Home- and Community-Based Services Options
Medicaid law permits states to request from the HCFA a waiver of standard
Medicaid rules in order to furnish a broad array of home- and community-based
services for individuals who would otherwise be in a Medicaid-covered institution.
Because of the federal rule that does not allow payment for services in an
Institution for Mental Diseases (IMD), this option is extremely difficult to
use for adults age 22-64 who are in hospitals or specialized nursing facilities
that are considered IMDs.
However, the home- and community-based services waiver is available to states
for the following populations: children through age 21 (see the child services
section below), adults over age 64 in states that have elected the optional
IMD service under Section 1905(a)(14), or adults of any age who reside in nursing
facilities covered under Section 1905(a)(4)(A).
For adults, only Colorado has a home- and community -based waiver focusing
specifically on individuals with serious mental illness. Colorado's waiver
serves adults who would otherwise be in nursing home care (but not in an IMD),
most of whom are over are 60. Other states may include this population within
the scope of a broader waiver, but anecdotal information suggests this is extremely
rare.
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