Maryland Medicaid Waivers

medicaid waivers

Maryland Medicaid's home and community-based services are offered through the regular Medicaid program and special Medicaid programs called “waivers.” Each waiver has different eligibility criteria and target a different population, such as older adults or people with a certain disability.

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Autism Waiver - Maryland State Department of Education

The Maryland Medicaid Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder (Autism Waiver) is designed to provide community-based, long-term, person-centered therapeutic services and support to eligible children and youth with Autism Spectrum Disorder (ASD). Its goal is to enable home and community living as an alternative to institutional care. Here are some key points about the Autism Waiver:

  1. Eligibility Criteria:
    • Children and youth must meet the following criteria to enroll in the Autism Waiver:
      • Have a current diagnosis of ASD.
      • Be between the ages of 1 and the end of the school semester in which they turn 21 years old.
      • Reside in Maryland.
      • Have an Individualized Educational Program (IEP) or Individualized Family Service Plan (IFSP) with at least 15 hours per week of special education and/or related services.
      • Meet eligibility requirements for an ICF-IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) institutional level of care.
      • Be able to be served and safely maintained in the home and community with Autism Waiver services.
      • Meet financial eligibility for Medical Assistance (monthly income not exceeding 300% of SSI benefits, and countable assets not exceeding $2,000 or $2,500, depending on eligibility category).
  2. Services Offered:
    • The Autism Waiver provides various services, including:
      • Respite care
      • Environmental accessibility adaptations
      • Family consultation
      • Residential habilitation
      • Intensive individual support services
      • Therapeutic integration
      • Adult life planning
  3. Capacity and Application:
    • The program is accepting new applications to be placed on the waiting list. 
    • Families interested in the Autism Waiver should contact the Autism Waiver Registry to have their child’s name added for future consideration.
  4. Administration:
    • The Autism Waiver is a partnership between the Maryland State Department of Education (MSDE) and the Maryland Department of Health (MDH).
    • MSDE handles day-to-day implementation, while MDH oversees the Medicaid program and the Autism Waiver.

For more detailed information, you can refer to the Maryland Department of Health’s Autism Waiver Fact Sheet If you have any specific questions, feel free to ask!

Community First Choice (CFC) program

The Community First Choice (CFC) program  in Maryland provides essential services and support to enable older adults and individuals with disabilities to live independently in their own homes. Here are the key points:

  1. Eligibility:
    • Individuals must reside in the community.
    • They must meet the level of care required for services in an institution.
    • Qualification for Medicaid in the community is necessary.
  2. Services Offered:
    • Personal Assistance Services: Assistance with activities of daily living, including bathing, grooming, dressing, and mobility.
    • Supports Planning: Guidance in developing a personalized plan for services.
    • Nurse Monitoring: Regular health monitoring.
    • Personal Emergency Response Systems: Ensuring safety and quick response during emergencies.
    • Assistive Technology: Tools to enhance independence.
    • Environmental Assessments: Evaluating home safety and accessibility.
    • Accessibility Adaptations: Modifications to accommodate specific needs.
    • Consumer Training: Skills development for self-care.
    • Transition Services: Assistance during transitions (e.g., hospital to home).
    • Home Delivered Meals: Nutritious meals delivered to the home.
  3. Application Process:
    • Contact the Department at 410-767-1739 to apply.
    • Eligibility is determined based on both financial and medical requirements.
    • Participants choose an approved Supports Planning Agency to guide them through service planning.

For more details, you can visit the Maryland Department of Health’s Community First Choice page. If you have further questions, feel free to ask!

Community Pathways Waiver (CPW)

The  Community Pathways Waiver (CPW)  helps participants live more independently in their homes and communities. This program provides a variety of services, including  Meaningful Day,  Support, and  Residential Services, promoting community living. Participants can choose between a  self-directed service model and a  traditional agency-based service model. Some of the services available in CPW include:

  • Meaningful Day Services:
    • Employment Services
    • Supported Employment
    • Employment Discovery and Customization
    • Career Exploration
    • Community Development Services
    • Day Habilitation
    • Medical Day Care
  • Support Services:
    • Assistive Technology and Services
    • Behavior Support Services
    • Environmental Assessment
    • Environmental Modifications
    • Family and Peer Mentoring Supports
    • Family Caregiver Training & Empowerment Services
    • Individual and Family Directed Goods and Services
    • Housing Support Services
    • Live-in Caregiver Supports
    • Nursing Support Services
    • Participant Education, Training & Advocacy Supports
    • Personal Support Services
    • Remote Support Services
    • Respite Care Services
    • Support Broker Services
    • Transition Services
    • Transportation Vehicle Modifications
  • Residential Services:
    • Supported Living
    • Shared Living
    • Community Living (Group Home)
    • Community Living (Enhanced Supports)

Eligibility guidelines include no age limitation, and individuals must require the level of care equivalent to services provided in an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/ID). Please note that the New Directions Waiver has been merged with the Community Pathways Waiver. If you have any specific questions or need further assistance, feel free to ask!

Community Personal Assistance Services Program - Maryland Department of Health

The Community Personal Assistance Services (CPAS) program in Maryland is designed to help individuals live independently in their own homes and communities. Here are some key points about CPAS:

  • Services Provided:
    • Personal Assistance Services: These services assist with activities of daily living, such as bathing, dressing, grooming, meal preparation, and light chores.
    • Supports Planning: CPAS helps participants plan for their needs and access appropriate services.
    • Nurse Monitoring: Nurses monitor participants’ health and well-being.
  • Eligibility Criteria:
    • Participants must  live in the community (not in an institution) and require assistance with daily activities at home.
    • Eligibility is based on both  medical and financial criteria.
    • Income and assets are reviewed to determine financial eligibility for  community Medicaid.

If you have any further questions or need additional information, feel free to ask!

Home and Community-Based Options Waiver - Maryland Department of Health

Home and Community-Based Options Waiver provides services for older adults and individuals with physical disabilities. Aimed at enabling them to live at home instead of in a nursing facility.

Services Offered:
  • Assisted living services (excluding room and board)
  • Behavior consultation services
  • Case management
  • Dietitian and nutritionist services
  • Medical day care
  • Senior Center Plus
  • All other standard Medicaid services, including Community First Choice if living at home
Eligibility Guidelines:
  • Age Requirement: Must be 18 years or older.
  • Financial Eligibility: Eligibility for Medicaid depends on income and assets.
  • Level of Care: Must require the level of care necessary for nursing facility services.
Application Process:
  • Individuals are encouraged to apply to determine financial eligibility.
  • Application is necessary to assess if the required level of care is met for nursing facility services.

For more information or to apply, individuals can contact 1-844-627-5465 (Toll Free).

Medical Day Care Services Waiver - Maryland Department of Health

The Medical Day Care Services waiver provided by the Maryland Department of Health offers individuals the opportunity to receive medical care in a community-based setting, aiming to provide an alternative to nursing facility care. Here are the key details:
Overview:

  • Purpose: Provide medical care during the day in a community-based setting.
  • Services Offered:
    • Skilled nursing and nursing assessments
    • Medication monitoring
    • Meals
    • Social work services
    • Activity programs
    • Daily living skills training
    • Transportation
    • Therapy
    • Personal care
    • Nutrition services
  • Providers: Services are delivered by licensed medical day care providers.
Eligibility Guidelines:
  • Age: Individuals must be at least 16 years old.
  • Waiver Enrollment: Cannot be enrolled in another home and community-based waiver.
  • Medicaid Eligibility: Must qualify for Medicaid in the community.
  • Level of Care: Must require the level of care necessary to qualify for nursing facility services.
For more information or to inquire about eligibility, contact:
  • Maryland Access Point: 410-767-1100 (Maryland), 1-844-627-5465 (Toll Free)
  • Maryland Department of Health: 410-767-1144 (Maryland), 1-800-535-0182 (Toll Free)

Model Waiver for Medically Fragile Children - Coordinator Center for Home and Community Care

Coordinator Center for Home and Community Care
Contact Numbers:
  • Baltimore: 410-987-1048
  • Washington: 301-621-7830
  • Maryland Department of Health: 1-877-463-3464
The Model Waiver allows medically fragile children to receive necessary care at home rather than in a hospital or nursing facility.

Key Points:

  • Purpose: Enable medically fragile individuals to live at home with their families.
  • Enrollment Limit: Maximum of 200 individuals can be enrolled in the Model Waiver.
  • Eligibility Guidelines:
    • Must be admitted before turning 22 years old.
    • Must meet the definition of a disabled child (chronically ill or severely impaired).
    • Must need hospital or nursing facility level of care, as determined by a state-contracted reviewer.
    • Medically necessary community-based services must be cost-neutral compared to institutional care costs.
    • Parents' income and assets are waived during the financial eligibility process.

Definition of "Disabled Child":

A disabled child is defined as:
  • Chronically ill or severely impaired.
  • Younger than 22 years old.
  • Condition does not necessarily require 24-hour inpatient care but may lead to hospitalization or prolonged stay in a facility without home care services.

Certification Process:

  • State-contracted reviewer assesses the level of care needed based on information provided by the referring physician.
This structured format helps clearly outline the eligibility criteria and process for the Model Waiver for Medically Fragile Children, ensuring clarity and ease of understanding for potential applicants and stakeholders.

Rare and Expensive Case Management (REM) - Maryland Department of Health

Here are the key points about the Rare and Expensive Case Management (REM) program :
  • Program Overview
    • Alternative to HealthChoice Managed Care Organization (MCO) for recipients with specified rare and expensive conditions.
    • Provides case management services on a fee-for-service basis.
  • Role of REM Case Managers
    • Managed by registered nurses or licensed social workers.
    • Goal: Help recipients achieve their highest level of functioning.
    • Services include: service coordination, home visits, assessment of needs, patient education, family support, treatment plan development, coordination of provider services, and progress follow-up.
  • Eligibility
    • Recipients must be eligible for HealthChoice to receive REM services.
    • Limited to individuals with qualifying rare and expensive conditions or diseases.
  • Referral Process
    • Referrals can be made by the Managed Care Organization (MCO), recipient's doctor, or any concerned person.
    • MCO must identify the recipient as a potential REM candidate before referral.
    • Recipients can also self-refer, either at the time of diagnosis or later.
  • Contact Information
    • Maryland Department of Health REM Program contact: 410-767-1903 (Voice), 1-800-565-8190 (Toll Free).
These points outline the structure, services, eligibility criteria, referral process, and contact details for the REM program provided by the Maryland Department of Health.

Traumatic Brain Injury Waiver Services for Adults - Maryland Department of Health, Behavioral Health Administration

  • Program Name: Home and Community-Based Services Waiver for Individuals with Brain Injury
  • Administered by: Maryland Department of Health, Behavioral Health Administration
  • Contact Numbers:
    • 410-402-8476 (Voice)
    • 1-877-463-3464 (Toll Free)
  • Services Provided:
    • Residential habilitation
    • Day habilitation
    • Supported employment
    • Individual support services
    • Case management
    • Medical day care
  • Additional Medicaid State Plan Services Include:
    • Physician and hospital care
    • Pharmacy services
    • Home health services
    • Laboratory services
    • Mental health services
    • Disposable medical supplies and durable medical equipment
    • Payment of Medicare premiums, co-payments, and deductibles
  • Eligibility Criteria:
    • Diagnosis of brain injury, requiring a specialty hospital or nursing facility level of care
    • Brain injury occurred after the age of 17
    • Inpatient in a State Behavioral Health Administration facility
    • Inpatient in a state-owned and operated nursing facility
    • Maryland licensed Special Hospital for Chronic Disease accredited by CARF for Brain Injury Inpatient Rehabilitation
    • Placed by Medicaid in an out-of-state facility
    • Must meet financial eligibility requirements

This summarizes the services, eligibility criteria, and contact information for the Traumatic Brain Injury Waiver Services for Adults provided by the Maryland Department of Health, Behavioral Health Administration.