Maryland Medicaid Home and Community-Based Services Waiver for Children with Autism Spectrum Disorder (Autism Waiver)

Purpose

The Autism Waiver through Medical Assistance allows eligible children with Autism Spectrum Disorder (ASD) to receive Waiver services to support them in their homes and communities.

Background

  • House Bill 99 was proposed by Delegate John Hurson during the 1998 legislative session. The General Assembly approved and required the Maryland Department of Health (MDH) to apply to the Centers for Medicare and Medicaid Services (CMS) for a Home and Community-Based Services Waiver under Section 1915(c) of the Social Security Act, to serve children with autism. 
  • In August 1998, MDH applied for a section 1915(c) Home and Community-Based Service Waiver that would allow children with autism, determined to be eligible for institutional services in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID), to receive Autism Waiver services in their home and community.
  • On September 1, 2000, MDH received confirmation from CMS that Maryland’s Home and Community-Based Service Waiver for Children with ASD was approved.

Target Population

  • Children and youth who have a current diagnosis (within the last three years) of ASD.
  • Children and youth who are ages 1 through the end of the semester that the child turns 21 years old; Children and youth with an Individualized Education Program (IEP) or Individualized Family Services Plan (IFSP) and receive at least 15 hours per week of special education and/or related services.
  • Children and youth who meet an ICF-IID institutional Level-of-Care.
  • Children and youth must be able to be served and safely maintained in the home and community through Autism Waiver services.
  • Children and youth must meet financial eligibility for Medical Assistance; their monthly income may not exceed 300% of SSI benefits, and their countable assets may not exceed a maximum allowable amount depending on eligibility category.

Note: Children and youth who are enrolled in another Medicaid Home and Community-Based Services Waiver must choose which waiver program best meets their needs.

Autism Waiver Services to Support the Child/Youth at Home and in the Community

  • Adult Life Planning
  • Environmental Accessibility Adaptations
  • Family Consultation
  • Intensive Individual Support Services
  • Residential Habilitation (Regular/Intensive) 
  • Respite Care
  • Therapeutic Integration (Regular/Intensive)
Note: Each Autism Waiver participant also receives Service Coordination through their local school system. 

Benefits

  • Waiver participants are eligible for Waiver services that are not provided through local school systems or early intervention programs.
  • Waiver participants are eligible to receive Medicaid services which include health insurance coverage through Medical Assistance for the child/youth, including: physician and hospital care, pharmacy, home health, laboratory services, disposable medical supplies and durable medical equipment, mental health, and other services.
  • Habilitative services include: Intensive Individual Support Services provided in the home or community and Regular/Intensive Therapeutic Integration services.
  • Local school systems and early intervention programs that are Medicaid providers will be able to seek Medicaid reimbursement for some of the health related services.
  • Additional children and youth with ASD will be eligible to receive health care through Medical Assistance.


Administration

  • The Maryland State Department of Education (MSDE), through the local school, will be responsible for administering the waiver.
  • The Waiver is approved to serve 1,200 participants beginning Fiscal Year 2019.
  • All Waiver service providers must be approved Medicaid providers and appropriately licensed or certified.
  • Families should contact the Autism Waiver Registry at 866-417-3480 to be eligible to apply to the Autism Waiver when a vacancy occurs. The Registry is a list of individuals interested in Waiver services.
  • The appeals process for this Waiver is through a request for a Fair Hearing under the Maryland State Medical Assistance Program/MDH.
  • For more information on the Autism Waiver, call the MSDE at 410-767-1446 or the MDH at 410-767-5220. 

Contact Information

Carmen A Brown, Branch Chief
Interagency Collaboration Branch
Phone: 410-767-7197

Tiffany Noël Hiob, Ed.D., Section Chief
Autism Waiver and Health Related Services
Phone: 410-767-0258
Email: tiffany.hiob@maryland.gov

Vacant, Section Chief
Interagency Initiatives
Chair, Interagency Rates Committee
Phone: 410-767-7197
Email: carmen.brown1@maryland.gov