Model Waiver is a Maryland Medicaid program, which allows medically fragile individuals, before the age of 22 years to live at home. Without this benefit, these individuals could be hospitalized long-term, as their medical needs require hospital or nursing facility level of care. Under the Waiver, the parents’ income and assets are waived during the financial eligibility process even though the child continues to live in the community with their parent(s).
Once enrolled, participants are assigned a Clinical Care Coordinator to assist with creating a plan of care to access the medical care and resources they need to meet their health goals. This plan of care is developed in collaboration with the participant and their support team, which may include their family and/or caregiver(s), as well as their medical team. Participants benefit from ongoing support from their Clinical Care Coordinator, including monthly contacts and scheduled face-to-face visits in their home and/or community.
Population Served and Medical Eligibility
Children and youth with complex medical needs who are at risk of long-term hospitalization/ institutionalization without appropriate care at home. Eligible participants must be:
- under the age of 22 at the time of referral; and,
- have needs that cannot be met by any other Medicaid program.
Medical eligibility is based on information completed by the referring physician.
Financial Eligibility
- Financial eligibility is determined through the Medicaid application process.
- The application is based on the child’s income and assets.
- Children who have access to private health insurance benefits are eligible for the program.
- Children who are currently Medicaid eligible, but who will imminently lose that eligibility due to financial reasons, may be able to access the program, assuming that other eligibility criteria is met.
- To maintain eligibility in the waiver the participant’s community-based medical services must be cost neutral. That is, the cost of the community-based services must not exceed the cost of institutional care.
Covered Services
All Model Waiver Participants have access to case management services provided by a licensed nurse, a Clinical Care Coordinator dedicated to their health and wellbeing. In addition, participating individuals are eligible to receive all Medicaid covered services that are not already covered by private insurance, including private duty nursing and prescribed services included in the Plan of Care. Medically necessary services must be ordered by a participant’s healthcare provider (with an active Maryland Medicaid number) and may require preauthorization. It is the role of the Clinical Care Coordinator to guide participants through accessing covered services.
How can The Center help?
Our expert Clinical Care Coordinators help with:
- Medication management and access issues
- Coordination of private insurance and Medicaid benefits
- Finding providers
- Accessing transportation
- Linking to community resources
- Facilitating equipment and supplies
- Coordination across programs
- Other needs to support participants with their goals
Referral and Application Process
The Coordinating Center assists with the intake and eligibility process for the Model Waiver. Maryland Department of Health approves waitlist placement, eligibility, and enrollment. Currently there is a prioritized waiting list and applications are processed in the order they are received.
For additional information, contact us at 410-987-1048 and ask to speak to a member of the Model Waiver Intake Team.
Let Us Know How We Can Help You with the Model Waiver Program
If you have questions about services or programs of The Coordinating Center please contact us at any time. Our staff are ready to assist you.
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