Medicaid Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder (“The Autism Waiver”)
Maryland’s Autism Medicaid Waiver is administered by the Maryland State Department of Education, under the auspices of The Department of Health and Mental Hygiene (DHMH). DHMH is Maryland’s single state Medicaid agency, providing oversight to all waivers in Maryland, including the Autism Waiver. The Autism Waiver allows eligible children with autism spectrum disorder to receive necessary waiver services to maintain them in their home and community.
The Autism Waiver is approved to serve 900 children and is currently at capacity. As of April 2009, there were 2,800 individuals on the Autism Waiver Registry. Interested individuals may request that a child be put on the Autism Waiver Registry, maintained by Spherix, by calling 1-866-417-3480. Upon registering the child, Spherix will send the parent/caregiver a letter of confirmation indicating the date that the child was placed on the Autism Waiver registry. Children who apply to the waiver are referred from the registry to MSDE in chronological order when there are waiver vacancies. It is for that reason that it is of the utmost importance for parents/caregivers to keep the confirmation letter from Spherix as documentation of the date their child was placed on the registry. Upon referral from the registry, each child must then meet all of the eligibility requirements (stated below) in order to receive Autism Waiver services.
To access waiver services, a child must meet all of the following criteria:
- The child has a diagnosis of Autism Spectrum Disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) as 299.00 Autistic Disorder or 299.80 Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism).
- The child is between the ages of 1-year-old through the end of the school year that the child turns 21 years old.
- The child has an Individualized Education Program and is receiving more than 12 hours per week of special education and related services and requires a more intensive therapeutic program than other students, or the child has an Individualized Family Service Plan.
- The child is able to be served in the community with the assistance of waiver services.
- The child”s parent or legal representative chooses autism waiver services as opposed to ICF- MR services.
- The child has less than $2,000 in assets (savings, trust, stock, etc.).
- The child”s monthly income is less than 300% of Supplemental Security Income.
- The child must meet the minimum requirements in two of three domains on the “Determination of Eligibility for Level of Care in an Intermediate Care Facility for the Mentally Retarded and Persons with Related Conditions (ICF-MR)” form which is completed by a licensed psychologist or certified school psychologist.
- Services Covered by the Autism Waiver
- Therapeutic integration services
- Residential habilitation
- Respite care, provided on a short-term basis in the individual”s home or place of residence
- Supported employment
- Environmental accessibility adaptations, including physical adaptations to the home
- Family training
- Service coordination
Autism Waiver Service Providers
Waiver service providers must be Medicaid approved and appropriately licensed or certified.
- Families of waiver participants will be eligible for waiver services that are not currently provided through local school systems, early intervention programs, or the regular state plan Medicaid.
- Health coverage for the eligible child will be provided through Medical Assistance at no cost to the family.
- Local school systems, specialized programs, and early intervention programs that become Medicaid providers will be able to seek reimbursement for some of the specialized services for which they are currently unable to bill.
- Additional children will be Medicaid eligible and receive Medicaid-covered IFSP/IEP services.
The Maryland State Department of Education, the local early intervention programs, and the local school systems are responsible for administering the waiver.
- Autism Waiver Fact Sheet
- Autism Waiver Application
- Maryland’s Autism Waiver:
A Practical Guide for Families (From the Maryland Disabilities Law Center)
- Statewide List of Waiver Providers
(The Department of Health and Mental Hygiene approves “providers” who meet the department’s criteria.)
- Autism Waiver Registry: 1-866-417-3480
- For more information on the Autism Waiver, please call the Maryland State Department of Education at 410-767-1446 or the Department of Health and Mental Hygiene at 410-767-5220.