Obtaining Medical Waivers in Virginia

Medicaid waivers were created to help residents with disabilities and the elderly to access services in their homes and communities. Funding for individuals who are eligible for long-term care in a nursing home, hospital or intermediate care facility is provided through Medicaid waivers.

Virginia Medicaid waivers allow the state to waive certain requirements, including the requirement that an individual must live in an institution in order to receive Medicaid benefits.

 

How to Obtain a Medicaid Waiver

If you are seeking a Medicaid waiver to cover services not typically covered under your state’s Medicaid program, you will need to be patient because the process takes some time. Follow these steps in order to obtain a Medicaid waiver:

 

  • You must be enrolled in your state’s Medicaid program
  • In order to obtain a Medicaid waiver you will need determine if you meet certain guidelines, specifically medical and financial guidelines
  • You must visit your state Medicaid office to obtain a waiver application. Additionally, you can call and request a form be sent to you or you can also download the form online.
  • Complete the waiver application. You will need to provide information about the home and community-based services in which you’re interested. Follow the instructions on the form on how and where to send the form.
  • Follow up on your application. Once your application has been accepted, an interview will be scheduled at which time your eligibility for services will be determined. You may be approved or your name may be added to a waiting list.

 

Overview of Available Medical Waivers

Virginia and the surrounding states have several different Medicaid waivers. An overview of Medicaid waivers follows with a focus on Virginia waivers.

  • Mental Retardation/Intellectual Disability (MR/ID) Waiver: To be eligible for this waiver, an individual must be six years or older and diagnosed with a mental disability or younger than six and at a developmental risk. Services available under this waiver include:
    • Residential support services
    • Day support
    • Supported employment and prevocational services
    • Personal care services
    • Respite care
    • Companion services
    • Assistive technology
    • Environmental modifications
    • Skilled nursing services
    • Therapeutic consultation
    • Crisis stabilization
    • Personal emergency response systems

 

  • Day Support Waiver: Persons who are on the MR/ID Waiver Urgent or Non-urgent waiting lists are eligible for this waiver. Selection is based on when services first became necessary, regardless of urgency. Individuals can remain on the MR/ID waiting list while being served by this waiver. The day support waiver allows individuals to receive the following:
    • Day support
    • Prevocational services
    • Support employment

 

  • Individual and Family Developmental Disabilities Support (DD or IFDDS) Waiver: This waiver provides services to individuals six years and older who have been diagnosed with a developmental disability and do not have a diagnosis of mental retardation. Such individuals must require the level of care provided by an intermediate care facility for mental retardation or related conditions. This waiver allows individuals to receive the following:
    • Day support and companion services
    • Supported employment
    • In-home residential support
    • Therapeutic consultation
    • Personal care services
    • Respite care
    • Skilled nursing services
    • Attendant services
    • Family and caregiver training
    • Crisis supervision
    • Environmental modifications
    • Assistive technology
    • Personal emergency response system

 

  • Elderly or Disabled with Consumer Direction (EDCD) Waiver: This waiver serves the elderly and those of all ages with disabilities. Individuals must meet the nursing facility requirement, including needing medical care as well as assistance with the activities of daily living. Services received through this waiver include:
    • Personal aide care services
    • Adult day health care
    • Respite care
    • Skilled nursing care
    • Personal emergency response system
    • Medication monitoring

 

  • Technology Assisted Waiver: To be eligible for this waiver, an individual must require substantial and ongoing skilled nursing care. Individuals under the age of 21 are eligible if they depend on technology to substitute for a vital body function and have exhausted third-party insurance funding for private duty nursing. Individuals using this waiver benefit from the following services:
    • Personal care services
    • Private duty nursing
    • Respite care
    • Environmental modification
    • Assistive technology

 

The number of U.S. residents enrolled in a Medicaid program has steadily increased in recent years. There were 73.5 million individuals enrolled in Medicaid in 2017. With so many people enrolled, Medicaid waivers are necessary to receive much needed services. Even so, the process of trying to obtain a waiver can be tedious and stressful.

Many people struggle to obtain the support they need and may find themselves struggling through the process of applying for one or more waivers. If you find this to be the case there are several avenues that you can try to obtain some assistance in applying.

Depending on your state, there are various advocacy groups that offer assistance in applying for Medicaid waivers. Some groups have tutorials while others may have experienced experts available to speak to.

Moms In Motion is one example of an advocacy group available for individuals who are working through the application process. Other options may be websites such as Autism Speaks which lay out steps one can take when applying and offer financial planning advice.

You may also want to consider searching for a Medicaid Services Facilitator who may be able to provide you with some insights on how the process of obtaining a waiver and working with their facility or company works.

 

Author Bio:

Michael Monheit, Esq is one of the founding lawyers of Monheit Law, P.C. where they are dedicated to the protection of individual rights. The firm specializes in birth injury, brain damage, brachial plexus injuries, negligence and malpractice lawsuits.

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