Waivers for Children
Overview of Waivers
Medicaid provides a wide variety of programs to children with disabilities, or who are low income. Waiver programs provide additional benefits to specific populations who meet special eligibility criteria. For some people, a waiver is the only way to qualify for Medicaid.
You must meet financial, medical, and program-targeting criteria to access services under a waiver.
Your income must be less than $2,094.00 or (300% of the Supplemental Security Income allowance) per month and your countable resources must be less than $2,000 for a single person or $3,000 for a couple.
Qualifying for Waiver Programs
The applicant must be at risk of placement in a nursing facility, hospital, or ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities).To utilize Waiver benefits, clients must be willing to receive services in their homes or communities. A client who receives services through a Waiver is also eligible for all basic Medicaid covered services except nursing facility and long-term hospital care.
When a client chooses to receive services under a Waiver, the services must be provided by certified Medicaid providers or by a Medicaid contracting managed care organization.
The cost of waiver services cannot be more than the cost of placement in a nursing facility, hospital, or ICF/IID. Each waiver has an enrollment limit and there may be a waiting list for any particular waiver. Applicants may apply for more than one waiver, but may only receive services through one waiver at a time.
Anyone who is denied Medicaid eligibility for any reason has a right to appeal. Talk to your County Department of Social/Human Services if you wish to exercise your right to appeal.
Types of Waivers
There are several different kinds of waivers for children and each has different qualifications and specifications.
Waivers are also available to people who are over-income, or who need additional services other than standard Medicaid benefits. Metaphorically speaking, if you think about Medicaid benefits as a house, waiver benefits are like a garage. You can have a house without a garage, but not a garage without the house. You can add on waiver benefits (the garage) to regular Medicaid benefits (the house), but you cannot have waiver benefits without regular Medicaid benefits.
In summary, each of the Colorado Medicaid Waivers for Children has differing eligibility requirements, and the requirements can change over time. For assistance with understanding any of the waivers please visit the Health Care Policy and Financing website or contact your local Community Centered Board or Single Entry Point Agency.