Missouri's Medicaid Waiver for Persons with Mental Retardation and Developmental Disabilities (Fact Sheet)
Comprehensive Waiver | Community Support Waiver | Sarah Jian Lopez Waiver
Waiver Home: Fact Sheet | Waiver Diagnosis Codes
What is the MRDD Waiver?
The Missouri Department of Mental Health's Division of Mental Retardation and Developmental Disabilities (DMRDD) administers three 1915(c) Home and Community Based Medicaid Waiver programs for individuals with mental retardation or other developmental disabilities. The three waivers are the:
- Comprehensive Waiver;
- Missouri Children with Developmental Disabilities Waiver (MOCDD or Sarah Jian Lopez Waiver); and
- Community Support Waiver.
Authority for 1915(c) waivers is the result of a special arrangement between the state and federal government that allows the state to use Medicaid funding for specialized services provided only to a target group of people and not to all people with Medicaid eligibility. The state determines the number of people it will serve, what services it will cover, and how much it will spend on waiver services. Medicaid funding in Missouri consists of matching 40 percent state tax dollars with 60 percent federal dollars.
What services are available through the MRDD Waiver?
| Comprehensive | Community Support | MOCDD (Sarah Lopez) |
| Personal Assistance | Personal Assistance | Personal Assistance |
| Day Habilitation | Day Habilitation | Day Habilitation |
| Respite Care | Respite Care | Respite Care |
| Transportation | Transportation | Transportation |
| Community Specialist | Community Specialist | Community Specialist |
| Environmental Accessibility Adaptations | Environmental Accessibility Adaptations | Environmental Accessibility Adaptations |
| Specialized Medical Equipment and Supplies | Specialized Medical Equipment and Supplies | Specialized Medical Equipment and Supplies |
| Crisis Intervention | Crisis Intervention | Crisis Intervention |
| Behavior Therapy | Behavior Therapy | Behavior Therapy |
| Communication Skills Instruction | Communication Skills Instruction | |
| Counseling | Counseling | |
| Physical Therapy | Physical Therapy | |
| Speech Therapy | Speech Therapy | |
| Occupational Therapy | Occupational Therapy | |
| Supported Employment | Supported Employment | |
| Individualized Supported Living | ||
| Residential Habilitation | ||
| Transition Services | ||
| Support Broker | Support Broker |
Who qualifies for the MRDD Waiver?
Comprehensive or Community Support Waiver:
- Eligible for Medicaid as determined by the Missouri Department of Social Services' Division of Family Services under an eligibility category that provides for Federal Financial Participation (FFP) and is not an "expanded" eligibility category under the 1115 Waiver.
- Community Support Waiver only, service needs cannot exceed $22,000 annually and the participant must not require residential services.
MoCDD or Lopez Waiver:
- Under the age of 18, ineligible for Medicaid due to the deeming of parental income and resources; live with family; have a permanent and total disability; and require habilitative (waiver) services.
ALL three waivers:
- Determined by the DMRDD regional office initially and annually thereafter to require an ICF/MR level of care if waiver services are not provided. The ICF/MR level of care requires that an individual have mental retardation or a related condition as defined in federal rule (42 CFR 435.1010), plus a need for the level of care provided in an ICF/ MR. In addition, it requires a determination that if you don't receive services under the waiver, you will actually need to live in such an institution. The service coordinator uses a two-page form to evaluate the level of care.
For more specific eligibility criteria, contact the regional office serving your area.
Are there participation limitations?
The number of individuals who may be served in each year of a waiver is pre-approved by the Centers for Medicare and Medicaid Services (CMS), based on the state's request. Once the waiver is serving the approved number of eligible individuals, no additional individuals may be enrolled. The number of participants requested by the state is limited by funding available for the state portion of the match.
If a person is determined eligible to participate in a waiver, but the maximum number of individuals are being served within the appropriation, the DMRDD Regional Office will offer to add the person's name to its list of persons waiting for regional office services. People are selected for services from this list according to most critical need.
How are services accessed through a waiver?
Requests to access waiver services may be made through an intake worker or service coordinator at the regional office. A determination of ineligibility for a waiver will not necessarily disqualify individuals from other regional office services for which they qualify and for which funding is available.
What are the rights of persons requesting waiver participation?
- To have eligibility for waiver participation determined within 60 days of a request for participation;
- To receive services as provided to persons with like need and similar presenting circumstances, in accordance with the waiver and dependent on availability of services and funding;
- To be informed of options and participate in selecting and planning for services and providers; and
- To request a fair hearing if dissatisfied with the decision(s) made on participation or service plan, or if denied the choice of provider. *
What are the responsibilities and duties of those requesting waiver participation?
- To report fully all circumstances affecting the application;
- To report any changes in circumstances which affect Medicaid eligibility;
- To cooperate in efforts to establish eligibility; and
- To cooperate with the service coordinator to ensure all state and/or federal participation requirements are met, i.e., maintaining a current, approved person-centered plan.
* Individuals denied participation in a waiver program have appeal rights with both the Departments of Mental Health and Social Services, Division of Legal Services. Individuals are encouraged to begin with the Department of Mental Health's appeal process. Once the appeal process is started with the Department of Social Services, all appeal rights with the Department of Mental Health shall terminate since a decision rendered by the single State Medicaid agency would supercede a decision made by the Department of Mental Health. However, an appeal can be made to the Department of Social Services before, during, or after the Department of Mental Health process. The service coordinator will assist persons who decide an appeal is necessary.
