Medicaid Home and Community-Based Services Waiver for Children with Autism Spectrum DisorderPurposeThe Autism Waiver through Medical Assistance will allow eligible children with autism spectrum disorder to receive additional waiver services to support them in their home and community.BackgroundHouse Bill 99 was adopted during the 1998 session of the General Assembly. It required the Maryland Department of Health and Mental Hygiene (DHMH) to apply to the Health Care Financing Administration (HCFA) for two Home and Community-Based Services Waivers under Section 1915(c) of the Social Security Act - one would target autistic children and the other would target seriously emotionally disturbed individuals residing in residential treatment centers. Thus, in August 1998, DHMH applied for a 1915(c) Home and Community-Based Service Waiver that, if approved, would allow autistic children in need of an Intermediate Care Facility for the Mentally Retarded (ICF-MR) to receive the necessary waiver services to maintain them in the community.On September 1, 2000 DHMH received confirmation from the HCFA that Maryland’s Home and Community-Based Service Waiver for Children with Autism was approved.Target PopulationChildren who are diagnosed with Autism Spectrum Disorder, defined in the DSM-IV as 299.00 & 299.80;Children who are ages 1 through the end of the semester that the child turns 21 years old with an Individualized Family Service Plan (IFSP) or an Individualized Education Program (IEP) and receives more than 15 hours per week of special education and related services;Children who meet an ICF-MR Level-Of-Care, that is, an institutional level of care, and can be safely maintained in the community through waiver services; andChildren who are enrolled in Rare and Expensive Case Management (REM) or in any other Medicaid Home and Community-Based Services Waiver are excluded.Services to Support the Child in the Community¨ Respite Care¨ Environmental Accessibility Adaptations¨ Family Training¨ Supported Employment¨ Day Habilitation ( regular / intensive,/therapeutic)¨ Residential Habilitation ¨ Targeted Case Management Program through the existing regulations COMAR 10.09.52, Service Coordination for Children with DisabilitiesBenefitsFamilies will be eligible for respite care, environmental modifications to their home, and family training that are not provided through local school systems, early intervention programs, or Medicaid as determined by the Waiver Plan of Care Team.Health insurance for the child at no cost to the family.Day Habilitation Services includes: intensive individual support services provided in the home, at school or in the community, therapeutic integration services, and regular day habilitation.Local school systems, specialized programs, and early intervention programs that become Medicaid providers will be able to seek reimbursement for some of the specialized services for which they are currently unable to bill.Additional children will be Medicaid eligible and receive Medicaid-covered IFSP/IEP services.DisadvantagesSignificant administrative requirements at the local and State level as well as for the family.AdministrationFinancial eligibility will be based upon the child’s income and resources. The Department of Human Resources will determine financial eligibility.The Maryland State Department of Education (MSDE), the local early intervention programs, and the local school systems will be responsible for administering the waiver.Families should contact their early intervention system, or the Special Education Office in their local school system for the name of the contact person to initiate the eligibility determination process.The waiver proposes to serve approximately 250 children the first year, 300 the second year, and 350 the third year on a statewide basis.The appeals process for this waiver is through a request for a Fair Hearing under the Maryland State Medical Assistance Program/ DHMH.Start Date - July 1, 2001NOTE: All Waiver Service providers must be approved Medicaid providers and appropriately licensed or certified. For more information on the Autism Waiver, call the Maryland State Department of Education at 410-767-0264 or the Department of Health and Mental Hygiene at 410-767-5220.
200 West Baltimore Street, Baltimore, MD 21201-2595
410-767-0100 • 1-888-246-0016
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