Home and Community-Based Services (HCBS) waivers, like the TEFRA State Plan Option, allow states to disregard family income for children with severe disabilities who are cared for at home but who might otherwise live in institutional settings. In contrast with the TEFRA State Plan Option, HCBS waivers usually provide additional services designed to support families in keeping their children in the community rather than in institutions. In addition to Medicaid coverage, HCBS waiver services may include respite, home or vehicle modifications, or medical day care. States are allowed to restrict eligibility by age, geographic region, and diagnosis. For example, the Children’s Choice waiver in Louisiana is for children, birth to 18, with autism, intellectual and developmental disabilities. Waiver services include center-based respite, specialized aquatic, art, and music therapies, and hippotherapy/therapeutic horseback riding among other services that are not available to all children enrolled in Medicaid. The South Carolina Medically Complex Children’s Waiver provides coordination, respite, and pediatric medical day care for medically fragile and technology dependent children, birth to 18.
States can limit the number of waiver slots available, which often results in waiting lists.
Applying for waiver services can be confusing. The Georgia Family-to-Family Health Information Center created a webinar titled “Katie Beckett Medicaid Deeming Waiver: A Step by Step Guide on the Application Process.” It explains the eligibility and application process for the state’s Katie Beckett Medicaid Deeming Waiver for children with disabilities who are under the age of 18 and who do not qualify for Supplemental Security Income (SSI) due to their family income and/or resources.
- Visit Medicaid.gov to choose a state and read its Program Documents, which includes descriptions of Demonstrations & Waivers.
- Public Insurance Programs and Children with Special Health Care Needs: A Tutorial on the Basics of Medicaid and the Children’s Health Insurance Program (CHIP) Section 4: Pathways to Coverage