Medicaid Waivers

Types of Medicaid waivers
 

The federal government approves Medicaid waivers that give states more control over their Medicaid programs by waiving certain rules. States can use them to expand coverage to specific groups of people, limit coverage to specific geographic areas within their state, and experiment with other methods of managing Medicaid.

Some types of care that may fall under waivers include:

• Adult day care

• Respite care

• Attendant care

• Homemaker services

These waivers provide an alternative solution to long-term nursing care.

Pros and Cons

Many families and elderly citizens enjoy waivers because it allows them the option to delay the need for long-term nursing care.

Many elderly citizens who choose to age at home for as long as possible receive unpaid care from family members and loved ones. Supplementing their care with a waiver allows family members to continue working, caring for their children, and otherwise relieving the burden of having to act as full-time caregivers. They are able to focus on other aspects of their lives, while remaining confident that their loved one is safe and receiving the care that they need in the family’s absence.

There are Medicaid waivers that allow self-directed care, also known as cash and counseling, so that individuals may select who provides their care. They may have the option to hire a loved one as a paid caregiver and in some cases, even their spouse.

Since waiver programs have participant caps, even if an individual meets the eligibility requirements, they may not be able to receive benefits immediately. If there are no available spots, the individual will be put onto a waitlist for several months, and even years, before there is space available for them to receive benefits.

Once benefits begin, services included under the waiver may include:

• Home health aides

• Skilled nursing care

• Meal delivery

• Personal care

• Case management

• Medical equipment

• Transportation

• Respite care

• Adult day care

These services are beneficial for beneficiaries who are elderly, disabled, or incapacitated by diseases such as dementia and Alzheimer’s. They allow individuals to continue living independently at home for as long as possible, delaying the need for institutionalized care.

Types of Waivers

Section 1915(c)

With a 1915(c) waiver, seniors can live in their homes and communities for longer periods of time, receiving the services they need to continue living independently. They may receive funding for services such as:

• Adults day care

• Activities of daily living

• Household chores and activities (housekeeping, meals)

• Transportation

• Respite care

• Meal delivery

• Wheelchairs and walkers

Many 1915(c) recipients select their own caregiver, including professional caregivers, or training and hiring family members or loved ones to take on the role.

Section 1915(b)

Also known as Freedom of Choice or Managed Care waivers, 1915(b) waivers require Medicaid beneficiaries to receive benefits through a managed care network. There are only a few options from which beneficiaries can receive care under this system. Beneficiaries may not select just any Medicaid-approved provider of their choice, rather the provider must be a member of the managed care plan in which the participant is registered.

Self-directed care, or the hiring of specific caregivers or loved ones to provide care, is not allowed under Section 1915(b).

1115 Demonstration Waivers

1115 Demonstration waivers also known as Research and Demonstration waivers are intended to provide states with considerable flexibility when it comes to how they operate their Medicaid programs.

1115 Demonstration waivers allow states to expand Medicaid coverage, such as increasing access to home and community-based services, providing benefits not otherwise provided by the state's Medicaid program, and implementing a change in the way benefits are delivered.

The 1115 Demonstration waiver program can cover a variety of services, including long-term home and community-based services, behavioral health services, and both primary care and emergency care.