Home and Community Based Waivers

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Medicaid Services at a Glance

Comprehensive Waiver:

The waiver is used as the primary source of funding for people who live in the community. The division uses general revenue funds to match federal Medicaid dollars to pay for services under the waiver. The waiver includes people who live in group homes, supported living, and with their families. Approximately 7,500 individuals are served by the waiver at an average cost of $77 per day.

Community Support Waiver:

Effective July 1, 2003, the Division of Mental Retardation and Developmental Disabilities received approval from CMS for its third Medicaid Home and Community Based Waiver. The waiver is called the community support waiver. All consumers considered for participation must:

• Be eligible for Medicaid as determined by the Missouri Department of Social Services, Family Support Division, under an eligibility category that provides for Federal Financial Participation (FFP) and is not an "expanded" eligibility category under the 1115 Waiver.
• Not require residential services.
• Be determined by the DMRDD regional office initially and annually thereafter to require an ICF/MR level of care if waiver services are not provided.
• Not be receiving services from any other waiver.

The Community Support waiver has the same services and uses the same service definitions as the Comprehensive waiver with two exceptions:

1) The waiver will not pay for residential habilitation (group home) or individualized supported living services, and

2) Each service has a maximum dollar limitation with an individual cost cap of $22,000 annually.

Sarah Jian Lopez Waiver:

The Sarah Jian Lopez Medicaid Waiver allows access to funding for appropriate care and support for children with developmental disabilities so they may continue living at home with their families.

Medicaid guidelines require parental income and resources be considered for children who live at home, but allow such income and resources to be disregarded for children who live out of the home, in an institution, a group home, or in other residential settings. The family of Sarah Jian Lopez, who was born with developmental disabilities, lobbied the Missouri General Assembly to change some of the requirements in the Medicaid program. The waiver, which went into effect in 1996, is named after Sarah, who died at the age of five.

The waiver allows parental income and resources to be disregarded for permanently and totally disabled children living at home who otherwise would require services at an institution.

Eligibility is based on the following guidelines: the income and resources of the child must not exceed Medicaid financial guidelines; the child's condition must meet the criteria set by Medicaid for the permanently and totally disabled; the child must be certified to need the level of services provided by an intermediate care facility designed to treat mental retardation; and the cost of providing the needed services in the child's home can be no greater than the cost of the services provided in an intermediate care facility.

The Sarah Jian Lopez Waiver will allow up to 200 children, under age 18, with developmental disabilities to receive specialized care funded by Medicaid while continuing to live at home with their parents.