Medicaid Waivers

Five states now have waiver programs that are specifically designated for patients with autim: Colorado, Indiana, Maryland, Massachusetts, and Wisconsin.

In general, there are different types of Medicaid waivers that a family may apply for. The number of available waivers and the qualification requirements vary from state to state. Most states classify patients with autism as individuals with a developmental disorder. This overview details the different waivers that exist in each state, but many states have waiting lists for these slots.

The types of Medicaid waivers that a family may consider include 1115 Waiver Research and Demonstration Projects, 1915 (b) Freedom of Choice Waivers, 1915 (c) Medicaid Home- and Community-based Services Waiver Programs, and Section 1915(b)/(c) Waiver Programs. Be sure to check in your state to see which waivers are available for you.

• 1115 Waiver Research and Demonstration Projects

Purpose: Section 1115 of the Social Security Act provides the Secretary of Health and Human Services with broad authority to authorize experimental, pilot, or demonstration project(s) which, in the judgement of the Secretary,(are) likely to assist in promoting the objectives of (the Medicaid statute).

General Features: flexibility under section 1115 is sufficiently broad to allow States to test substantially new ideas of policy merit. States commit to a policy experiment that will be evaluated. Section 1115 should demonstrate something that has not been demonstrated on a widespread bases, the specific research / demonstration finding will be drawn from the projects results.

• 1915(b) Freedom of Choice Waivers

General Features: States are permitted to waive statewideness, comparability of services, and freedom of choice. 1915(b) waivers are limited in that they apply to existing Medicaid eligible beneficiaries, authority under this waiver can not be used for eligibility expansions. There are four 1915(b) Freedom of Choice Waivers:

(b)(1) mandates Medicaid Enrollment into managed care

(b)(2) utilize a "central broker"

(b)(3) uses cost savings to provide additional services

(b)(4) limits number of providers for services

• 1915(c) Medicaid Home and Community-Based Services Waiver Program

HCBS waivers afford States the flexibility to develop and implement creative alternatives to placing Medicaid-eligible individuals in hospitals, nursing facilities or intermediate care facilities for persons with mental retardation. The HCBS waiver program recognizes that many individuals at risk of being placed in these facilities can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institutional care.

• Section 1915(b)/(c) Waiver Programs

Increasingly, States are expressing an interest in providing long-term care services in a managed care environment or using a limited pool of providers. In addition to providing traditional long-term care State plan services (e.g., home health, personal care, institutional services), many States are proposing to include non-traditional home and community-based "1915(c)-like" services (e.g., homemaker services, adult day health services, respite care) in their managed care programs.

Medicaid