Medicaid Waivers: The Basics

Medicaid Waivers pay for services that support people with developmental disabilities.

  • You qualify based on how much support you need to live on your own.

  • You should apply as soon as you can, since there's often a long wait list.

Please note: The waivers system has been changing in Louisiana. The goal is to better serve people who need services and get help as soon as possible to those who need it most. The information in this Guide will be updated as things change. Last update: 7/2/19.

Medicaid Waivers can:

  • Help you care for your child at home instead of a care facility

  • Help adults with daily activities — like cooking, managing money, and transportation — so they can live in their own homes

  • Help adults with basic care needs like bathing and dressing, if they cannot do these activities alone

  • Help adults take part in community activities or find and keep a job

 

Waivers are a part of Medicaid, which is a state-funded health insurance. They're also called Home and Community-Based Waivers. 

Image of a family and their home being supported by hands

If a person can live at home, but only with support, the waivers give that support.

The goal is to help people to not have to live in a residential or nursing home. (These are sometimes called institutional care facilities or ICFs.)

 

 

 

Click on the boxes below to learn more. You can click on the title again to close each box.

The short answer — people with developmental disabilities who cannot live on their own or with their parents unless they have some extra support.

The long answer:

This is a complicated process! It depends on your family member's situation, their disability, and how much money the state has available at the time.

If it was simple, we'd tell you exactly who qualifies. But we can't.

So we'll tell you about the process and how to make the best case for your family member's needs.

What is a developmental disability?

developmental disability is when a child or adult cannot do certain things that people usually do at their age.

A person should meet the waiver definition of developmental disability if they:

  • had this disability before they turned 22 years old

  • will have this disability for life

  • have trouble taking care of themselves, talking with others, learning, moving around, etc.

  • need more care and more services because of their disability

In children, this may be called a developmental delay, because they might catch up as they grow.

In adults, it's more often called a disability.

How will they decide?

  • The state has certain things they look at to see if your family member qualifies.

  • You'll meet with someone at the HSD. They'll ask you questions and look at your family member's medical records and other paperwork that shows their challenges. They call this the system entry process.

  • They will decide if your family member qualifies. 

We'll tell you more later about how to prepare the documents.

Source: LDH

It depends on the waiver, but here are some examples:

For children:

  • Respite care to give caregivers a break

  • Family training

  • Help adapting a home or car to be accessible

  • Buying and learning how to use special devices they may need

  • Special therapies like music, aquatic, or sensory-motor integration

For adults living on their own:

  • Help with things like bathing, cooking, and paying bills

  • Transportation and support to help them take part in community activities

  • Support and training for getting a job

  • Help paying the costs of moving from a nursing facility

There are many others — we will tell you more in the next section!

 

Sources: LDH, OCDD

We will go over this in detail later in the Guide. 

But here is the basic process:

  • You will call your Human Services District (HSD) office and tell them you want to get a Medicaid Waiver. (See the list of regional offices below.)

  • They will meet with you to see if your family member is eligible, and tell you which Waivers they qualify for.

  • If your family member qualifies, their name will go on a on the Registry, or wait list. The wait lists can be very long — sometimes years! We'll tell you how to look for other services to help during this time.

  • When your family member gets off the wait list, you'll be assigned a support coordinator, who will help you through the process.

  • You'll work with the support coordinator to write up a Plan of Care (POC). Thisdescribes how your family member will use the services to work toward their personal goals.

  • You will choose a provider agency who will provide the services.

  • Your support coordinator should help you with everything!

 

Source: LDH

Flowchart showing organization within the Louisiana Department of Health: Within the LDH, there are different offices.(They are really departments.), OCDD is in charge of services for children and adults with developmental disabilities, and The HSD offices are where you go in your region to connect to these services.

Your local Human Services District (HSD) office is the place to go for all of these services. Call them to ask about Waivers and other services.

Look at the map below to find the phone number for your local HSD. Or click on this list of OCDD Districts and Authorities from the LDH website. (It will open in a new tab on your screen)

Map showing Louisiana Human Services Departments and contact information

Source: LDH

There are 4 different Medicaid Waivers for people with developmental disabilities.

Each of them covers a list of services that can help support your family member.

Note: This system is changing. You will still hear about these 4 waivers, but they will soon be  integrated into one. The important thing is to start the process as soon as possible and get on the list. Keep reading and we'll tell you how!

Here are the basics of the 4 Medicaid Waivers:

  • Children's Choice Waiver

    • Ages 0-20

    • Support for children living at home with their families

  • NOW (New Opportunities)

    • Ages 3+

    • Support for children and young adults living at home or on their own

  • Supports

    • Ages 18+

    • Supports for people looking to integrate into the community and find work opportunities

  • ROW (Residential Options)

    • Ages any

    • Supports for people moving from a care facility to independent living

We'll give you more details about the services offered by each of these Waivers.  This is just a quick look for now!

 

Sources: LDH, OCDD

Learn more:

Click here to read more on the LA Dept. of Health Website

 

Sources: Medicaid, LDH

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