A Medicaid waiver is a program that allows states to provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. The name "waiver" comes from the fact that the federal government "waives" Medical Assistance/Medicaid rules for institutional care in order for states to use the same funds to provide supports and services for people closer to home in their own communities.
There are several types of Medicaid waiver programs, including:
- Katie Beckett or TEFRA waivers: allow children under the age of nineteen to receive medical care in their home without regard to their parents income level, provided the cost of in-home care is less or equal to the cost of providing the care in a hospital setting.
- Section 1115 Research & Demonstration Projects: States can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and CHIP.
- Section 1915(b) Managed Care Waivers: States can apply for waivers to provide services through managed care delivery systems or otherwise limit peoples choice of providers.
- Section 1915(c) Home and Community-Based Services Waivers: States can apply for waivers to provide long-term care services in home and community settings rather than institutional settings.
- Concurrent Section 1915(b) and 1915(c) Waivers: States can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements are met.
Each waiver has its own unique set of eligibility requirements and services. Medicaid waivers are for people with disabilities and chronic health conditions, and they allow healthcare professionals to provide care in a person’s home or community instead of a long-term care facility.
In Pennsylvania, for example, the Department of Human Services administers multiple Medical Assistance/Medicaid waivers, including the PA Medicaid Waiver for Infants, Toddlers and Families, Support Services Waivers, and the Living Independence for the Elderly Program (LIFE).
