The Virginia Medicaid Waiver System

If you have a loved one that has been diagnosed with a developmental disability, there is a likelihood that you are wondering about what sort of services may be available to your family.  Where do you begin?  How do you choose a provider for those services?  And who pays for it?

Or perhaps you have a family member who is already receiving services within the community, such as day support or services at a group home, but you’re wondering if there are other options out there.  How do you go about choosing another provider?

Unless you have the financial resources to pay for services out of pocket, or the ability to keep your child or family member living with you at home, the answers to those questions start with Virginia Medicaid waivers.

What is a Medicaid waiver?

Medicaid waivers were developed to encourage people with disabilities to access services in their own homes and communities, as opposed to receiving services in an institution, nursing facility, or intermediate-care facility.

Waivers allow states to “waive” certain requirements, specifically the requirement that individuals live in institutions in order to receive funding.

What’s the difference between Medicaid and Medicare?

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. Medicare is a federal program that provides health care coverage primarily for seniors.

What does a Medicaid waiver pay for?

Virginia has many kinds of Medicaid waivers, so it depends on the kind of waiver. The people that ECHO supports generally have one of the following three waivers: Community Living, Family Supports, or Building Independence. All of which cover Day Support, Supported Employment Services, and Transportation.

How is financial eligibility for a waiver determined?

The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). The MAGI-based methodology considers taxable income and tax filing relationships of the individual that is applying to determine financial eligibility for Medicaid. Other income and assets, such as parents’ or guardians’ incomes, are disregarded.

How do I apply for a waiver for my child or family member?

Contact the intake specialist at your local Community Services Board (CSB) to request a screening. If your child or family member does not already have a support coordinator at your local CSB, he or she will be assigned one at that time.  Dependent on where the applicant lives, for ECHO services you would either reach out to The Fairfax-Falls Church Community Services Board or  Loudoun County Department of Mental Health, Substance Abuse and Developmental Services.

How long will it take to get the waiver?

Unfortunately, Virginia currently has a waiting list for waivers, with priority given to people who meet the criteria for the Urgent Waiting List. Your CSB support coordinator will be able to tell you more.

Medicaid Services

How do you access services with a Medicaid Waiver?
Your CSB Support Coordinator will provide you with a list of approved providers in your area.  For Day Support and Supported Employment Services you will see ECHO as one of the providers in Loudoun and Fairfax Counties.  We currently accept 3 types of waivers:  Community Living, Family Supports, and Building Independence.  If you are interested in ECHO’s services you’ll want to be sure to have one of these waivers.  If you don’t see ECHO as a potential provider you can ask about us by name, computer glitches do happen from time to time.
Who chooses the provider?
You or your loved one will choose the service provider.  Your CSB Support Coordinator will be able to share information about your options but is not permitted to make suggestions about which provider you should choose.  Be sure to visit the organizations that you are interested in, tours of ECHO are always available. 
How do I change providers?
Your CSB Support Coordinator can assist you with any changes that you wish to make.  You can ask for ECHO by name and request a tour at any time.