Dissecting the Medicaid Waiver

I know there is a great need for information about the Medicaid Waiver, because it can be confusing and daunting to anyone just starting the process.  While I am aware that Medicaid Waiver systems are basically in place all across the country, (see map ) the state of Florida is different than most others and is unique.  We are aware that parents and caregivers of developmentally disabled individuals are moving into Florida all the time, and the state from where they are coming may have very different funding processes for the person with DD.  Additionally, new residents may not be aware that the funding they received in one state doesn’t automatically transfer.   Ashamedly, Florida ranks  somewhere between 47- 50 out of 50 states in funding for the developmentally disabled, so people moving here with their DD children probably aren’t aware that the process for funding is lengthy and can take years.  Because I personally haven’t gone through the system, I asked for a little help from Kathy Harris, Senior Program Director at ARC Marion.  Here’s the info in lay terms as plain as I can make it.

First of all, in order to qualify for the Medicaid Waiver an individual must be diagnosed at birth with one of the following disabilities: mental retardation with an IQ of less than 70, autism, cerebral palsy, Prader-Willi or Spina Bifida.  If you have a school-aged child with any of these medical diagnoses, you need to know about and apply for the Medicaid Waiver right now!  The waiting list in Florida to receive these services is into the tens of thousands of names, so if you aren’t already on it, GET ON THE LIST! 

To apply, contact the Agency for Persons with Disabilities in your local area and make an appointment.   (The local Ocala contact is Traci Alesiani, the state coordinator for APD in Wildwood, 352-330-2763).  At that appointment, APD reps will meet with you to determine if indeed you qualify for the Waiver. If you do qualify, they will help you complete the process to be put on the state waiting list for funding.

A “crisis” application for Medicaid Waiver includes: homelessness, senior adult parents who can no longer take care of an individual, the death of a caregiver, or any other significant life change.  If in crisis, APD can determine if a candidate’s case can be moved to the front of the line to get help right away.

Over 90% of the funding for ARC Marion’s 350 clients comes from the state Medicaid Waiver.  The other remaining monies come from private payers, United Way of Marion County funding and Scholarships of Hope, a program of the Heart of Florida Hope Foundation, ARC Marion’s fundraising arm.

The Waiver differs from traditional Medicaid in that Medicaid is a federal-state healthcare program for low income children, individuals and families.  Medicaid Waiver is a specific initiative to fund only those developmentally disabled people groups mentioned above.  If you have a child with DD living in Florida , apply now.  If you are considering moving to Florida with an individual with DD, please call APD first to see what you can do to get on the list now.  If you are in another state, please check with your state organizations to see what funding is available.  The Waiver is the states’ way of “taking care” of those who cannot take care of themselves.