Friday, January 27, 2012

Medicaid Waivers for Children With Special Needs

Special Needs children can present a whole host of challenges completely aside from their actual physical or mental impairments. They may present a physical danger to themselves that requires constant supervision or they may need living assistance to help them with daily activities such as eating. Often these children have significant difficulties communicating and moving about their environment which then results in significant anxiety disorders. Physical and mental delays can be further exacerbated by the sensory disorders that often accompany the original disorder.

Autism, which is one of the leading disorders among children with disabilities, affects 1 in 110 children, or currently 730,000 children (up to the age of 21). Autistic children and those considered to be in the spectrum, face sensory challenges that prevent them from learning alongside other typical children. An aversion to sound for instance can cause that child to shut down when placed in a noisy school environment and as a result block out any potentially beneficial input. In the case of intellectually challenged children, just wandering out of the house could be disastrous. They often don't know their own strength and can present a danger and challenge to potential caregivers - so the typical avenues of childcare and daycare become out of the question. In these situations, a special care facility, or in-home provider often becomes necessary.

The costs for this type of care and accommodation can be exorbitant if not prohibitive. This is where the Medicaid waivers come into play. While the usual category of Medicaid eligibility for children is a parent who is below a particular federal threshold of poverty, special needs children are assessed on need alone if they personally have no income or assets/resources. The family financial status is not a factor.

There are three main waivers that generally apply to special needs children including the ID, DD, and the EDCD waivers. Each of the waivers exist to provide an alternative to institutional care. The DD Waiver is for the developmentally disabled child and would include children with physical disabilities that limit their functioning. The DD waiver is a first-come first-served waiver that can take many years to be implemented. These waiting lists are a sticking point for many individuals simply because if the child needs services today, then why are they not getting them for many years? The reason is funding.

The ID waiver is also known as the MR waiver, Intellectually Disabled and Mentally Retarded. This waiver requires an IQ test result of below 70. There is another test that can sometimes be used in its placed called the Adaptive Behavior test. The ID waiver too has a waiting list; however this waiver is applied based on need and emergency need will trump those waiting on the list. Again, due to funding the wait can be many years.

Lastly is the EDCD waiver (Elderly or Disabled with Consumer-Directed Services) which was originally designed to provide services and benefits to the elderly who would otherwise have needed institutionalization. However, children (re: children, not family) that meet the financial criteria can apply as disabled if they meet the skilled nursing and physical supervision requirements of the Waiver. The consumer directed services aspect of the waiver allows for the client or clients guardian, to direct the care by hiring the care-givers themselves without agency intervention. There are guidelines, and the provider cannot be a parent, or someone that lives in the home and they must meet state licensing requirements. Most qualifying children in need fall into this Waiver category and it is implemented immediately. Services begin as soon as paperwork is completed unlike the two previous waivers which can have extremely long waiting lists.

The Medicaid waiver system is administered by the states and their individual agencies. This is an important fact to consider as moving from one state to another will negate the clients status and the client would have to reapply and wait on a new list. As the administrators, the states individually determine the types of services that they offer. These services can change from one legislative period to another based on budgets and of course politics. Check with the local DSS, heath department, or consumer directed services bureau in your area to find out more information regarding these Waivers.

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