How To Be Approved For A Medicaid Waiver

They Said a Medicaid Waiver Will Help Us. How Do I Get One?

Understanding What a Medicaid Waiver Is and How It Supports Autism Families

If you're the parent of a child with autism, you've probably heard the phrase:“Get on a Medicaid waiver—it will help.”

But what is a Medicaid waiver, what does it actually do, and how do you qualify? This post breaks it all down so you can take the next step with clarity and confidence.

🧾 What Is a Medicaid Waiver?

A Medicaid waiver is a special program that allows people with disabilities or long-term health needs to receive services at home or in the community, rather than in a hospital, group home, or nursing facility.

For families raising children with autism, this can be a critical support system—helping you access services that make life at home safer, smoother, and more sustainable.

🔍 Why Is It Called a “Waiver”?

The term “waiver” comes from the fact that the federal government waives certain Medicaid rules, giving states permission to offer more flexible, customized services. Instead of requiring institutional care, a Medicaid waiver makes it possible for eligible individuals to receive home and community-based services (HCBS).

This allows families to keep their loved ones at home—with support—rather than placing them in full-time care facilities.

🧩 What Is a Medicaid Waiver Used For?

Medicaid waivers are specifically designed to:

• Support people with disabilities (including autism, cerebral palsy, Down syndrome, and more)

• Prevent institutionalization by funding in-home and community care

• Help families stay together by easing the daily burden of caregiving

  
  

✅ Services Often Covered by Medicaid Waivers:

Depending on your state and your child’s specific needs, a Medicaid waiver may cover:

• In-home personal care (help with bathing, feeding, dressing)

• Speech therapy, occupational therapy, behavioral therapy, and physical therapy

• Respite care (giving parents and caregivers short-term breaks)

• Case management and care coordination

• Home modifications (e.g., wheelchair ramps, adaptive bathrooms)

• Transportation to medical appointments

• Day programs, job training, or educational supports

• In some states, payment to a family caregiver—like a parent or sibling

  
  

👶 Common Medicaid Waivers for Children with Autism:

Each state names and structures their programs differently, but here are a few of the most common types of waivers used for autistic children:

• Home and Community-Based Services (HCBS) Waiver

• Katie Beckett Waiver (also called TEFRA) – allows children to qualify for Medicaid based on disability, not household income

• 1915(c) Waivers – specifically designed for people with intellectual and developmental disabilities (IDD)

  
  

📍 Important Things to Know About Medicaid Waivers:

• Waivers vary by state – Every state has its own rules, service lists, and eligibility requirements.

• There are often waitlists – Some families wait months or even years to be approved for services.

• Not all Medicaid recipients qualify automatically – You must apply and meet strict criteria related to:

  • Medical need

  • Functional limitations

  • Financial eligibility

  • Proof that your child requires a level of care typically provided in an institutional setting

In Summary.....

In many cases, unless your child will eventually need to be institutionalized, and/or their support at home is limited, your child may not be approved for the Medicaid Waiver. The Medicaid Waiver is very limited and is reserved for extreme cases in which the child could possibly end up in the state system. Unfortunately, parents have been told that this waiver will assist them, but the reality is that it's for those who don't have the assistance they desperately need. For families who are on the waiting list, they shouldn't assume they will be approved.