Medicaid Waivers to Help Children with Health Insurance Eligibility
Part 4, Chapter 13: Specialized Situations: Programs for Children and Adults with Disabilities and Special Health Care Needs Page 2
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Medicaid Waivers
The Medicaid program may also differ from state to state as a result of the Medicaid waiver system. Federal law currently allows individual states to request specific Medicaid waivers. Each waiver exempts the particular state from a set of federal Medicaid regulations and/or specific restrictions. Some waivers relate to the way in which services are delivered and deal with issues such as coverage through Medicaid HMOs and other types of managed care programs. Other Medicaid waivers are part of the home and community-based waiver system, and relate to eligibility for particular services.
A number of waivers have already been established and may be applied for by any state Medicaid office. Proposals for new waivers can be developed by an individual state at any time. Two established Medicaid waivers -- the Katie Beckett waiver and the Traumatic Brain Injury waiver -- serve as illustrations of waivers that relate to eligibility for services.
The Katie Beckett waiver was developed in the early 1980s. The rule at that time was that Medicaid generally included the parents' income in determining a disabled child's eligibility for benefits if the child lived at home. However, Medicaid did not include the parents' income if the child was hospitalized or institutionalized for an extended period.
As a result, children like Katie Beckett -- who was on a ventilator in a hospital -- were sometimes eligible for continued Medicaid coverage only if they remained in the hospital, even though home care would have been more appropriate and far less expensive. In many cases, the lack of Medicaid coverage for home-based care in such situations made it economically impossible for families to provide the medical equipment and the medical services necessary to care for a child at home.
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