The 1915(c) waiver is known as the “home and community-based services waiver” (HCBS) because it allows states to treat certain Medicaid populations in home or other community based settings rather than in institutional or long-term care facilities such as hospitals or nursing homes.
Home & Community Based Services:
Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community. These programs serve a variety of targeted populations groups, such as people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.
These services can take place in the person’s home or in the community. Both children and adults can be supported by Medicaid Waiver services. Medicaid usually pays for doctor appointments, hospital expenses, medicine, therapy, and some adaptive equipment. The Medicaid Waiver allows for Medicaid to be used to pay for additional services. The state writes a plan that tells what kind of services will be provided under their Medicaid Waiver program. The federal government has to approve the Medicaid Waiver plan. The Medicaid Waiver dollars are part state and part federal money.
The NOW waiver will provide supports to people who don’t need 24 hour care. The Comprehensive waiver will provide supports to people who need 24 hour care. Families who have heard about the new waivers are excited because they will have more options for support and more will have more control in making the decision about how the money is spent.
Examples of HCBS Waiver Programs:
- Aged & Disabled Waiver (A&D)
- Family Supports Waiver
- Traumatic Brain Injury (TBI)
- AIDS Waiver
- Independence Waiver
- Health & Disability Waiver (H&D)
- HCBS Elderly
- Physical Disabilities (PD)
With the new waivers, every person will have an individual budget based on their needs. The family will be aware of how much money is available to purchase the supports needed. In the past the dollars went to the providers to reimburse them for providing the service.
Choice of Services/Freedom of Choice (FOC)
If a family is happy with the services they are currently receiving, they can choose to continue to purchase those same services. If they want to think of other
ways to support their family member, they can look at new and innovative ways of providing the community supports. Families can even choose to become responsible for hiring the people to work with their family member.
Supports Intensity Scale:
The Case Managers/Support Coordinators have been trained to use the Supports Intensity Scale in an effort to find out what the individual needs. It is an interview that is done with people who know the individual well. The score on the Supports Intensity Scale (SIS) along with other information will be used to decide how many waiver dollars will be set aside for your family member’s supports and services.