Florida Medicaid Waiver - The HCBS/DD Waiver Program

The HCBS/DD Waiver Program

The Home and Community Based Services Waiver, also called the HCBS/DD Waiver or "Big" Waiver, is one of Florida's Medicaid Waiver Programs that assists people who have disabilities. These disabilities include: Cognitive Impairments, Spina Bifida, Cerebral Palsy, Prader-Willi syndrome, Down Syndrome, and Autism. The HCBS/DD medicaid waiver program helps cover the cost for things that regular medicaid does not pay for. The Home and Community Based Services Waiver is fully operated by Humana Medical Plan, Inc. from January 1, 2012. The organization is contracted by the State and receive a capitated payment to provide, manage, and coordinate a qualified enrollee's full continuum of care. Generally speaking, the managed care organization provides care through contracted providers, which can include home health agencies and assisted living facilities. The HCBS Waiver currently has 28 services and there is no spending cap. However, services must be "medically necessary".

Individuals that meet the following criteria are eligible to receive services under the Home and Community Based Services Waiver:

• Be 65 years of age or older
• Reside in a Diversion Project service area
• Be a Florida resident
• Be a U.S. citizen or qualified noncitizen
• File for any other benefits to which they may be entitled
• Disclose any rights to third party liability (i.e., health insurance)
• Have Medicare part A and part B
• Meet nursing facility level of care criteria and additional clinical criteria as determined by the Department of Elder Affairs' CARES Unit
• Meet the income limit of $2022 for an individual or $4044 for a couple
• Meet the asset limit of $2000 for an individual or $3000 for an eligible couple
• If your monthly income exceeds $2022/month you still can benefit from Medicaid Diversion by setting up an income trust. This is a legal document and it must be done by an attorney

In 2008 there was a waiting list of over 15,000 people for this waiver. Some of the people on the waiting list receive services from the FSL waiver.