Medicaid Waiver

About the Medicaid Waiver Division

What is the Elderly and Disabled Waiver?

The Elderly and Disabled (E&D) Waiver is a statewide program designed to offer assistance to qualified Medicaid beneficiaries.

The program allows qualified individuals to remain in a home or community-based setting as an alternative to nursing facility care or other institutional care.

Who is qualified?

• Beneficiaries must be 21 years of age or older
• Persons qualify by either SSI or 300% of SSI
• Beneficiaries must score 50 or above on the Medicaid Long Term Service and Support Assessment instrument
• Persons must require nursing facility level care, if assistance is not provided

All persons who are eligible to receive Home and Community-based Services under this waiver must first be approved through the Division of Medicaid.

What services are offered under this waiver?

• Case Management: Everyone who participates in the waiver is assigned to a local case management team. This team consists of a Registered Nurse and licensed Social Worker. They are responsible for managing and coordinating the services for each participant.
• Personal Care Services (PCS): These are supportive services provided in the home of the participant. They include assistance with light housekeeping, laundry, meal preparation, grooming, medication reminder, and accompanying the beneficiary to the doctor.
• Adult Day Services: This is a structured program that focuses on the strengths and abilities of the participant. This service allows participants to contact connections with their community and/or use all of their retained skills. Depending on the specific facility, the following services are provided: supervision and/or assistance with ADLs group activities, nutritious meals, and medication monitoring.
• Home Delivered Meals: A well-balanced meal is delivered to the home of the person who is unable to leave his/her home without assistance and/or is unable to prepare his/her own meals.
• Non-Emergency Transportation (NET): This is offered for the frail beneficiary and may be used to facilitate trips to the doctor and dialysis, when the participant has no other means of transportation.
• Institutional Respite and/or In-Home Respite: This is provided to participants on a short-term basis because of the absence of or need for relief for the primary care giver. This can be provided in the home or other licenses respite care centers.
• Environmental Safety Services
  • These are services provided for the purpose of supporting members in maintaining a healthy and safe environment through the performance of tasks in and around the individual’s home that are beyond the individual’s capability.
  • This service includes minor home maintenance and repair, heavy household cleaning, non-routine disposal of garbage posing as a threat to the individual’s health and welfare, pest control and related tasks to prevent, suppress, eradicate or remove pests posing a threat to the individual’s health and welfare.
  • This is a one-time service only per program year at a maximum of $500.
  • Individual must be the owner of the property.
• Medication Management
  • Medication Management services are services in which enrolled individuals with one or more chronic health conditions who are prescribed a daily regimen of at least five (5) prescription medications can receive consultations and follow up visits with a licensed pharmacist.
  • As a core component of the service, the pharmacy provider will review all prescription and over-the-counter medications taken by the individual on at least a monthly basis in order to support the individual’s adherence with the therapeutic regimen and minimize potentially preventable decline in condition or hospitalizations/institutionalization resulting from medication errors.
  • Reviews may occur more frequently, on an as-needed basis, upon significant change in the individual’s condition or immediately following discharge from an acute hospital stay.
  • The service will include two components: a comprehensive initial/annual consultation and subsequent follow-up consultations.
  • Currently, there are 3 participating pharmacies in Oxford and one in Saltillo in the Three Rivers service area.
• Expanded Home Health Visit: are provided when home health benefits under the State Plan have been exhausted. These services include skilled nursing, nurse aide, physical therapy, and speech therapy.