What is a Medicaid Waiver?

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The Medicaid waiver program is a state-level program that helps pay for health-care services for people who have developmental disabilities. It gives states the freedom to “waive” some of the federal requirements that people need to fulfill in order to be eligible for Medicaid. In the past, Medicaid was only available to people who were institutionalized, but the Medicaid waiver makes it possible for disabled people to receive health-care services at home or at community level. About 75 percent of the state funds allocated for services for disabled people come from Medicaid.

Eligibility

There are certain requirements that determine if a person is eligible for a Medicaid waiver. A person is not eligible if he has income or assets in excess of state-specified amounts. For instance, an adult who earns more than $740 a month is not eligible. Disabled children who reside in the same house as their family are not eligible because they have access to family income. These restrictions differ from state to state.

Features

The amount of Medicaid money available to a disabled individual depends on the specific individual’s needs. An evaluation team determines these needs by collecting information from people who know the individual personally. The family of the disabled person has the freedom to choose how the money is used. They can even choose the service provider. They also have access to financial support services, which take care of all the paperwork.

Services

There are a number of services that are covered by Medicaid waivers, but there are limits on the amount of money that can be used for some services. These services include (as of 2009): behavioral support ($2,460 per year), community access, community guide ($2,000 per year), community living support, alternative community residence, dental ($500 per year), accessibility adaptation ($10,000 per lifetime), financial support, services, physical therapy ($1,800 per year), family respite, special equipment ($13,374 per lifetime), support coordination, transportation ($2,800 per year) and vehicle alteration ($6,240 per lifetime).

Application

Anyone wanting a Medicaid waiver has to get in touch with the regional Medicaid office. There is a screening process after which the evaluation teams put the applicant on a short-term or long-term waiting list. Upon approval, the evaluation staff helps the applicant with all the paperwork and provides the information about the service providers available in that region.

Misconceptions

There is a misconception that the waiting list is 10 years long. Recent legislative developments have made it possible for people to receive Medicaid waivers within 5 years. Some service providers fear that they may go out of business, but the new waiver program will only provide them with more clients.

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