Title XIX I/DD Waiver Program
The Medicaid Title XIX I/DD Waiver Program for individuals with Intellectual 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).
All persons who are certified eligible to be in an ICF/MR setting are eligible to participate in the I/DD Waiver Program. The program is a health care coverage program that reimburses for services to instruct/train, support and assist individuals who have intellectual and/or developmental disabilities to achieve the highest level of independence and self-sufficiency possible in their lives. The I/DD Waiver Program provides services in natural settings, homes and communities where the member resides, works and shops instead of ICF/MR facilities.
Who Is Eligible for I/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 requires the same level of intensive instruction and services that are provided in an ICF/MR facility.
- 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.
The costs of I/DD Waiver services to participants on average cannot be more expensive than the average cost of supporting people in the ICF/MR facility.
Where Can I Obtain an Application for the I/DD Waiver Program?
- Local Behavioral Health Center (FMRS)
- Local Department of Health and Human Resources (DHHR) Office
- APS Healthcare
The Following Lists the Services that are Reimbursable Through the State MR/DD Waiver Program:
- Service Coordination Services
- Respite Care Services
- Transportation Services
- Skilled Nursing Services
- Self-Directed Services
- Environmental Accessibility Adaptations
- Therapeutic Consultative Services
- Behavioral Specialist Services
- Supported Employment Services
- Person Centered Support Family Services
- Person Centered Support Agency Services
How do I get more information about the program?
For further information, contact FMRS (304-250-0051) or APS Healthcare (1-866-385-8920).
Family Support Services
The FMRS Health Systems, Inc. Family Support Program is part of a statewide program passed by legislation in March 1991. It is a program designed to assist families with a member with a qualified developmental disability living in their natural home. Family Support was created as a last resort to assist when other resources and programs are not available. The Family Support Program is available regardless of income or the age of the person with a disability.
- An applicant must be developmentally disabled and living with their natural family.
- Proof of developmental delay is required. Recipients of the Birth to Three Program must provide an IFSP and a report detailing the delays dated within the last 12 months that shows a delay of 25% to 39% in three (3) areas or 40% or greater in two (2) areas. All other consumers must have documentation from an educator, therapist, psychologist, medical practitioner. Applicant must have been diagnosed with a developmental disability by the age of 21.
- There are no age requirements for applicants to Family Support Services.
- There are no income requirements or limits for applicants. Although due to the reduced funds, this may be taken into consideration if there are multiple requests.
- Priority will be given to families on the I/DD Waiver wait list.
Applicants must apply at the Center that serves their community/catchment area or the Center where they receive services. The Family Support Council will determine allocation of funds to eligible families based on need. Meetings will be held quarterly. Emergency requests will still be considered but with more requirements for denials from other sources. Applications will be reviewed at the time of application to determine if eligibility or more information is needed. Please submit applications throughout the quarter instead of at the time of the quarterly meeting. This will allow applicants time to gather additional information if needed. Applications must include the following:
- Proof of delay
- Documentation of need
- Proof of denials from at least 2 other funding sources
- Estimates from at least 2 contractors/providers*
- Partial Payment Acceptable*
- Proof of other payments*
Requests must be specific to the consumer’s needs. These are the areas that are outlined in WV Code as appropriate areas for reimbursement:
- Respite Care: Includes care provided as a break to the family in either the family’s home or the respite worker’s other home.
- Personal Care: Includes assistance with eating, bathing, dressing and other activities of daily living provided in the home or community on a regular basis.
- Child Care: Includes after school program, child day care costs and child care for siblings so that parents can spend time alone with their handicapped child.
- Architectural and Vehicle Modifications: Includes ramps, lifts, door widening, bathroom modification and other needed modifications. The Council will request two (2) contractors' bids for architectural and vehicular modifications. Requests for home repairs must provide proof of ownership (deed or title to a mobile home in the guardian’s name). Repairs must be specific to the consumer’s needs.
- Equipment and Supplies: Includes individualized adaptations such as special chairs and beds, communication devices and computers. May also include specialized household equipment such as intercoms and air purifiers. Requests for computers, electronic tablets and other electronic devices MUST have documentation of the need from an educator, therapist, psychologist or medical practitioner. Council will not consider requests for computers or electronic tablets for applicants under age 12.
- Specialized Nutrition and Clothing: Includes specially prepared food that cannot be purchased at a grocery store and specially made clothing and shoes. Applications for Ensure and Pediasure and other similar nutritional items must have a doctor’s order.
- Homemaker Services: Includes home chores, cooking and cleaning.
- Transportation: Includes gas, food and lodging costs associated with special trips related to the person with a disability.
- Utility Costs: Utilities will be limited to one time per year for heating assistance from November 1 through March 31 (electric or gas). The applicant must submit a copy of a utility bill that has a 60 day past due notice. The amount approved will be at the Council’s discretion.
- Integrated Community Activities: Includes activities that facilitate social integration with peers, such as Boy and Girl Scouts and other community recreation programs.
- Training and Technical Assistance: Includes classes and individualized consultations for parents and other family members that pertain to the needs and/or care of the developmentally delayed family member.
- Vehicle Repair: Requests for vehicle repairs may be approved at the Council’s discretion but shall not exceed $500.00 in the fiscal year (July 1 through June 30). Proof of ownership and two estimates will be required for consideration.
A minimum of 25 families will be served with the funds received during each grant allocation period. All family recipients of Family Support funds must submit proof of purchase to the Council that verifies goods and services applied for are actually received. If receipts are not provided, additional applications will not be considered. Receipts must be for approved items. Discrepancies will be reviewed by the Council and may result in the denial of future requests.
Applications are available at any FMRS Health Systems, Inc. office or may be downloaded HERE
Please submit applications to the attention of the Family Support Coordinator by faxing to 304-929-5417 or mailing to 101 S. Eisenhower Drive, Beckley WV 25801