Waiver programs don't look at the income and assets of the family -- they only look at the income and assets of the individual. For kids with disabilities, each state has different programs, some including autism-specific programs.
Don't assume that if your child qualifies for a Medicaid waiver program, somebody somewhere along the line would surely have told you so.
Between the waiver programs and EPSDT, if your child requires skilled care, your child will get it. If they need nursing, they get skilled nursing. If they need a full time attendant, they will get it.
Whatever a doctor says is medically necessary for your child, your child will get it.
That isn't to say that the state is going to hand you the services as soon as you ask for them. But the start is knowing that your child is entitled to them. The process of fighting for them is worth the effort, because nobody can tell you how far your child could progress if they really truly received all the services they need.
A Primer in the Different Types of Medicaid Waiver Programs
There are two primary categories of Medicaid Waivers. The differences have to do with which part of the Social Security Act is providing the authorization for the particular waiver.
A 1915(c) waiver program refers to Section 1915, item (c) of the federal Social Security Act. The definition is:
A second type of medicaid waivers are those authorized under Section 1115 of the Social Security Act.
These are managed care medicaid programs.
There are several descriptions online of the differences between Section 1915(c) and Section 1115 waivers, but the following is very to the point:
The budgeting distinction between the two types of waivers has enormous impact on the provision of the long term care services provided to Medicaid participants:
An enormous source of tension with Section 1115 "demonstration projects" is that they allow profit-making companies to administer EPSDT. The National Health Law Project has published a list of 30 questions that all should be answered "yes" in evaluating whether a managed care project is meeting EPSDT requirements.
We believe that allowing for-proft companies to administer EPSDT (and medicaid waiver programs) is a wasteful use of funds. Money that could be directed towards helping children is instead being re-directed to pay for-profit business executives and generate additional profit for their companies.
