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Medicaid Waivers

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Understanding the Virginia Medicaid Waiver System

If your child has been diagnosed with a developmental disability and is aging out of the special education system, changes are good that you’re now seeking adult services. Where do you begin? How do you choose a provider? And who pays for it?

Or perhaps you have a family member who is already receiving services within the community, such as day support or services at a group home, but you’re wondering if there are other options out there. How do you go about choosing another provider?

Unless you have the financial resources to pay for services out of pocket, or the ability to keep your child or family member living with you at home, the answers to those questions start with Virginia Medicaid waivers.

What is a Medicaid waiver?

Medicaid waivers were developed to encourage people with disabilities to access services in their own homes and communities, as opposed to receiving services in an institution, nursing facility, or intermediate-care facility.

Waivers allow states to “waive” certain requirements, specifically the requirement that individuals live in institutions in order to receive funding.

What’s the difference between Medicaid and Medicare?

Medicaid is a state-federal program that provides health care coverage for lower-income people, families with children, the elderly, and people with disabilities. It also provides long-term care for eligible individuals through the Medicaid waiver program. Medicare is a federal program that provides health care coverage primarily for seniors.

What does Medicaid waiver pay for?

Virginia has many kinds of Medicaid waivers, so it depends on the kind of waiver. The people Hope House supports have a Family & Individual Supports Waiver or a Community Living Waiver, which covers residential support services, day support, supported employment, respite care, assistive technology, therapeutic consultation, and more.

How is financial eligibility for a waiver determined?

Financial eligibility for a Medicaid waiver is based only on the income and assets of the individual who is applying. Other income and assets, such as parents’ or guardians’ incomes, are disregarded.

How do I apply for a waiver for my child or family member?

Contact the intake specialist at your local Community Services Board (CSB) to request a screening. If your child or family member does not already have a support coordinator at your local CSB, he or she will be assigned one at that time.

How long will it take to get the waiver?

Unfortunately, Virginia currently has a waiting list for waivers, with priority given to people who meet the criteria for the Urgent Waiting List. Your CSB support coordinator will be able to tell you more.