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Medicaid Waivers

Are you or your family member in need of services such as respite, personal care, assistive technology, employment, nursing or behavioral supports? If so, you need to find out about Medicaid Waivers. Virginia’s Medicaid Waivers pay for a variety of supports and services for children and adults with developmental delays/disabilities and their families who need long-term support systems to live successfully in the community rather than in institutional settings.

Don’t worry about the financial Medicaid requirements! For children and adults with developmental disabilities, the family’s income is NOT considered.

Medicaid: Medicaid is the insurance that pays for Waiver Services

Waiver: Waiving the requirement that Medicaid services be provided to all in the state. Only for select population(s). 

What are the Medicaid Waiver Programs?

Virginia offers several Medicaid waiver programs. There are two waiver programs that are most commonly used by people with developmental disabilities.  They are:

  • Developmental Disabilities (DD)

  • Commonwealth Coordinated Care Plus (CCC Plus)

Click here to watch the video on waivers

Developmental Disabilities Waiver Program 

The DD Waiver serves individuals of any age with a developmental disability and children (birth through age 9) with a substantial developmental delay or specific congenital or acquired condition.  Within the Developmental Disabilities Waiver Program, there are three waivers that provide a continuum of services. They are the Building Independence (BI), Family & Individual Support (FIS) and Community Living (CL) waivers. The Developmental Disabilities (DD) Waiver Program provides supports and services options for successful living, learning, physical and behavioral health, employment, recreation and community inclusion.

Click to view the DD Waiver Services & Descriptions.

Eligibility Requirements, How to Apply & Waiver Assignment Process:

To be eligible for the waiver

To apply for the Developmental Disabilities Waiver services contact your local Community Services Board

The Community Services Board (CSB) staff will determine if you:

  1. meet the definition of a developmental disability 

  2. meet the functional criteria as assessed on the VIDES screening tool.

The Waiver Assignment Process is coordinated by your local Community Services Board. Waivers are assigned based on the urgency of support needs. Individuals who meet the eligibility criteria are placed on the waiting list due to the limited number of waivers funded. It is not a chronological waiting list.

What happens when you are placed on the DD waiver waiting list?

  1. The Community Services Board (CSB) staff will assess your situation with you to establish your Priority Level of 1, 2, or 3 on the waiting list. Contact your case manager/support coordinator when your support needs change or you move. Your priority level may change as your needs change.

  2. IF you are in Priority Level One, your needs will be assessed by the CSB/case manager to generate a priority needs score on the Critical Needs SummaryThe Critical Needs Summary is reviewed and updated annually and whenever your needs change which may result in a different priority needs score. It is important that you contact your case manager when your needs change.

  3. When waiver slots are available for assignment, individuals with the highest priority needs scores in each local CSB, are considered for a waiver. If you are in the pool of people with the highest scores, then your case manager will prepare a written summary of your needs and situation on the Slot Assignment Review Form. Discuss the information requested on the Slot Assignment Review Form with your case manager. Note: priority needs scores are relative to the individuals in priority one at your local CSB.

  4. When waiver slots are available for assignment, your anonymous Slot Assignment Review Form is distributed to your local Community Services Board’s Waiver Slot Assignment Committee. The Waiver Slot Assignment Committee scores each individual on the Waiver Slot Assignment Scoring Summary to determine who is assigned a waiver slot.

Emergency Waivers are assigned by the VA Dept. of Behavioral Health & Developmental Services (DBHDS) to individuals who meet the Emergency Waiver Criteria.  There are a limited number of emergency waivers.

P.S. When you are on the waiting list you are eligible for the Individual and Family Support Program. Add your information to the list serve to receive important information.  

Advocacy Tips for Individuals/Families Requesting Services and on the Waiting List

  • Review the VIDES, Priority Level Determination, Critical Needs Summary and Slot Assignment Review forms so that you are prepared to report the information required to the Community Services Board screener and case manager.

  • Review the completed documents for accuracy and request copies for your records.

  • Communicate changes in your situation in a timely manner to your case manager so that your support needs are accurately documented on the VIDES, Priority Level Determination, Critical Needs Summary and the Slot Assignment Review forms. 

Resources While You Wait

Explore the Commonwealth Coordinated Care Plus (CCC Plus).  Individuals may be on the DD Waiver Wait List and receive waiver services from another waiver program while they wait for the DD Waiver.

Regulations: Click to view the Developmental Disability Waiver Emergency Regulations starting on p. 97.

Reimbursement Rates for DD Waiver Services

Commonwealth Coordinated Care Plus (CCC Plus)

CCC Plus Waiver Program serves individuals with a disability and a daily medical need(s); and it serves Children and adults over age 65 with significant medical needs. Services include: Adult Day Care, Personal Assistance Services, Private Duty Nursing, Respite Care, Services Facilitation, Assistive Technology (AT), Environmental Modifications (EM), Personal Emergency Response System, and Transition Services. If enrolled in Money Follows the Person.

Click to view the CCC Plus Waiver Services.

Eligibility Requirements and How To Apply

To be eligible for the CCC Plus Waiver:

  • You must have a medical or nursing need(s).

  • If under age 65, you must also have a disability. (Note: mental illness solely does not qualify as a disability for this waiver).

  • You must meet the criteria for the Uniform Assessment Instrument.

  • To utilize the waiver, individuals must  apply for and qualify for Medicaid if not already enrolled in Medicaid.  You do not have to be enrolled in Medicaid when you apply for a waiver.

To apply for the CCC Plus waiver, contact your local Departments of Health OR Social Services. Requests for the waiver may also occur if the individual is hospitalized.  There is no waiting list for this waiver.

Advocacy Tips for individuals/families requesting the waiver

  • Review the Uniform Assessment Instrument (UAI) in advance of the screening. To view additional information about the screening click here: UAI Screening Guidance. Request a copy of your completed UAI for your records.

  • If you are not found eligible for the CCC Plus Waiver, explore the Developmental Disabilities Waiver Program.

Appeal Rights:  You have the right to challenge decisions and actions by Medicaid/VA Dept. of Medical Assistance Services.  An Appeal must be requested within 30 days of the decision or action that you disagree with. Click to view Medicaid Appeal information.

Regulations:

Click to view the CCC Plus Waiver Regulations

Other Important Resources 

  • Early, Periodic, Screening, Diagnosis and Treatment – additional coverage for individuals who have Medicaid ages 0-21.

  • HIPP– Health Insurance Premium Payment Program (HIPP) is financial assistance for individuals who have private insurance coverage and Medicaid coverage

  • Consumer Directed  – Consumer directed services allows the individual or family caregiver to direct and controls whom, how, and when services are provided.

  • Assistive Technology Loan Fund Authority – offers alternative funding resources for Virginians with disabilities to acquire assistive technology.

  • My Life My Community -- DBHDS is committed to being good listeners, good partners and good stewards of the public resources entrusted to the agency. As we meet the challenges that lie ahead, we are dedicated to a system re-design that truly provides opportunity for citizens to receive the supports they need to live full lives in the community.