that your child is at risk of placement outside the home.

Important facts to remember:

Keep your information current – update addresses and phone numbers if
they change
Respond to calls, letters, or emails right away

We hope this answers some of your questions about the Medicaid Waiver Program. Always turn to your state for help – there are resources available that you may not know.

Free Downloads

Helpful Articles

This post originally appeared on our March/April 2021 Magazine