WAG 06-11-01-c.

To qualify for initial and ongoing waiver services all of the following criteria must be met:

  • the person must be under age 21; and
  • a physician must determine that the person requires a level of care provided by a hospital or long term care facility, but can be provided outside of an institution; and
  • the person must be medically fragile and technology dependent; and
  • the estimated cost of care outside an institution is less than the estimated cost in an institution; and
  • the person would be eligible for Medicaid if their responsible relative's income and assets were not considered.

Waiver services are not approved if:

  • the estimated cost of care exceeds the cost of institutional care, or
  • the person would be institutionalized solely because of a severe mental or developmental disability.

An eligible person continues to qualify for waiver services as long as the estimated cost of care does not exceed the cost in an institution.

HFS considers waiver approval for a person who is:

  • Receiving MANG and is unnecessarily institutionalized because returning home for less costly medical care would result in a loss of MANG coverage. The loss of MANG coverage would have to be due to the person's parent's income and/or assets creating or increasing spenddown, or
  • Living at home and not covered under Medicaid because their spenddown prevents coverage at home, but who would be eligible for coverage if residing in a long term care, or other medical facility, and
  • Recommended by the Division of Specialized Care for Children (DSCC) for waiver services.

If the Family Community Resource Center learns that a person under age 21 could benefit from waiver services, or would be institutionalized if such care is not provided in the home, review their situation to see if it meets the above criteria.