Montgomery County, MD

Maryland Medicaid Waivers

Autism Waiver - Maryland State Department of Education
410-767-1446 (Maryland State Department of Education)  •  1-866-417-3480 (Waiver Registry)
Maryland’s Home and Community Based Services Waiver for Children with Autism Spectrum Disorder (Autism Waiver) allows eligible children with Autism Spectrum Disorder to receive specific waiver services and certain Medicaid services to support them in their homes and communities. Provides services to children with Autism, ages 1 through 21, who need an Intermediate Care Facility for the Intellectually Disabled (ICF-ID) level of care. Services include respite care, environmental accessibility adaptations, family consultation, residential habilitation, intensive individual support services, therapeutic integration, and adult life planning. Note: Each Autism Waiver participant also receives service coordination through their local school system. Eligibility Guidelines: Individual must be certified as needing services from an ICF-IID. Must have an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) with at least 15 hours of special education and related services. Must be able to be served in the home and community with Autism Waiver services. Must meet additional Autism Waiver medical and technical eligibility criteria. Must meet financial guidelines. The program is at capacity and is not accepting applications at this time. Contact the Autism Waiver Registry to have your child’s name added. Administered by MSDE.

Community First Choice - Maryland Department of Health
1-844-627-5465 (Toll Free)
Provides community services and supports to enable older adults and people with disabilities to live in their own homes. For Maryland residents who need support with activities of daily living, such as bathing, grooming, dressing, and getting around. Available community first choice services include personal assistance services, supports planning, nurse monitoring, personal emergency response systems, technology, assistive technology, environmental assessments, accessibility adaptations, consumer training, transition services, and home delivered meals. Eligibility guidelines: Individuals must reside in the community; Individuals must meet the level of care required for services in an institution. Individuals must qualify for Medicaid in the community.

Community Pathways Waiver - Maryland Developmental Disabilities Administration
410-767-5600 (Voice) • 1-844-463-3464 (Toll Free)
Community Pathways provides services and supports in the community for individuals with developmental disabilities. Waiver participants receive services and supports from provider agencies funded by DDA. Services that may be provided include: assistive technology and adaptive equipment; behavioral support services; community learning services; day habilitation; employment discovery and customization; environmental accessibility adaptations; family and individual support services; fiscal management services (for people self-directing services); live-in caregiver rent; medical day care services; personal supports / community supported living arrangements; respite care; shared living; support brokerage (for people self-directing services). Eligibility Guidelines: No age limitation. Individuals must need the level of care required to qualify for services in an intermediate care facility for individuals with developmental disabilities or persons with related conditions (ICF/ID). Please note: The New Directions Waiver has been merged with Community Pathways.

Community Personal Assistance Services Program - Maryland Department of Health
1-844-627-5465 (Toll Free)
Provides community services and supports to enable older adults and people with disabilities to live in their own homes. Community services include personal assistance services; supports planning; and nurse monitoring. Participants may also be eligible to receive other Medicaid services: physician and hospital care; pharmacy; home health; laboratory services; mental health services; disposable medical supplies; and durable medical equipment. Eligibility Guidelines: Individuals must live in the community, need help with activities of daily living in their homes, and meet the program’s medical level of care. An individual’s income and assets are reviewed to determine financial eligibility for community Medicaid.

Home and Community-Based Options Waiver - Maryland Department of Health
1-844-627-5465 (Toll Free)
Provides services for older adults and individuals with physical disabilities in order for them to live in their own homes instead of a nursing facility. Services that may be provided include: assisted living services (not including room and board); behavior consultation services; case management; dietitian and nutritionist services; medical day care; Senior Center Plus; and all other standard Medicaid Services, including Community First Choice, if living at home. Eligibility Guidelines: Must be age 18 and older. Eligibility for Medicaid depends on an individual’s income and assets. Individuals are encouraged to apply so that financial eligibility can be determined. Individuals must need the level of care required to qualify for nursing facility services.

Medical Day Care Services Waiver - Maryland Department of Health
410-767-1100 (Maryland Access Point) • 1-844-627-5465 (Toll Free)
410-767-1144 (Maryland Department of Health) • 1-800-535-0182 (Toll Free)
The Program provides individuals the opportunity to receive medical care during the day in a community-based setting offering individuals an alternative to nursing facility care. Medical Day Care Services that may be provided include skilled nursing and nursing assessments; medication monitoring; meals; social work services; activity programs; daily living skills training; transportation; therapy; personal care; and nutrition services. Services are provided by licensed medical day care providers. Eligibility Guidelines: Individuals must be at least 16 years old. Individuals must not be enrolled in another home and community-based waiver. Individuals must qualify for Medicaid in the community. Individuals must need the level of care required to qualify for nursing facility services.

Model Waiver for Medically Fragile Children - Coordinator Center for Home and Community Care
410-987-1048 (Baltimore) • 301-621-7830 (Washington) • 1-877-463-3464 (Maryland Department of Health)
Allows medically fragile individuals who would otherwise be hospitalized and are certified as needing either hospital or nursing facility level of care to receive medically necessary and appropriate services in the community. As a result, the Model Waiver clients can continue to live at home with their families. The maximum number of individuals who may be enrolled in the Model Waiver is 200. Eligibility Guidelines: Admission must be completed before the individual becomes 22 years old. The individual must meet the definition of a disabled child at the time application for Model Waiver services is made. The term “disabled child” means a chronically ill or severely impaired child, younger than 22 years old, whose illness or disability may not require 24-hour inpatient care, but which, in the absence of home care services, may precipitate admission to or prolong stay in a hospital, nursing facility, or other long-term facility. The individual must be certified as in need of a hospital or nursing facility level of care. This level of care is determined by a state contracted reviewer using information supplied by the referring physician. The individual’s medically necessary and appropriate community based medical services must be cost neutral and must not exceed the cost of institutional care. Parents’ income and assets are waived during the financial eligibility process.

Rare and Expensive Case Management (REM) - Maryland Department of Health
410-767-1903 (Voice) • 1-800-565-8190 (Toll Free)
Program is a case managed fee for service alternative to HealthChoice Managed Care Organization (MCO) participation for recipients with specified rare and expensive conditions. REM case managers, either a registered nurse or a licensed social worker, assist the recipient with reaching his/her highest level of functioning capability. This is done through service coordination, home visits and a variety of other case management services including: assessment of recipient needs; patient education; family support services; development of treatment plan; coordination of provider services; and follow-up of recipient’s progress. Eligibility Guidelines: A person must be eligible for HealthChoice in order to receive REM services. Also, the REM program is limited to individuals with certain qualifying conditions or diseases. The Managed Care Organization, the recipient’s doctor or any other concerned person, can refer a recipient to the REM Program. Before a recipient can be referred to the REM Program, the MCO must first identify the recipient as a potential REM candidate. A recipient can also refer himself or herself. The referral can take place at the time of diagnosis or anytime afterwards.

Traumatic Brain Injury Waiver Services for Adults - Maryland Department of Health, Behavioral Health Administration
410-402-8476 (Voice) • 1-877-463-3464 (Toll Free)
Home and Community-Based Services Waiver for Individuals with Brain Injury provides residential habilitation, day habilitation, and supported employment services to adults with brain injuries. Brain injury services include residential habilitation; day habilitation; supported employment; individual support services; case management; and medical day care. Waiver participants are also eligible to receive all Medicaid state plan services which may include: physician and hospital care; pharmacy; home health; laboratory services; mental health services; disposable medical supplies and durable medical equipment; and payment of Medicare premiums, co-payments and deductibles. Eligibility Guidelines: For individuals with brain injury who require a specialty hospital or nursing facility level of care. Individuals must have experienced the brain injury after the age of 17. Individuals must be inpatient in a State Behavioral Health Administration facility, inpatient in a state owned and operated nursing facility, a Maryland licensed Special Hospital for Chronic Disease that is CARF accredited for Brain Injury Inpatient Rehabilitation, or individuals who have been placed by Medicaid in an out-of-state facility. Must meet financial eligibility requirements.