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Medicaid Waiver Qualifications

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    • Medicaid waivers are provided to help an individual stay in the community.lit d'hopital image by photlook from Fotolia.com

      Medicaid waivers allow for medical services that would normally be provided only in an institution-type setting to be provided in the home and community. The waivers also pay for additional services that are typically not covered by Medicaid. Medicaid waivers cover care for elders, those suffering from a traumatic brain injury and those with developmental disabilities. Children and adults both qualify for Medicaid waivers. Although the category a waiver falls under may vary by state, the qualifications are generally the same.

    Age and Disability Waiver

    • A Medicaid waiver can be granted to a person who is 65 years or older and living in a nursing facility who wishes to return to the community. The community can include the person's home or an assisted-living facility. The same applies to a disabled person in a nursing facility. If a person is disabled or 65 years of age or older and living in the community, a waiver can be granted to provide supplemental and complementary services to keep him in the home. A person must be classified as needing a nursing facility level of care to qualify for a Medicaid waiver in this category.

    Developmental Disabilities Waiver

    • A person with a developmental disability can receive a Medicaid waiver in order to remain at home or in a community setting. To receive a Medicaid waiver based on a developmental disability, the person must meet the criteria to be considered eligible for treatment at an intermediate care facility of the mentally retarded (ICF-MR). Most people who fall in this category need supervision and/or assistance with daily living tasks. A waiver would allow for support staff to provide assistance. Depending on the state, the waiver can include people who are considered to be mentally retarded, autistic or who have other mental disorders.

    Traumatic Brain Injury Waiver

    • A Medicaid waiver can also be granted for a person who has suffered a traumatic brain injury. The waiver only covers a person if she is classified as needing support in a nursing facility. The waiver provides for supportive care within the person's home or community. In some cases, it also covers rehabilitative and respite care. The waiver may also cover modifications to the person's home or community.

    Additional Waivers

    • Each state makes the determination for which services a Medicaid waiver covers. Most states provide waivers with the goal of allowing a person to remain within his home and still receive any needed support. Contact your state's human services department to find out if you or a loved one qualify for a Medicaid waiver.

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