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What is the Medicaid Waiver?

Let’s talk about the Medicaid “waiver” and what it can do for you. If you’re involved with services available through state or federal programs, you likely have heard the term “waiver”. Since this program can be complex and comprehensive, you may ask “waiver from what?” I’ll give some background and history to help answer that question in this blog. 

Prior to 1981, services for people with disabilities were paid by federal and state dollars when individuals lived in institutions. In Minnesota, this included State institutions (known as State Hospitals), nursing homes, and Intermediate Care Facilities for people with disabilities (now known as ICF/IID). The Federal Government has a specific set of rules and regulations for these settings. In 1981, this changed in most states, allowing individuals to receive community based services supported with Federal money in settings that allowed these rules and regulations to be “waived”. 

These “waiver services” first only included services for individuals with a diagnosis of developmental disabilities. Individuals who received these services did so while living in their family home, their own home, or what is often referred to as a “group home”(a licensed child or adult foster care). Eventually, Minnesota’s waiver plans expanded to include a much broader range of individuals.

The waiver program in Minnesota now includes the following waivers:

DD waiver: Home and community-based services to children and adults with a diagnosis of a developmental disability or a related condition who require the level of care provided in an intermediate care facility for persons with developmental disabilities (ICF/DD). These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety, and community integration.

BI waiver: Home and community-based services to children and adults with a diagnosis of brain injury who require the level of care provided in a specialized nursing facility or neurobehavioral hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety, and community integration.

CADI waiver: Home and community-based services to children and adults with disabilities who require the level of care provided in a nursing facility. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety, and community integration.

CAC waiver: Home and community-based services to children and adults who are chronically ill or medically fragile, and require the level of care provided in a hospital. These services are an alternative to institutionalization. They help a person live as independently as possible in community settings and promote optimal health, independence, safety, and community integration

Elderly waiver:  Home and community-based services for people 65 years old and older who are eligible for Medical Assistance (MA), require the level of care provided in a nursing home, and choose to live in the community.

Once an individual is approved for one of the above disability waivers, the next task is to choose how they would like their services managed or directed. The two options for service delivery are the traditional waiver support (agency driven/managed) or they can choose to direct their own services (self-directed services). In Minnesota, self-directed services are known as, Community-Directed Community Supports (CDCS).  Fun fact, every state has the option for self-directed services. Under the traditional waiver there are a variety of services available, depending on the waiver type. Under CDCS those same services are available as well as non-traditional support.

Want to hear more about the two service delivery options for individuals? Check back soon, as our next blog will dive deeper into the services available under both the traditional agency delivered services and self-directed services.

Meet Barb Turner! She’s an expert on Medicaid, has spent over 35 years in the field of disability services, and works closely with the Minnesota State Capital advocating for improvements to services for people with special needs. She is thrilled to share her knowledge with the Joshin community and make Medicaid easier to navigate for all!

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