what are medicaid waivers?

Medicaid waivers provide services to you or your family member such as respite, personal care, assistive technology, employment, residential services, nursing or behavioral supports. Virginia’s Medicaid Waivers pay for a variety of supports and services for children and adults with disabilities and their families who need long-term support systems to live successfully in the community rather than in institutional settings. For those who are offered an active waiver slot (versus being on the waitlist), family income is NOT considered.

Waiver services offer an alternative to placement in an institution such as a nursing home or intermediate care facility. Equivalent care is offered in the home and community, along with Medicaid, for each individual who receives a waiver.

Waivers are specific to the needs of disabled individuals within each state, such as the elderly, those with autism, traumatic brain injury, autism, or intellectual disability. In Virginia, waivers are available for individuals with developmental disabilities (DD Waivers) and for those with disabilities which occur on or after the 22nd birthday (CCC Plus Waiver), to include disabilities associated with aging. There are thousands of people on the DD Waiver waitlist, which is based on urgency. The CCC Plus Waiver has no waitlist and individuals may be on the waitlist for a DD Waiver while receiving supports under the CCC Plus Waiver.

DD WAIVER REQUIREMENTS

  • Intellectual or Developmental Disability

  • Functional Limitations – VIDES
  • Medicaid eligible as an Individual

  • Accept at least one ongoing waiver support

CCC Plus WAIVER REQUIREMENTS

  • Physical Disability (ongoing medical or nursing needs)

  • Functional Limitations – UAI
  • Medicaid eligible as an Individual

  • “Imminent risk” of out-of-home placement

how do I apply for a waiver

Contact information to request services

specialized children’s services – epsdt

Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), Medicaid’s comprehensive and preventive child health program for individuals under the age of 21, includes periodic screening, vision, dental and hearing services. In addition, Medicaid is required to provide any medically necessary health care to correct and ameliorate physical and mental conditions.

EPSDT Specialized Services are medically necessary treatment services for children that are not routinely covered through Virginia Medicaid. The six most commonly requested EPSDT Specialized Services are listed below. This list is not exclusive. To access EPSDT Specialized Services, the medical provider sends an order to an enrolled service provider chosen by the family. The service provider then obtains a service authorization if necessary. The table below identifies who to contact depending on the type of service and the child’s benefit.

Determination of whether a service is medically necessary is made on a case-by-case basis, taking into account a particular child’s needs. Please note that EPSDT cannot cover experimental treatment or treatment which is not determined to be medically necessary.

For questions regarding these or other available specialized services please call (804)786-6134 or email epsdt@dmas.virginia.gov. Additional EPSDT information can also be found under the Maternal and Child Health link on the DMAS website at www.dmas.virginia.gov.

Contact information for Managed Care Organizations (MCOs) can be found at www.virginiamanagedcare.com or by calling the Medicaid Managed Care Help Line at 1-800-643-2273.

Picking The Right Classes

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Useful Resources

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