Autism Understanding & Acceptance 2014 Day 26: Medicaid Waiver, a new-to-us service

I mentioned in my last post that we had been on a waiting list for a Medicaid Waiver for seven years. You may be wondering what a Medicaid Waiver is, so I'll explain.

Medicaid Waivers provide staffing, therapies, services & supports for individuals with significant special health care needs in order for them to live as independently as possible in their own homes & communities (hence their full name of Home and Community Based Services or Waivers).  Specifically, it "waives" the requirement that these individuals be institutionalized in order to receive the care that they need (think nursing homes, or the group home in the movie Rainman where Raymond lived before Charlie took him on their cross-country road trip).

That level of institutional care is very expensive, and the option of providing services to people in their homes & communities is less expensive in the vast majority of cases.  In fact, if a person's waiver budget is more expensive than an institutional placement, then that person can be placed in an institution, but this is rare these days.  It is a better use of state & federal dollars for people to be living as independently as safe and possible.  But most importantly in my book: it keeps our loved ones IN the community, PART of the community, not set aside from the community.

There is much to be said about the waiver program in our state currently.   Because of the recession AND because our waiting lists simply weren't sustainable any more (10-12 years long), major changes occurred about 18 months ago.  The state made changes to the program, more federal dollars rolled in, and after seven years, T now has his Medicaid Waiver.

What does this do for us now?  It is paying for Music Therapy and mass amounts of Respite Care.  We are thinking of reducing the amount of Respite and adding some Recreation Therapy, which would be a staff person taking T to parks, gyms, sports activities, and getting him active.  All this is wonderful.  But where we'll really feel the impact is with what comes along with a Medicaid Waiver: Medicaid Disability.

It will be T's secondary policy, and here's the beautiful thing: as long as the doctor or therapist accepts Medicaid Disability, it will cover T's co-pays, co-insurance and deductibles up to our out-of-pocket maximum of our private policy.  And if our primary policy doesn't cover an important therapy, or limits the amount of sessions a child can have?  Again, as long as the provider accepts Medicaid Disability, it's covered.  How is this possible when we are over income for Medicaid?  A beautiful thing called Senate Bill 30 that waives parental income requirements when a child under 18 is on a waiver.

For some families, this is the deciding factor between bankruptcy and financial stability.  Medical treatments & therapies that aren't covered by insurance can quickly mean financial ruin for a family.  We've been very, very blessed that our primary insurance has been so good.

Eventually, the hope is that his waiver budget will allow him to live in an apartment or home with roommates with the staffing he needs.  I will dive into this look into the future before the month is out.