The Waiver Offer Packet

When your family member's name comes up on the Registry and it's their turn to get a Waiver, they will get a waiver offer packet.

It will come in the mail from Statistical Resources, Inc. (SRI).

There will be a few forms in the waiver offer to fill out and return:

  • Waiver Decision Form — You'll let them know if you want to get Waiver services or not.

  • Freedom of Choice Form — You'll choose a Support Coordination agency.

  • Request for Medical Eligibility Determination Form (90-L form) — Your child's doctor must fill this out no more than 90 days before the services start.  This will describe the level of help your family member needs.


Click on the link at the bottom of the page to download a copy of the 90-L form:


Image of parent character Paula filling out a form
You must fill out these forms and return them to the registry before waiver services can start!




Source: LDH