Medicaid Waivers
Are you or your family member in need of services such as respite, personal care, assistive technology, employment, nursing or behavioral support? 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:
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Developmental Disabilities (DD)
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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:
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Building Independence (BI),
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Family & Individual Support (FIS)
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Community Living (CL).
The Developmental Disability (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
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You must meet Virginia’s Definition of Developmental Disability.
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You must meet the functional criteria for the VA Individual Developmental Disability Eligibility Survey (VIDES) Click to view the VIDES Infant, VIDES Child, VIDES Adult,
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To utilize the waiver you must apply and qualify for Medicaid if you are not already enrolled in Medicaid.
Remember...
1. You do not have to be enrolled in Medicaid when you apply for a waiver.
2. The parent/family income is never considered for Medicaid Waiver eligibility.
To utilize the waiver you must apply and qualify for Medicaid if you are not already enrolled in Medicaid.
To apply for the Developmental Disabilities Waiver services contact your local Community Services Board
The Community Services Board (CSB) staff will determine if you:
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meet the definition of a developmental disability
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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 support needs. Individuals who meet the eligibility criteria are placed on the needs based waiting list due to the limited number of waivers funded. It is NOT a chronological waiting list.
Advocacy Tips for individuals/families applying for the Waiver and on the Wait List:
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Prepare for the DD Waiver Screening by reviewing the VIDES, and Priority Needs Checklist forms prior to the screening, so that you are prepared to report the information required to the Community Services Board screener/case manager.
This is a good time to contact The Arc of Virginia for assistance with the process.
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When being assessed for the VIDES, describe how you/family member would perform if you/they have NO supports or services available: that means no parents, family or other caregivers around.
How would the individual perform the skills being assessed if they were completely alone in their home/community? Describe challenges. Do not sugar coat.
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The individual does not have to be present for the entire screening if there is someone else who can respond to the questions.
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Be sure to keep copies of the VIDES and Priority Needs Checklist, review for accuracy and report any changes while on the wait list.
What happens when you are placed on the DD waiver waiting list?
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The Community Services Board (CSB) staff will assess your situation with you to establish your Priority Needs Checklist 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.
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IF you are in Priority Level One, your needs will be assessed by the CSB/case manager/support coordinator to generate a priority needs score on the Critical Needs Summary. Discuss the information requested on the Critical Needs Summary with your case manager. The 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 whenever your needs change. Keep a copy of your Critical Needs Summary.
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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/support coordinator 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: the priority needs score (on the Critical Needs Summary) is relative to the individuals in Priority Level one at your local CSB.
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Individuals who are in the pool of those with the highest scores in the CSB, are reviewed by the Waiver Slot Assignment Committee. The Committee reviews the anonymous Slot Assignment Review Form for those in pool. The Waiver Slot Assignment Committee scores each individual on the Waiver Slot Assignment Scoring Summary to determine who will be assigned waivers.
MIND YOUR MAIL - While you are on the DD Waiver Wait List you will be contacted annually to find out if you want to stay on the Wait List. The Virginia Dept. of Behavioral Health and Developmental Services will send you forms ("Documentation of Individual Choice Between Institutional Care of Home and Community-Based Services"; "Annual Attestation Documentation of Individual Choice"; and "Needed Services") that you must complete and return to remain on the DD Waiver Wait List. If you want to stay on the DD Waiver Wait List you must check that you want DD Waiver Services or check that you want to be served by an Intermediate Care Facility and be on the DD Waiver Wait List.
***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 Waiver Wait List.
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Communicate changes in your situation in a timely manner to your case manager/support coordinator so that your support needs are accurately documented on the VIDES, Priority Needs Checklist, Critical Needs Summary and the Slot Assignment Review forms applicable to your status.
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Review the completed documents for accuracy and request copies for your records.
Advocacy Tips for Individuals/Families Requesting Services and on the Waiting List
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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.
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Review the completed documents for accuracy and request copies for your records.
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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 Waitlist and receive waiver services from another waiver program while they wait for the DD Waiver.
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Crisis services for all ages with developmental disabilities and behavioral or mental health challenges, provide prevention and stabilization support. Click to view the REACH (Regional Education Assessment Crisis Habilitation) Program.
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The Individual and Family Support Program (IFSP) provides funding for those on the waitlist for the Developmental Disability Waiver Program. Check frequently for updates on the website for VA Dept. of Behavioral Health and Developmental Services.
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Housing Options and Flexible Funds are available to those 18 years and older who are on the Developmental Disability (DD) waiver waiting list or receiving DD Waiver services. Click to view information on Housing & Flexible Funds.
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:
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You must have a medical or nursing need(s).
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If under age 65, you must also have a disability. (Note: mental illness solely does not qualify as a disability for this waiver).
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You must meet the criteria for the Uniform Assessment Instrument.
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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
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Review the Uniform Assessment Instrument (UAI) in advance of the screening. Request a copy of your completed UAI for your records.
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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
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2023 Medicaid Renewal Process - Virginia Medicaid has returned to its regular renewal activities. They have started reviewing members’ health coverage to make sure you still qualify. Medicaid has started sending a notice in the mail to members who need to take action to renew their coverage. The entire process will take 12 months, so it may take several months before you hear from them. If action is required to keep your coverage, you will receive a notice about 2 months before your renewal is due. You can view our calendar to find out when to expect your notice.
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Early, Periodic, Screening, Diagnosis and Treatment (EPS – additional coverage for individuals who have Medicaid ages 0-21.
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HIPP– Health Insurance Premium Payment Program (HIPP) is financial assistance for individuals who have private insurance coverage and Medicaid coverage
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Consumer Directed – Consumer directed services allows the individual or family caregiver to direct and control whom, how, and when services are provided.
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Assistive Technology Loan Fund Authority – offers alternative funding resources for Virginians with disabilities to acquire assistive technology.
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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 support they need to live full lives in the community.