Medicaid Waiver Overview
Home and Community-Based Waivers were established by the U.S. Congress to slow the growth of Medicaid
spending for nursing facility care and to address criticism of Medicaid’s institutional bias. Congress was
responding to the growth in institutional costs and to people with disabilities who preferred to live in their own
homes with services such as personal assistance and community living supports. In 1981, Congress amended the
Medicaid program to allow for Home and Community-Based Waivers. States are given the option to develop
Waiver programs as alternative services for people who are eligible for placement in an institution.
You do not have to go into an institution or agree to apply to an institution to receive Waiver services. To
be eligible for Waiver services, you must demonstrate through a screening process that you need the level of
support that people receive in an institution.
Alternatives to: Nursing Facility and Long-stay Hospital
- Alzheimer’s Waiver
- EDCD Waiver
- Tech Waiver
Alternatives to: ICF/DD
- DD Waiver
- Day Support Waiver
- ID Waiver
Medicaid Waiver Service Descriptions
Therapeutic consultation is provided in fields such as psychology, social work, behavioral analysis, speech therapy, occupational therapy, therapeutic recreation, physical therapy disciplines or behavior consultation to assist people with disabilities, parents and family members, and providers to implement goals and services. (DD and ID Waivers)
- Gather information about the Waiver you qualify for. Read the Regulations for that specific Waiver. See the charts on the following pages for the locations to the Regulations: DD Waiver, page 14; EDCD Waiver, page 19; ID Waiver, page 22; and the Tech Waiver, page 25 – LINK ABOVE
- Services should be individualized to meet your preferences and needs
- Work with your case manager/support coordinator and providers to discuss your needs and goals. Be candid and clear about your needs and preferences.
- Request only those services that are needed now. Your plan can be revised at any time to add needed services or to change services.
- Review information about available providers. If the service is a center-based service, go to the center and
observe the program. Ask providers about their expertise and experience with the services you are asking them to provide. Ask other people who are using Waiver services about their providers.
- Make your requests in writing if you think the request will be met with resistance. Otherwise, it is fine to request screening, services, and changes verbally. A friendly follow-up letter may help to keep your request moving forward in a timely manner.
- Stay involved in the process to establish and monitor your services.
- Be friendly and persistent. Your guidance is vital for employees if they are going to assist you with planning and
- Monitor your services. Providers maintain periodic reports about your services. Most providers develop
assessments and reports that include information about the services provided, adequacy of services, progress
with goals and objectives, your satisfaction with services, and other individual and personal information. You may want to review this documentation, often referred to as supporting documentation and semi-annual reports.
- If you are told that something won’t be provided, the provider should give you written documentation explaining why and describing your right to appeal the decision.
- Keep copies of documentation. Ask for copies of your service plans. You may also want to have copies of the
quarterly or semi-annual reports that providers develop. These documents help to substantiate your need for
services. You will want them to reflect your goals and preferences.
- Consider pursuing an appeal if screening is denied or delayed and if services are denied, reduced or if your
requests are not acted on with reasonable promptness.
- Communicate adequately with providers so that they understand your expectations. Be sure the provider
communicates adequately with you, using your preferred way to communicate.
- Consider changing providers if the provider is not meeting your needs. It may be difficult to change providers if
there is a shortage of providers in your community.