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 would be hospitalized, 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).
Population Served and Eligibility
Children and youth with complex medical needs who are at risk of long-term hospitalization/institutionalization without appropriate care at home and who:
- Are under the age of 22 at the time of referral
- Are not eligible for any other Medicaid funded programs
Medical eligibility is based on information completed by the referring physician. 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 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.
The Coordinating Center provides care coordination services for the Model Waiver. In addition, participating individuals are eligible to receive all Medicaid covered services, as well as nursing assistance and prescribed services delineated in the Plan of Care.
Referral and Application Process
The Coordinating Center assists with the intake and eligibility process for the Model Waiver. Currently there is a prioritized waiting list and applications are processed in the order they are received.
For additional information, contact Evelyn Klaiss, Program Director, Model Waiver and Program Manager, REM at 410-987-1048.