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General Texas Medicaid Waiver Information

General Texas Waiver Information

Medicaid Waiver 101

Medicaid waiver programs are services program provided by the State of Texas to eligible individuals with disabilities.  Determining whether an individual is eligible and which program can provide appropriate services is often confusing.  Each waiver serves a different population.  Not all waivers are available in all counties in Texas.  Each waiver provides a different set of services.  Each waiver has different individual spending limits or “caps.”  Also the current waiver programs were not necessarily designed to meet the needs of individuals with autism.  This is slowly changing as some of the waivers, (TxHL, HCS, and CLASS for now) do approve Board Certified Behavior Analysts as service providers.

You must sign up on each waiver’s waiting list separately.  To find out how to sign up for the “interest lists,” visit  http://www.dads.state.tx.us/services/interestlist/index.html  and follow the links to find the mental retardation authority agency that serves your local area.

Once an individual or child with a disability is determined to meet the eligibility requirements to receive services from the waiver program, benefits extend beyond therapy and include Medicaid health insurance.  A family could be reimbursed for their private health insurance if they have it.  The family can be reimbursed for mileage resulting from medical treatment or therapy.  Please make sure that your case worker informs you completely about all the benefits associated with your child’s waiver program.

Many people confuse Medicaid with the Medicaid waiver programs.  Medicaid is a health insurance program provided by the federal and state government to families with incomes at 180% of the federal poverty level. Exactly what that income is changes year to year, but it is pretty low.  The federal government matches the dollars that the state is willing to put into its own Medicaid program.

Medicaid waiver programs, however, allow each state to serve whatever special population they see a need to serve.  Each waiver program can be designed any way the state wants.  They are called waivers, because the programs “waive” or by-pass the usual Medicaid eligibility criteria.  Usually, BUT NOT ALWAYS, the two requirements that are waived for persons with specific needs due to a disability are 1) family income requirement, and 2) the license requirement for service providers.  All but the Texas Home Living waiver uses the INDIVIDUAL’S income rather than the family’s income.  In most cases, children have no income–unless a generous grandparent or other relative has given them money under the Uniform Gifts to Minors Act. (Note:  It may benefit a child with a disability not to have  assets in his/her name, but have assets held instead in a Special Needs Trust held for the child’s benefit.) By waiving the licensing requirement, the Medicaid waiver program could pay for services such as attendant care, day habilitation, respite, hippotherapy, recreational therapy, massage or other therapies not covered by “traditional” Medicaid.

Medicaid will ONLY reimburse services provided by “LICENSED practitioners of the healing arts.” This is a small but important detail.  This means IF there is a health service offered by someone like a dental assistant (generally not licensed) they won’t pay, but they will for a dentist, who is licensed.

This website gives only brief descriptions of the various waiver programs.  For a more detailed comparison: http://www.dads.state.tx.us/providers/waiver_comparisons/index.html.

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