Woman in Field

medicaid waivers

Please note:
The following information is applicable for the Commonwealth of Virginia. If you are visiting our site from another state, please visit medicaidwaiver.org or contact your local chapter of The Arc. 
 
When a person has a developmental disability, he or she is entitled to services and supports, such as health care, help with employment, behavioral supports, and community living. These supports can be offered in their homes and communities, or in an institutionalized setting. 
If your loved one chooses to receive their supports in the community, he or she will need a Developmental Disability Medicaid Waiver. The Developmental Disability Medicaid Waivers allow a person who typically would not qualify for Medicaid to receive Medicaid services without being in an institutional setting. 
There are three waivers that fall under the umbrella of a Developmental Disability Waiver. They are:
Waivers are funded by the General Assembly, and the number of people who need these services far outweigh the number of waivers available. Therefore, it is incredibly important to apply for a waiver slot AS SOON AS POSSIBLE, as most people will wait between 10-15 years to receive services. There are currently over 13,000 Virginians waiting for a waiver slot. 

applying for a waiver

Where to start

To apply for a waiver in the Commonwealth of Virginia, you will need to contact your local Community Services Board. If you live in the Northern Shenandoah Valley, you will need to contact Northwestern Community Services Board at 540-636-2931.

What you need

You only need to contact the waiver specialist in order to schedule an assessment. If you do not receive a call, make sure you CALL BACK.

Eligibility

Your loved one must meet three separate criteria to be eligible for a DD waiver.

  • Diagnostic criteria: This means that your loved one must have a developmental disability as described in Virginia code; 

  • Functional criteria: Your loved one must show a need for support in at least of the following categories:

    • Health status; ​

    • Communication needs; 

    • Task learning skills; 

    • Motor skills; 

    • Social & emotional skills; 

    • Behavior; 

    • Community living; and

    • Self-direction

  • Financial criteria: Your loved one must meet the financial eligibility for Medicaid. This does not include your income as a parent, and your loved one does not need to meet the criteria UNTIL he or she is offered a waiver slot.

    • Income cap of $2,349 per month; ​

    • Assets valued at no more than $2,000

    • Your loved one may be assessed a copay for services

    • If there are more than $2,000 in assets, please consider an ABLE account or Special Needs Trust.

The Family & Individual Supports Waiver

About

This waiver is available to both children and adults with moderate support needs. 

People who receive supports through this waiver can live with their families, or they can live in their own homes. 

Supports

  • Individual & supported employment; 

  • Group supported employment; 

  • Workplace assistance services; 

  • Community engagement; 

  • Community coaching; 

  • Group day support; 

  • Center-based crisis supports; 

  • Community-based crisis supports;  

  • Crisis support services; 

  • Assistive technology allowances; 

  • Benefits planning; 

  • Community guide; 

  • Electronic home-based services; 

  • Individual/family caregiver training; 

  • Environmental modifications; 

  • Limited non-medical transportation services; 

  • Transition services; 

  • Shared living; 

  • In-home supports; 

  • Supported living; 

  • Consumer-directed services facilitation; 

  • Companion services; 

  • Personal assistance services; 

  • Respite; 

  • Private duty nursing; 

  • Skilled nursing; 

  • Therapeutic consultation; and

  • Personal emergency response system

The Family & Individual Supports Waiver

About

This waiver is available to both children and adults with moderate support needs. 

People who receive supports through this waiver can live with their families, or they can live in their own homes. 

Supports

  • Individual & supported employment; 

  • Group supported employment; 

  • Workplace assistance services; 

  • Community engagement; 

  • Community coaching; 

  • Group day support; 

  • Center-based crisis supports; 

  • Community-based crisis supports;  

  • Crisis support services; 

  • Assistive technology allowances; 

  • Benefits planning; 

  • Community guide; 

  • Electronic home-based services; 

  • Individual/family caregiver training; 

  • Environmental modifications; 

  • Limited non-medical transportation services; 

  • Transition services; 

  • Shared living; 

  • In-home supports; 

  • Supported living; 

  • Consumer-directed services facilitation; 

  • Companion services; 

  • Personal assistance services; 

  • Respite; 

  • Private duty nursing; 

  • Skilled nursing; 

  • Therapeutic consultation; and

  • Personal emergency response system

Family Portrait
Paying Customer

The Building Independence Waiver

About

The Building Independence Waiver is for adults 18 years and older who are able to live independently, and with limited supports.


People with this waiver usually have their own home or apartment. Many times, they are able to receive rent subsidies.

Services
  • Individual & supported employment; 
  • Group supported employment; 
  • Community engagement; 
  • Community coaching; 
  • Group day support; 
  • Center-based crisis supports; 
  • Community-based crisis supports; 
  • Crisis support services; 
  • Assistive technology allowance; 
  • Benefits planning; 
  • Community guide; 
  • Electronic home-based services; 
  • Environmental modifications; 
  • Non-medical transportation; 
  • Transition services
 
 
Community Garden

The Community Living Waiver

About

This waiver is available to both children and adults, and is the most comprehensive of all the waivers.

People who have the Community Living Waiver have very high support needs, including medical and behavioral needs. They usually receive around the clock supports in their own homes, group homes, sponsored residential programs and more. 

Supports

  • Individual supported employment; 

  • Group supported employment; 

  • Workplace assistance; 

  • Community engagement; 

  • Community coaching; 

  • Group day support; 

  • Center-based crisis supports; 

  • Community-based crisis supports, 

  • Crisis support services; 

  • Assistive technology allowance; 

  • Benefits planning; 

  • Community guide; 

  • Electronic home-based services; 

  • Environmental modifications; 

  • Limited non-medical transportation services; 

  • Transition services; 

  • In-home supports; 

  • Supported living; 

  • Group home residential; 

  • Sponsored residential services; 

  • Consumer-directed services facilitation; 

  • Companion services; 

  • Personal assistance services; 

  • Respite

  • Private duty nursing:

  • Skilled nursing;

  • Therapeutic consultation; 

  • Personal emergency response system

 
Copying Down

Frequently asked questions

Does everyone with a Developmental Disability qualify for a waiver?

No. Not everyone who has a developmental disability will qualify for a waiver. To be eligible for a waiver, a person must meet:

  • Diagnostic eligibility: This means the person's disability must impact his or her ability to live and work independently; 

  • Functional eligibility: This means the person's disability must impact learning, independent living, communication and several other categories; 

  • Medicaid financial eligibility: This means a person must meet the financial qualifications for Medicaid. This is ONLY when a waiver is awarded. A person does not need to meet Medicaid financial eligibility in order to apply for services or be placed on the waiting list. 

Why are these waivers so important?

Many people with Developmental Disabilities will require life long supports to participate in their community, such as working in a deli or grocery store, attending worship services, going shopping, attending medical appointments and more. Waivers pay for the supports needed for a person to engage in these activities, plus a wide variety of medical care options and behavioral supports as well.

Many parents are concerned as to what will happen when they are no longer able to care for their loved one. Medicaid Waivers are a source of support that will provide care for a person with a Developmental Disability throughout his or her lifetime, particularly when the supports of an IEP are no longer available and as parents and/or caregivers age.

Unfortunately, many parents place their loved ones on the waitlist too late and find themselves without necessary supports when they age out of the school system. It is IMPERATIVE for families to have their loved ones screened for eligibility as soon as possible. 

How can my loved one be screened for a waiver?

​You will need to contact your local Community Services Board for your loved one to be screened for a waiver.