Medicaid Waiver
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Missouri's Medicaid Waiver For Persons With Mental Retardation And Developmental Disabilities (Fact Sheet)
What is the MRDD Waiver?
The Missouri Department of Mental Health's Division of Mental Retardation and Developmental Disabilities (DMRDD) administers a Medicaid program called the Home and Community-Based Waiver for individuals with mental retardation or other developmental disabilities (the MRDD Waiver, for short). This type of Medicaid waiver program is the result of a special arrangement between state and federal governments that allows a state to use Medicaid funding for specialized services provided only to a target group of people and not to all people with Medicaid eligibility. The state determines the number of people it will serve, what services it will cover, and how much it will spend on waiver services. Medicaid funding in Missouri consists of matching 40 percent state tax dollars with 60 percent federal dollars.
Missouri's MRDD Waiver program allows the DMRDD regional centers to offer specific services in the home and community to individuals who are Medicaid eligible and who would otherwise, without these services, require placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR). Services received through the MRDD Waiver must be needed to avoid institutionalization, and the cost of these services must not exceed what Medicaid would otherwise have spent for services in the institution. For the MRDD Waiver, the DMRDD pays the state match from its legislative appropriation with assistance from some county mil tax boards. The amount that can be spent under the MRDD Waiver is limited by the availability of state funds from these two sources.
What services are available through the MRDD Waiver?
| Residential Habilitation | Individualized Supported Living | Day Habilitation |
| Personal Assistance | Physical Therapy | Speech Therapy |
| Behavior Therapy | Occupational Therapy | Respite Care |
| Transportation | Communication Skills Instruction | Crisis Intervention |
| Community Specialist | Environmental Accessibility Adaptations | Counseling |
| Supported Employment | Specialized Medical Equipment & Supplies |
Who qualifies for the MRDD Waiver?
Anyone who participates in the MRDD Waiver must meet the following criteria:
- Be eligible for Medicaid as determined by the Missouri Department of Social Services Division of Family Services under an eligibility category that provides for Federal Financial Participation (FFP) and is not an "expanded" eligibility category under the 1115 Waiver; and
- Be determined by the DMRDD regional center initially and annually thereafter to require an ICF/MR level of care if waiver services are not provided. The ICF/MR level of care requires that an individual have mental retardation or a related condition as defined in federal rule (42 CFR 435.1009), plus a need for the level of care provided in an ICF/MR. In addition, it requires a determination that if you do not receive services under the waiver, you will actually need to live in such an institution. The service coordinator uses a two-page form to evaluate the level of care.
Only service coordinators affiliated with the regional centers or with certain SB 40 Boards (County Boards) approved by the DMRDD may perform evaluations of level of care. The regional center administration reviews the evaluations and makes the determination of eligibility for the MRDD Waiver.
A determination of ineligibility for the MRDD Waiver will not necessarily disqualify individuals from other regional center services for which they qualify and for which funding is available.
Are there participation limitations?
The number of individuals who may be served in each year of the MRDD Waiver is pre-approved by the Health Care Financing Administration (HCFA), based on the state's request. Once the MRDD Waiver is serving the approved number of eligible individuals, no additional individuals may be enrolled. The number of participants requested by the state is limited by funding available for the state portion of the match.
For persons determined eligible to participate in the MRDD Waiver, but denied participation because the maximum number of individuals are being served, the DMRDD Regional Center will offer to add their names to its list of persons waiting for regional center services. Furthermore, even those enrolled in the MRDD Waiver may not immediately receive all the services requested. Again, the regional center will offer to add eligible names to its list. People are selected for services from this list in the order they applied, given the available resources, except that those in most critical need receive priority consideration.
How are services accessed through the MRDD Waiver?
Requests to access MRDD Waiver services may be made through an intake worker or service coordinator at the regional center. Persons will need to be determined eligible by the regional center through an assessment process. In addition, a service coordinator will evaluate the need for an ICF/MR level of care using the results of the assessment, in addition to observation, interviews, and other available information. The service coordinator will also confer with the individual and other members of a planning team to write a plan showing the services needed as an alternative to institutional care. The regional center will review the evaluation of level of care and the service plan, and, subject to the availability of waiver "slots" and funding, will determine eligibility for the MRDD Waiver.
What are the rights of those requesting waiver participation?
- To have eligibility for MRDD Waiver participation determined within 60 days of the first planning meeting;
- To receive services as provided to persons in like need and similar presenting circumstances, in accordance with the waiver and dependent on availability of services and funding;
- To be informed of options and participate in selecting and planning for services and providers; and
- To request a fair hearing if dissatisfied with the decision(s) made on participation or service plan, or if denied the choice of provider. *
What are the responsibilities and duties of those requesting waiver participation?
- To report fully all circumstances affecting the application;
- To report any changes in circumstances which affect Medicaid eligibility;
- To cooperate in efforts to establish eligibility; and
- To cooperate with the service coordinator to ensure all state and/or federal participation requirements are met, i.e., maintaining a current, approved person-centered plan.
* Individuals denied participation in the program have appeal rights with both the Department of Mental Health and the Department of Social Services, Division of Medical Services. While not required to do so, individuals are encouraged to begin with the Department of Mental Health's appeal process. However, an appeal can be made to the Division of Medical Services before, during, or after exhausting the Department of Mental Health process. The service coordinator will assist persons who decide an appeal is necessary.
