Medicaid Waiver Program for Persons with
Medicaid is a state/federal partnership
started in 1965 to offer health
insurance and long term care-related
services to the poor. Over the years,
Medicaid has partnered with states like
Illinois to expand services to other
people with special needs.
States must write a state Medicaid plan
and submit it to the federal government
for review. The Federal Centers on
Medicaid and Medicare is the agency that
approves these plans. When a state’s
plan is approved, the federal government
shares in the cost of services for
eligible populations. In Illinois, it is
a 50/50 split, and administrative costs
are reimbursed at 90/10.
In 1972, Congress authorized the ICF/MR
(in Illinois, ICF/DD) program. ICF is an
acronym for “intermediate care facility”
and is a 24-hour specialized nursing
home and institution, regardless of
size, as defined by statute and
regulation. They are medically based
facilities that provide individuals with
“active treatment” as defined in federal
regulation to differentiate the ICF from
a skilled nursing facility. For
individuals who are certified eligible
on an annual basis, a plan is
implemented based on his/her individual
goals. The goal is to have the
individuals receive these developmental
services as long as they are determined
to be needed.
The funds are available to the provider
and the facility. They are not portable,
and do not follow the person when they
leave or are discharged. The choice the
individual has is whether they chose to
be admitted. In 1981, the Home and
Community-Based Services (HCBS) Medicaid
waiver was authorized. This program
allows the Secretary of the U.S.
Department of Health and Human Services
(DHHS) to “waive” some Medicaid
requirements. States can choose what
populations can be covered, as well as
the number of services. States also have
the discretion to choose the number of
participants in the HCBS program.
The federal government through the
Secretary of DHHS has the authority to
respond to a state’s request to waive
the Medicaid institutional rules for the
otherwise eligible institutional
populations and to develop a menu of
home and community based services. In
essence, an eligible individual does not
have to meet the criteria for
institutional care to develop flexible
community supports. This offers huge
promise and potential as Illinois seeks
to rewrite its current Waiver to move it
to a self-determined, money following
the person approach.
HCBS costs cannot exceed those of
individuals who would otherwise reside
in institutional settings. Since 1982,
each year, nationally, the number of
individuals in the waiver has increased.
It is also interesting to note that
individuals in the waiver programs, in
many cases, have disabilities similar to
those in ICF/DD.
The greatest difference between the
waiver and ICF-DD lies in choice and
flexibility offered to the individual
and his/her family.
Unlike ICF/DD, the money follows the
person and is flexible. This allows
maximum choice and control over who
provides one’s services and the type
Waivers are written in five-year cycles.
Illinois’ next waiver is due for renewal
by June 30, 2012.
Illinois has a tremendous opportunity to
help transform its service delivery
system because of the rewrite of the
Medicaid Waiver. We believe that the
Waiver is not only a funding mechanism
but also should be about vision, values,
and policy. We stand ready to provide
technical assistant, support, and
advocacy to assist in this effort.
This Summary adapted from a 2007 paper
courtesy of the Institute on Public
Policy for Persons with Disabilities.
Illinois Health and Family Services
Department of Human Services Waiver
Arc of Illinois letter to DD Director
Casey on Illinois Waiver Rewrite