Medicaid waiver

A Medicaid waiver is a state program that pays for extra supports at home and in the community. Usually this means a 1915(c) home and community-based services (HCBS) waiver. It serves people who would otherwise need the level of care given in an institution. Each state runs its own waivers, with their own names, rules and services. States use other kinds of waivers too.

States can target a waiver by age or diagnosis, and some have waivers just for autism. A waiver can let a child qualify even when a parent's income is too high for regular Medicaid. States also cap how many people a waiver serves, so many have waiting lists. Waiver services can include case management, personal care and respite care. They follow a written plan built around the person.

If your child already has Medicaid, you don't need a waiver to ask for applied behavior analysis (ABA). For children under 21, the main route is the regular state plan. There, Medicaid's EPSDT benefit (Early and Periodic Screening, Diagnostic, and Treatment) covers services that are medically necessary.

Some waivers, like one in California, include ABA-based services. Still, a waiver doesn't replace EPSDT. A waiver can still add other supports. Because of waiting lists, it helps to apply early and learn your state's options, like the Texas waiver programs.

• Ask your state Medicaid agency: Ask which waivers your state offers for children with autism and how to join each waiting list.
• Ask about eligibility: Ask how the waiver decides level of care and whether a parent's income counts.
• Ask your behavior analyst: Ask your Board Certified Behavior Analyst (BCBA) whether ABA in your state goes through the state plan or a waiver.