Baltimore 410-987-1048

Washington 301-621-7830

 

Model Waiver Program

The Model Waiver is designed to avoid costly long term hospitalization of children with complex medical needs and disabilities by providing medically necessary supportive services in the home funded by Maryland Medicaid. Children receive Medicaid eligibility and benefits based on their own income and assets without respect to parental income.

Population Served

Children with complex medical needs who are at risk of long term hospitalization/institutionalization without necessary services in the home and who:

  • Are under the age of 22 at the time of referral
  • Are not eligible for any other Medicaid funded programs

Covered Services

Children participating are eligible to receive all Medicaid covered services. Also they receive other defined program services including care coordination, which is provided by The Center, as well as nursing assistance and prescribed services delineated in the Plan of Care.

The Coordinating Center assists with the intake and eligibility process as well as ongoing comprehensive, family centered care coordination.

Eligibility

Medical eligibility is based on information completed by the referring physician. Children must have complex medical needs, including needs that would have the potential for hospitalization without appropriate care at home.

Financial eligibility is determined through the Medicaid application process. The application is based on the child`s income and assets compared to expanded SSI limits. Children who have access to private health insurance benefits may still be 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 criteria are met.

Cost Effectiveness is based on a comparison of projected costs in the hospital or institution and projected costs for home care. The cost at home must be less or meet the cost of hospital or institutional care.