From Autism Transition Handbook
Support Services and Waivers
General information for all families
Support Services Overview
What are Waivers?
“Waivers” is a shortened term to describe the Medicaid Home and Community Based Waiver Program. This program provides funding for supports and services that help individuals with disabilities live in their homes and communities. Services offered go beyond those provided by Medical Assistance in order to help the individual remain in the community, rather than being admitted to a Long-Term Care Facility. Unlike Medicaid, waivers are not an entitlement program and may have long waiting lists. Most states offer waivers to provide home- and community-based services to people with developmental disabilities (DD), which may cover individuals with autism. For a complete list in your state, you can go directly to the agency within your state that administers the waiver program. Alternatively, you can find a complete listing of waiver programs at the Centers for Medicaid and Medicare services website.
In recent years, many states have added a waiver program specifically for individuals with autism. Currently, there are 11 states with autism waivers, largely for children: Colorado (0-6), Indiana (0 to no max), Kansas (0-5), Maryland (1-21), Massachusetts (birth to 8), Montana (1-4), Nebraska (0-17), North Dakota (birth to 4), Pennsylvania (21 and older), and South Carolina (3-10). These waivers have different requirements, and cover different services such as intensive individual supports, respite, case management, adaptive equipment/environmental mods, OT, PT, speech/language therapy, transportation, individual goods and services, program design & monitoring, adult day, day services, rent and food for unrelated live-in caregiver, residential hab and support, adult foster care, behavioral support services/crisis assistance, community transition, family and caregiver training, music therapy, psychological therapy, recreational therapy, and specialized medical equipment and supplies.
How Do I Know Which Waiver(s) My Child May Be Eligible For and Which One is Best for My Child?
Choosing the right waiver depends upon what your child's specific needs are. Prior to starting the process, it is a good idea to read the eligibility factors for each waiver, and see which one best fits your child's situation and needs. It may be possible that he or she is eligible for more than one waiver; in this case, you may want to apply for more than one waiver. Also, if your child is already covered under one waiver, but you want to apply for a different waiver, you may also do this. Please note, in this case priority for waivers are given to individuals who do not already have a waiver.
Waiver Funded Services to Support Living in the Community
Home and Community Services waivers can help your son or daughter gain, maintain, and improve skills that allow them to live and participate in their local community. The following is a description of waiver services that may be available:
- Habilitation is designed to assist individuals to gain, maintain, and improve skills in the areas of self-care, daily living activities, social skills, and to enable the person’s involvement in community activities. These services help people live in their home; participate in local community activities; use community resources such as parks, pools, movies etc.; and access informal supports such as service clubs, senior programs, and other community opportunities. Services can be provided by a service agency that provides trained individuals to provide assistance or by someone the person and family already knows who is qualified and willing to provide assistance.
- Community Habilitation is delivered in a licensed Adult training facility. Adult training facilities provide services that assist individuals in meeting personal needs and performing basic daily activities. JCAHO Accredited/MA Certified Non-Residential Agencies providing Community Habilitation assist individuals in acquiring, retaining, and improving self-help, socialization, and adaptive skills.
- Transportation services are offered to enable individuals to gain access to their community including both services and informal supports. Transportation covers emergency transportation in certain circumstances.
- Older Adult Day Services support people in meeting their personal care and social needs.
- Home Finding services provide assistance with activities related to self-determined housing. These include education about housing, and home ownership working with landlords, location of housing, and assessment for appropriate physical adaptations to make housing accessible.
- Environmental Accessibility Adaptations: Vehicle Adaptations for improved access and/or safety. Home Adaptations to homes for improved access and/or safety.
- Adaptive Appliances/Equipment The purchase or modification of items for increased functional involvement by individuals in activities of daily living.
- Habilitation Supplies for direct use by individuals and/or caregivers to address health and safety needs. Supplies are limited to those listed in the long definitions document.
- Homemaker Indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. There is no funding cap for this service in the P/FDSW. The consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year.
- Chore indirect services including household cleaning/maintenance and homemaker activities such as meal preparation. The initial duration of this service is limited to one month. A mandatory 2-week interval must be observed for evaluation purposes prior to any extension of this service. After six (6) weeks, additional criteria must be met to extend the service. Consolidated Waiver funding for homemaker and chore services combined may not exceed a total of $2000 in a fiscal year. There is no funding cap for this service in the P/FDSW.
- Residential Home and Community Habilitation - Licensed Homes Direct service and services to meet regulatory requirements and contract conditions provided in licensed community homes to assist individuals in acquiring, retaining, and improving self-help, socialization and adaptive skills