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Medicaid Waiver 101

Medicaid Waiver 101. Medicaid Waiver 101. One Family’s Experience. One Family’s Experience. Eligibility. Parent income is not considered when determining eligibility for Waiver services. Eligibility. Must meet criteria for placement in an institution to be eligible for waiver.

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Medicaid Waiver 101

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  1. Medicaid Waiver 101 Medicaid Waiver 101 One Family’s Experience One Family’s Experience

  2. Eligibility • Parent income is not considered when determining eligibility for Waiver services.

  3. Eligibility • Must meet criteria for placement in an institution to be eligible for waiver. • This does not mean you must agree to an institution, just meet criteria.

  4. Home and Community Based Waivers in Virginia • AIDS Waiver • Consumer-Directed Personal Assistance Waiver • Elderly and Disabled Waiver • Individual and Family Development Disabilities Support Waiver • Mental Retardation Waiver • Technology Assisted Waiver

  5. Different Institutional Placements Have Different Waivers • Hospitals are alternatives to: • AIDS Waiver • Tech Waiver

  6. Different Institutional Placements Have Different Waivers • Nursing homes are alternatives to: • AIDS Waiver • CD-PAS Waiver • E&D Waiver • Tech Waiver

  7. Different Institutional Placements Have Different Waivers • ICFs / MR are alternatives to: • DD Waiver • MR Waiver

  8. History • Home and community based waivers were established by the U.S. Congress to assist families who objected to institutionalization as the only way to receive support such as personal care and training.

  9. History • In 1981, states were given the option to develop Waiver programs as an alternative for people who were eligible for institutional placement.

  10. MR Waiver Services • Adult Companion (8 hours max./day – Consumer directed and agency) • Assistive Technology ($5,000 max./year) • Crisis Stabilization (60 days max./year) • Day Support (780 units max./year of prevocational and supported employment units) • Environmental modifications ($5,000 max./year)

  11. MR Waiver Services • Residential Support (Congregate, group home or person’s home) • Respite Care (720 hours max./yr. – Consumer directed or agency) • Skilled nursing services • Supported employment (780 units max./yr. of day support and prevocational units) • Therapeutic consultation

  12. MR Waiver: Benefits to the child and family • Environmental modification – up to $5,000 each year • The environmental modification can be used to make modifications to your home to make it more accessible and safer for your child. • Fencing, accessible deck/ramp, accessible bathroom

  13. MR Waiver: Benefits to the child and family • Assistive technology - $5,000 year • Assistive technology can be used to provide equipment to help the child to be more mobile; provide learning aids; provide communication aids. • Special strollers/wheelchairs, Go-Talk Boards, touchscreen computers, specialty software

  14. Wicycle

  15. Maclaren Special Needs Stroller

  16. MR Waiver: Benefits to the child and family • Residential Support • Support provided to the child to work on specific goals and self help skills. • Residential support worker can accompany family on outings to assist child with meeting goals and self help.

  17. MR Waiver: Benefits to the child and family • Respite Care – up to 720 hours a year • Respite Care provides care for your child while the family runs errands, has a day out, or just a much needed break. • Respite worker can accompany family on vacation / outing to assist with child.

  18. MR Waiver: Benefits to the child and family • Personal Assistance (Consumer directed and agency) • Provides a person to assist in the care of your child.

  19. MR Waiver: Benefits to the child and family • Easier access to equipment and modifications necessary for continued independence. • Access to professionals to assist in continuation of meeting goals to achieve maximum potential.

  20. MR Waiver: Benefits to the child and family • The major benefits our family has seen with this program is increase in independence for our child with disabilities, time to be able to focus on our other two children and the ability to more easily have whole family time together.

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