Guest guest Posted August 21, 2001 Report Share Posted August 21, 2001 For what it's worth: I'm a Medicaid Waiver Case Manager in Indiana. We currently have five " waivers " available: ICF/MR, Aged & Disabled, Autism, Medically Fragile Children, and traumatic brain injury (TBI). To qualify, the person must first be eligible for Medicaid. What is " waived " for children (18 or under) is the income/assets of the parents that might otherwise preclude their eligibility for Medicaid. Beyond this, the applicant must subsequently meet other diagnositc eligibility criteria based on the particular " waiver " applied for. The end result is that these people can then receive the support they need to live in their homes/communities where historically these services/supports could only be provided in institutions due to costs, administration, etc. The intent of this national/state policy is to keep/move people from institutional settings, and (of course) eventually cut the costs associated with the long-term care of these citizens. Normally a state will have a designated single " Point of Entry " (POE) to apply for waivered services. Your state office of Medicaid Policy & Planning, or the state office of Family & Social Services Administration (I think all states have these) should know who/where this is in your state. If you'll tell me what state you are in, I will see if I can find out for you. The waiver waiting lists are long here, and Indiana is about 10 years behind some other states in developing and adhering to the best practices of delivering these services. But we're gettin' there. Hope this helps. Prather Re: Medicaid Waiver? >Hello everyone, > >My family and I have good friends who have an Autistic Child. This friend >insists that all disabled children are entitled to a Medicaid Waiver. Problem >is no matter who I contact,, noone seems to know what this is.. Has anyone >heard of this? Who do I contact? > >Thanks all, > > and Tyler 9 weeks > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2001 Report Share Posted August 21, 2001 For what it's worth: I'm a Medicaid Waiver Case Manager in Indiana. We currently have five " waivers " available: ICF/MR, Aged & Disabled, Autism, Medically Fragile Children, and traumatic brain injury (TBI). To qualify, the person must first be eligible for Medicaid. What is " waived " for children (18 or under) is the income/assets of the parents that might otherwise preclude their eligibility for Medicaid. Beyond this, the applicant must subsequently meet other diagnositc eligibility criteria based on the particular " waiver " applied for. The end result is that these people can then receive the support they need to live in their homes/communities where historically these services/supports could only be provided in institutions due to costs, administration, etc. The intent of this national/state policy is to keep/move people from institutional settings, and (of course) eventually cut the costs associated with the long-term care of these citizens. Normally a state will have a designated single " Point of Entry " (POE) to apply for waivered services. Your state office of Medicaid Policy & Planning, or the state office of Family & Social Services Administration (I think all states have these) should know who/where this is in your state. If you'll tell me what state you are in, I will see if I can find out for you. The waiver waiting lists are long here, and Indiana is about 10 years behind some other states in developing and adhering to the best practices of delivering these services. But we're gettin' there. Hope this helps. Prather Re: Medicaid Waiver? >Hello everyone, > >My family and I have good friends who have an Autistic Child. This friend >insists that all disabled children are entitled to a Medicaid Waiver. Problem >is no matter who I contact,, noone seems to know what this is.. Has anyone >heard of this? Who do I contact? > >Thanks all, > > and Tyler 9 weeks > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 Hello everyone, My family and I have good friends who have an Autistic Child. This friend insists that all disabled children are entitled to a Medicaid Waiver. Problem is no matter who I contact,, noone seems to know what this is.. Has anyone heard of this? Who do I contact? Thanks all, and Tyler 9 weeks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 Hello everyone, My family and I have good friends who have an Autistic Child. This friend insists that all disabled children are entitled to a Medicaid Waiver. Problem is no matter who I contact,, noone seems to know what this is.. Has anyone heard of this? Who do I contact? Thanks all, and Tyler 9 weeks Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 In a message dated 8/25/2001 12:40:26 PM Eastern Daylight Time, CandJRusso@... writes: > This friend > insists that all disabled children are entitled to a Medicaid Waiver. > Problem > is no matter who I contact,, noone seems to know what this is.. Has anyone > heard of this? Who do I contact? > No, their disability has to affect certain life functions. Each state has different criteria for their waiver program. For instance, there are many children with autism that do not have severe enough delays in life functions to meet the requirements for waivers. You must remember, waivers are for the population that would meet the requirements to live in an institution if left on their own. Nowadays, they are served in the community INSTEAD of the institution. What is " waived " is the requirement that they physically live IN the institution. Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 In a message dated 8/25/2001 12:40:26 PM Eastern Daylight Time, CandJRusso@... writes: > This friend > insists that all disabled children are entitled to a Medicaid Waiver. > Problem > is no matter who I contact,, noone seems to know what this is.. Has anyone > heard of this? Who do I contact? > No, their disability has to affect certain life functions. Each state has different criteria for their waiver program. For instance, there are many children with autism that do not have severe enough delays in life functions to meet the requirements for waivers. You must remember, waivers are for the population that would meet the requirements to live in an institution if left on their own. Nowadays, they are served in the community INSTEAD of the institution. What is " waived " is the requirement that they physically live IN the institution. Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 Medicaid Waiver is available to keep children and adults with disabilities in the community vs. being in an institution. Not all children with DD are eligible. The child must meet the ICF/MR level of care. A child who has spina bifada with only physical disabilities would not qualify). Generally, our kids would qualify. The thing about medicaid waiver is that there are only so many slots given to localities each year. There is a long waiting list and those who are the highest risk of being institionalized are moved to the top. The medicaid waiver (sometimes called Title 19 or Beckett) is not dependent on the parents income. Re: Medicaid Waiver? > Hello everyone, > > My family and I have good friends who have an Autistic Child. This friend > insists that all disabled children are entitled to a Medicaid Waiver. Problem > is no matter who I contact,, noone seems to know what this is.. Has anyone > heard of this? Who do I contact? > > Thanks all, > > and Tyler 9 weeks > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 Medicaid Waiver is available to keep children and adults with disabilities in the community vs. being in an institution. Not all children with DD are eligible. The child must meet the ICF/MR level of care. A child who has spina bifada with only physical disabilities would not qualify). Generally, our kids would qualify. The thing about medicaid waiver is that there are only so many slots given to localities each year. There is a long waiting list and those who are the highest risk of being institionalized are moved to the top. The medicaid waiver (sometimes called Title 19 or Beckett) is not dependent on the parents income. Re: Medicaid Waiver? > Hello everyone, > > My family and I have good friends who have an Autistic Child. This friend > insists that all disabled children are entitled to a Medicaid Waiver. Problem > is no matter who I contact,, noone seems to know what this is.. Has anyone > heard of this? Who do I contact? > > Thanks all, > > and Tyler 9 weeks > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 A medicaid waiver is where the child is eligible for medicaid irrespective of the family's income. Your case manager for early intervention should be aware of it. Also, once it is approved, at least here in PA... you are then eligible for WIC.... the extra milk and cheese came in handy..... and since I breastfed I got the extra mom's food for a whole year. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2001 Report Share Posted August 25, 2001 A medicaid waiver is where the child is eligible for medicaid irrespective of the family's income. Your case manager for early intervention should be aware of it. Also, once it is approved, at least here in PA... you are then eligible for WIC.... the extra milk and cheese came in handy..... and since I breastfed I got the extra mom's food for a whole year. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 11:53:16 AM Central Daylight Time, cindysue@... writes: > Medicaid Waiver is available to keep children and adults with disabilities > in the community vs. being in an institution. Not all children with DD are > eligible. The child must meet the ICF/MR level of care. A child who has > spina bifada with only physical disabilities would not qualify). Generally, > our kids would qualify. > > The thing about medicaid waiver is that there are only so many slots given > to localities each year. There is a long waiting list and those who are the > highest risk of being institionalized are moved to the top. The medicaid > waiver (sometimes called Title 19 or Beckett) is not dependent on the > parents income. > > Something that I have found from another list that I'm on is that this waiver is very different in each state. Here in Wisconsin any child that meets the criteria for Social security disability gets the waiver. Karyn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 11:53:16 AM Central Daylight Time, cindysue@... writes: > Medicaid Waiver is available to keep children and adults with disabilities > in the community vs. being in an institution. Not all children with DD are > eligible. The child must meet the ICF/MR level of care. A child who has > spina bifada with only physical disabilities would not qualify). Generally, > our kids would qualify. > > The thing about medicaid waiver is that there are only so many slots given > to localities each year. There is a long waiting list and those who are the > highest risk of being institionalized are moved to the top. The medicaid > waiver (sometimes called Title 19 or Beckett) is not dependent on the > parents income. > > Something that I have found from another list that I'm on is that this waiver is very different in each state. Here in Wisconsin any child that meets the criteria for Social security disability gets the waiver. Karyn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 12:52:55 PM Eastern Daylight Time, cindysue@... writes: > Medicaid Waiver is available to keep children and adults with disabilities > in the community vs. being in an institution. The thing about medicaid > waiver is that there are only so many slots given to localities each year. > There is a long waiting list and those who are the highest risk of being > institionalized are moved to the top. The medicaid waiver (sometimes > My understanding of the Beckett waiver is that it is intended to keep children with severe medical needs at home as opposed to in a MEDICAL institution (i.e. a hospital or long term care facility). It is not a " blanket program " provided to families of kids with disabilities. I think in New York state, there are twenty slots available per county. Jimmy was on the Beckett waiver for three years, from ages 1 to 4. He had a tracheostomy and frequent bouts of pneumonia. The waiver paid for the equipment we needed for his trach (suction machine, mist machine, apnea monitor), for disposable trach supplies, and for respite care 8 hours per weekday and 4 hours on the weekend. The costs of all this " stuff " was in the range of $1000 per week. NONE of these things were covered by our " regular " health insurance....so without the waiver, we wouild've been forced to put him somewhere that the " regular " insurance would've covered. (No way could we have afforded to provide this ourselves.) As soon as Jimmy's trach was out and healed, we were taken off the program because his reduced medical needs no longer supported his being on the program. I hope this is helpful. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 12:52:55 PM Eastern Daylight Time, cindysue@... writes: > Medicaid Waiver is available to keep children and adults with disabilities > in the community vs. being in an institution. The thing about medicaid > waiver is that there are only so many slots given to localities each year. > There is a long waiting list and those who are the highest risk of being > institionalized are moved to the top. The medicaid waiver (sometimes > My understanding of the Beckett waiver is that it is intended to keep children with severe medical needs at home as opposed to in a MEDICAL institution (i.e. a hospital or long term care facility). It is not a " blanket program " provided to families of kids with disabilities. I think in New York state, there are twenty slots available per county. Jimmy was on the Beckett waiver for three years, from ages 1 to 4. He had a tracheostomy and frequent bouts of pneumonia. The waiver paid for the equipment we needed for his trach (suction machine, mist machine, apnea monitor), for disposable trach supplies, and for respite care 8 hours per weekday and 4 hours on the weekend. The costs of all this " stuff " was in the range of $1000 per week. NONE of these things were covered by our " regular " health insurance....so without the waiver, we wouild've been forced to put him somewhere that the " regular " insurance would've covered. (No way could we have afforded to provide this ourselves.) As soon as Jimmy's trach was out and healed, we were taken off the program because his reduced medical needs no longer supported his being on the program. I hope this is helpful. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 3:37:00 PM Eastern Daylight Time, wildwards@... writes: > What is " waived " is > the requirement that they physically live IN the institution. > I don't believe this is correct, at least not in New York State. For us, what is " waived " is the income bar. Jimmy didn't qualify for Medicaid because we make too much money (!!!!!!). He was, however, allowed into the waiver program because his medical needs were such that we couldn't afford to keep him at home under our health insurance coverage. As you say, though, it may be different in different states. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/25/01 3:37:00 PM Eastern Daylight Time, wildwards@... writes: > What is " waived " is > the requirement that they physically live IN the institution. > I don't believe this is correct, at least not in New York State. For us, what is " waived " is the income bar. Jimmy didn't qualify for Medicaid because we make too much money (!!!!!!). He was, however, allowed into the waiver program because his medical needs were such that we couldn't afford to keep him at home under our health insurance coverage. As you say, though, it may be different in different states. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 3:45:35 PM Eastern Daylight Time, LK38 writes: > I don't believe this is correct, at least not in New York State. For us, > what is " waived " is the income bar. Jimmy didn't qualify for Medicaid > because we make too much money (!!!!!!). He was, however, allowed into the > waiver program because his medical needs were such that we couldn't afford > to keep him at home under our health insurance coverage. > It is in our state. Income is not waived, there are requirements you must meet. I will send you more information from work tomorrow, I have everything there. Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 3:45:35 PM Eastern Daylight Time, LK38 writes: > I don't believe this is correct, at least not in New York State. For us, > what is " waived " is the income bar. Jimmy didn't qualify for Medicaid > because we make too much money (!!!!!!). He was, however, allowed into the > waiver program because his medical needs were such that we couldn't afford > to keep him at home under our health insurance coverage. > It is in our state. Income is not waived, there are requirements you must meet. I will send you more information from work tomorrow, I have everything there. Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 1:08:30 PM Central Daylight Time, lauralk38@... writes: > .) As soon as Jimmy's trach was > out and healed, we were taken off the program because his reduced medical > needs no longer supported his being on the program. > > I hope this is helpful. > > > > > The requirements do indeed differ from state to state. In Mn it's called TEFRA riather then Kaitie beckett but is for the same purpose, to keep those who would otherwise have been instutionalized at home. Here that includes children with ds. the rules changed while we used the waiver , has never had a need for alot of things like the medical equiptment you discribe. She has never been hospitalized since she was 11 1/2 months old. Her biggest problem has been more strep infections since she started going to school. So the criteria does differ from state to state. Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 1:08:30 PM Central Daylight Time, lauralk38@... writes: > .) As soon as Jimmy's trach was > out and healed, we were taken off the program because his reduced medical > needs no longer supported his being on the program. > > I hope this is helpful. > > > > > The requirements do indeed differ from state to state. In Mn it's called TEFRA riather then Kaitie beckett but is for the same purpose, to keep those who would otherwise have been instutionalized at home. Here that includes children with ds. the rules changed while we used the waiver , has never had a need for alot of things like the medical equiptment you discribe. She has never been hospitalized since she was 11 1/2 months old. Her biggest problem has been more strep infections since she started going to school. So the criteria does differ from state to state. Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 2:48:04 PM Central Daylight Time, lauralk38@... writes: > I don't believe this is correct, at least not in New York State. For us, > what is " waived " is the income bar. Jimmy didn't qualify for Medicaid > because we make too much money (!!!!!!). He was, however, allowed into the > waiver program because his medical needs were such that we couldn't afford > to > But the purpose for the Kaite beckett is to keep those kids who would otherwise be institutionalized at home. Which is what the program did with Jimmy. kept him in his home. Each state has different requirments to meet and in your case the cost of his medical care would have possibly forced you to give him over to the state to care. It costs alot more to pay for round the clock coverage with the same medical equiptment needs then it does to pay for those needs while letting the family do the majority of care. And that is what the waiver is supposed to help do. met the requirements, she had no big medical issues once the heart repair was done. And that was before we bothered to apply for the waiver. The income bar that we had to get over at first was 's income...since she had none she qualified. They would reimburse 1/6 or our insurance premiums (when I rememberd to send in the papers, lol)They did change this about 5 or 6 yrs back and she still would qualify but they also apply a fee based on parental income. They also changed the way they looked at personal insurance policies and decided that ours wasn't cost effective (this was a yr or so before we rolled into a ppo) We made way to much that year that dairy prices were so high so terminated the states coverage. hehe. we recieved a letter stateing that she would still have the number/account available for reinstatement for 3 yrs past the date that we terminated. All we would have to do to reinstate would be make the request in writing...since we never tried I don't know how well that works. :-) Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 2:48:04 PM Central Daylight Time, lauralk38@... writes: > I don't believe this is correct, at least not in New York State. For us, > what is " waived " is the income bar. Jimmy didn't qualify for Medicaid > because we make too much money (!!!!!!). He was, however, allowed into the > waiver program because his medical needs were such that we couldn't afford > to > But the purpose for the Kaite beckett is to keep those kids who would otherwise be institutionalized at home. Which is what the program did with Jimmy. kept him in his home. Each state has different requirments to meet and in your case the cost of his medical care would have possibly forced you to give him over to the state to care. It costs alot more to pay for round the clock coverage with the same medical equiptment needs then it does to pay for those needs while letting the family do the majority of care. And that is what the waiver is supposed to help do. met the requirements, she had no big medical issues once the heart repair was done. And that was before we bothered to apply for the waiver. The income bar that we had to get over at first was 's income...since she had none she qualified. They would reimburse 1/6 or our insurance premiums (when I rememberd to send in the papers, lol)They did change this about 5 or 6 yrs back and she still would qualify but they also apply a fee based on parental income. They also changed the way they looked at personal insurance policies and decided that ours wasn't cost effective (this was a yr or so before we rolled into a ppo) We made way to much that year that dairy prices were so high so terminated the states coverage. hehe. we recieved a letter stateing that she would still have the number/account available for reinstatement for 3 yrs past the date that we terminated. All we would have to do to reinstate would be make the request in writing...since we never tried I don't know how well that works. :-) Joy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 5:24:56 PM Eastern Daylight Time, JTesmer799@... writes: > So the criteria does differ from state to state. > > In Virginia we have six different waivers to cover people with diabilities. > For folks that are elderly, for folks that are MR, for folks with AIDS, > for folks who need assistive medical technology, for folks who are DD, and > I forgot what the other one is. Each waiver has different kinds and limits > of support. Some waivers are just not very good. Different states just > cover everyone and identify what your needs are and give you services based > on that. Some day I hope VA comes out of the dark ages and does the same. > Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2001 Report Share Posted August 26, 2001 In a message dated 8/26/2001 5:24:56 PM Eastern Daylight Time, JTesmer799@... writes: > So the criteria does differ from state to state. > > In Virginia we have six different waivers to cover people with diabilities. > For folks that are elderly, for folks that are MR, for folks with AIDS, > for folks who need assistive medical technology, for folks who are DD, and > I forgot what the other one is. Each waiver has different kinds and limits > of support. Some waivers are just not very good. Different states just > cover everyone and identify what your needs are and give you services based > on that. Some day I hope VA comes out of the dark ages and does the same. > Cheryl in VA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2001 Report Share Posted August 27, 2001 Here's some more info on Medicaid waivers: Waivers are an optional program that affords States the flexibility to develop and implement alternatives to institutionalizing Medicaid eligible individuals. States may request waivers of certain federal rules which impede the development of Medicaid community based treatment alternatives. The program recognizes that many individuals who would otherwise be institutionalized can be cared for in their homes and communities at a cost no higher than that of institutionalized care. The services must be administered with an even hand, comprehensive, effectively working plan for placing qualified persons with disabilities in less restrictive settings. The waiting list must move at a reasonable pace. Waivers were established originally as a means to slow down Medicaid spending (cheaper to provide services in the community vs institution). To be eligible ( in VA) you must meet Medicaid eligibility ( don't have to be on Medicaid) which means PWD cannot have an income higher than $1,536.00 per month and parental income does not count, regardless of child's age. PWD must also fit criteria for Level of Functioning criteria to determine the level of care that is needed. Does this clear anything up or make things more confusing? ;-) Cheryl in VA Quote Link to comment Share on other sites More sharing options...
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