Title XIX MR/DD Waiver Program

The Medicaid Title XIX MR/DD Waiver Program for individuals with Mental Retardation and/or Developmental Disabilities is a Federal and State funded Medicaid program designed to deliver services to individuals in their home and community as an alternative to receiving services in an Intermediate Care Facility for individuals with Mental Retardation and related conditions (ICF/MR).

The program provides health care coverage that reimburses for services to instruct, intervene, support and assist individuals who have mental retardation and/or related conditions to achieve the highest level of independence and self-sufficiency possible in their lives.  FMRS supports a person-centered approach that focuses on each individual's hopes and dreams.

FMRS Health Systems, Inc. provides Waiver Consumers with a highly qualified team of professionals.  Each Waiver consumer is assigned to a Service Coordinator and a Therapeutic Consultant. 

Service Coordinators assist consumers by coordinating supports and provide linkage to needed medical, social, educational, and behavioral services.  Service Coordinators advocate for the consumer to reach their maximum potential and productivity while maintaining inclusion in the community.  Service Coordinators maintain caseloads of 20 or less and are available to provide intensive case management services.

The Therapeutic Consultant is responsible for the development of programming to teach the consumer skills necessary for reaching their goals.  The Therapeutic Consultant trains primary care givers in the individualized methods of intervention and evaluate the progress of the consumer.  Consumers who demonstrate maladaptive behaviors are provided with Positive Behavior Support services, which assist in preventing the targeted behavior from occurring and teach the consumer new skills.

Waiver consumers are also provided with a Social Worker, Psychologist and RN, to assess behavioral and medical health care needs.  Additional services provided by FMRS as available and appropriate include Respite II, Adult Companion II, Community Residential Habilitation, Day Habilitation, Supported Employment, Environmental Accessibility and Transportation.  Additional Waiver Services are accessible via collaboration with other local Waiver provider agencies and contracted professionals.

Who is Eligible for MR/DD Waiver Services?

To be medically eligible, an individual must have a primary diagnosis of mental retardation and/or a related condition with substantial deficits in major life areas that require the same level of intensive instruction and services that are provided in an ICF/MR facility.  Additionally, the mental retardation and/or related condition with adaptive deficits must have occurred prior to the age of 22 and is likely to continue indefinitely.

To be financially eligible, the individual must have a monthly income of less than three times the current maximum amount of Supplemental Security Income (SSI), and have less than $2,000 in assets (excluding residence and furnishings).  The parent's assets and income are not considered for determining financial eligibility.  Financial eligibility is determined by the County DHHR office of the applicant's residence.

Program eligibility is determined by the Bureau for Behavioral Health and Health Facilities - Waiver Department and the Bureau of Medical Services.

Where do I apply for the MR/DD Waiver Program?

You may obtain the initial application form (DD-14) at the following locations:

• FMRS Health Systems, Inc.
• State MR/DD Waiver Office
• County Department of Health and Human Resources Offices (DHHR)
• Other local Waiver Provider agencies

What should I expect during the application process?

Expect to be contacted by an FMRS staff person to schedule an intake and a psychological evaluation.

Be prepared to bring copies of the most recent IEP, Birth to Three assessments and any other evaluations regarding diagnosis to your appointment with the psychologist.

You will need to take the form (DD2A) provided at time of application to your primary care physician for completion.  That form will then need to be returned to FMRS.

FMRS Waiver staff will prepare the application packet, which will include the psychological, medical report, additional evaluations and IEP as appropriate and mail to the State MR/DD Waiver Office for determination.

Expect to receive a letter from the State, which will announce if your application was approved or denied.  If you receive a denial, you may appeal that decision.  Please contact Waiver Staff at FMRS for further assistance.

What services are provided through the WV Title XIX MR/DD Waiver Program?

(**FMRS does not provide all services listed, but will link consumers with services as available and appropriate)

• IPP Program Development
• Service Coordination
• Transportation
• Respite Care (Levels I and II)
• Residential Habilitation (Community and Agency)
• Adult Companion (Levels I and II)
• Day Habilitation
• Pre-Vocational Training
• Supported Employment
• Therapeutic Consultative Services (Skills Specialist, Behavior Specialist, Behavior Analyst, Psychologist)
• Extended Professional Services (Registered Dietitian, Physical Therapist, Occupational Therapist, Speech Therapist, Licensed Psychologist Consultative)
• Skilled Nursing Services - LPN
• Nursing Services - RN
• Crisis Services
• Environmental Accessibility Adaptations (home and vehicle)
• Extended Physician Services
• Psychiatric Diagnostic Evaluation
• Psychological Testing
• Social History