Medicaid Basics

Medicaid Waivers: What Are They and What Should I Expect? 

If you have a loved one with a disability or you’re a self advocate, there are so many resources, information, and services available. Not sure where to begin? Here we break down the Medicaid waiver for you. “What is it, how will it help, and how can I apply?” These are all questions we’ll answer to help you navigate the waiver application process so you or your loved one can get the services needed to thrive. 

What is the Difference Between Medicaid Insurance and a Medicaid Waiver? 

Thankfully, the government provides different support options for people with disabilities. But when applying for this support, there’s a lot of confusion surrounding Medicaid insurance and a Medicaid waiver.  

Medicaid is a program supported by both the federal and state government that provides coverage. Medicaid is largely income-based and includes pregnant women and children as well as individuals receiving Supplemental Security Income, among others.  

A Medicaid waiver is quite different. If you have a disability or are the guardian of a loved one with a disability, a waiver is going to provide the financial resources that will benefit the individual with disabilities not only in the present, but for the long term. 

It is common to feel a sense of guilt when considering applying for a waiver. Many families feel like they can cover costs on their own or desire to independently provide the services their child needs without assistance. However, a Medicaid waiver sets your loved one and the rest of your family up for long-term success. 

How Can I Apply for a Medicaid Waiver? 

The application process for a Medicaid waiver varies state by state, but you can begin by contacting your county’s disability department or . Tell them you want to begin the application process for a Medicaid waiver, and they will give you further instruction on how to proceed. Every state and every case are nuanced, but at the end of the process, your child will be set up with the financial resources they need to thrive both now and in the future. 

How Does a Medicaid Waiver Help My Family? 

A Medicaid waiver provides resources and support for people of any age with a disability. There are two ways to access this support once your waiver has been granted: through an agency or through a process called “self-direction.” 

Agency-based services are like a turn-key operation. One of Joshin’s ambassadors described it as ordering off of a : you contact an agency, tell them the services you need, and they send someone to you. 

But we’re going to focus on self-direction. A self-directed waiver provides you with a yearly stipend. You then choose independent caregivers and services, and spend your allocated sum according to a plan that you design yourself. Self-direction gives you greater control over what services you choose and the caregivers that come into your home to care for your loved one. When you choose a self-direction waiver, you get to choose what to focus your funding on – like therapies, respite care, and activities. That’s where Joshin comes in. 

Joshin connects families with caregivers that they can trust. Our sitters are background checked, and each caregiver’s profile gives you extensive information that helps you choose the perfect match for your loved one’s needs. When you choose self-direction, you have the autonomy to select caregivers from our database that are a great fit for you. And we make it easy to exchange payment all within our app. Families utilizing self-directed funding pay a monthly fee and utilize our database to recruit caregivers on our platform. From there, families and self-advocates can hire caregivers directly and use our app to manage the care. 

What Services Does a Self-Directed Waiver Give Me Access to? 

Once an individual is evaluated for a waiver, their assessor will provide a summary of what they learned about the applicant and what supports might benefit the applicant. They can then inform you of programs and resources the individual might be eligible for. These resources include therapies, classes, unique opportunities for socialization catering to individuals with disabilities—the list goes on and on. 

The benefit of the Medicaid waiver is that you not only have access to services now, but as you continue to re-up each year, you’re ensuring your child will have the financial means to take advantage of the services they’ll need in the future. This includes housing, caregivers, and other services they’ll continue to need even after you’re gone.

What to Expect When Going Through the Process

Each state is very different when it comes to the Medicaid waiver application process. And each individual case has nuances that affect what the process looks like for each individual. There are a few things we’d like to bring to your attention so you can have an idea of what to expect as you’re applying and waiting on approval. We’ve surveyed some of our clients and asked them what they wish they would have known coming into this process. Our team has compiled their answers so you can have realistic expectations and take advantage of the advice of families just like yours who have completed this process before.

1. Start Early: When it comes to self-direction, you can expect months of paperwork, phone calls, and assessments. Regardless of your state of residence, long timelines (upwards of 12 months) are typical. As soon as possible, begin the Medicaid waiver application process. The sooner you can start, the sooner you can finish, and that means you’ll have the funding you need for various services.

2. Be Realistic About Your Child’s Abilities: When you’re out assessment paperwork for your child (or yourself, if you’re applying as an adult), you’ll be asked about the applicant’s abilities to complete tasks. For example, can your child cross the alone and unsupervised, do they need you to watch them, or do you need to walk them across yourself? We are our children’s biggest advocates and cheerleaders, but to receive the most financial support possible, it’s important that you’re realistic about your child’s capabilities. It’s better to err on the side of caution rather than to overstate your child’s ability to complete certain tasks, which can result in a smaller yearly stipend.

3. Paperwork, Paperwork, Paperwork: When applying for a Medicaid waiver, you’re going to be met with mountains of paperwork. Your child will have screenings at , assessments by therapists and maybe even psychologists, a physical from their , plus more. You’ll have to complete and organize all of the paperwork accurately before your child can be evaluated for waiver benefits. Paperwork requirements of this magnitude will be overwhelming. But, Rest assured, once the process is done, you’ll have the financial support you need to ensure quality care and services. Don’t be intimidated! You can do it.

4. Find a Support Group: No one understands a special needs parent like another special needs parent. Finding a community of individuals who can not only empathize with you but who can give you personal advice is going to be key when navigating the waiver application process. Facebook is a great place to connect with other people who have walked the same journey you’re on. Even if your support is virtual, having someone in your corner who understands not only the logistics but also the emotional side of this process can be helpful. Join the Joshin Community group HERE to connect with other individuals and families with special needs.

5. Self-Direction is Worth It: Every family we’ve spoken to says that self-direction has been a great avenue for them to receive the services they need. The process to gain approval may seem daunting, but when all is said and done, it’s worth it. Self-direction gives you the control to make decisions regarding services, care, and the caregivers that are working with you or your loved one.

When you’re ready, the team at Joshin is here to connect you with caregivers that you choose, so you can find the perfect fit for your needs.

Looking to schedule care? Find special needs caregivers near you.