DDA Waiver MYTHS


If a family has private health insurance and their relative enrolls in the waiver, the family and the individual must use Medical Assistance (MA) coverage for all of their health and medical needs.

Not true. The MA card covers only the individual who is enrolled in the waiver. It can be used to pay for certain health and medical expenses for that individual that are not covered by private insurance. MA is always the payer of last resort.

Enrolling in the waiver means more paperwork for my provider and me and means more people coming to my house.

There are only two more pages required for waiver participants compared to what is required for consumers not enrolled in the waiver. There is a one-page form to enroll in the waiver and a one-page certification and recertification form.

Providers are not required to submit additional documents for waiver participants receiving residential or day habilitation services. For individuals receiving supported employment or personal support, providers must submit one monthly invoice (Community Based Services Invoice - DHMH248) based on that waiver participant's attendance to enable DDA to prepare and submit a claim for federal reimbursement.

The DDA requirements that apply to in-home reviews are the same whether an individual is enrolled in the waiver or not.

Annually, for individuals not receiving SSI, the The Department of Health and Mental Hygiene's Division of Eligibility Waiver services will send a request for information to one of the following: the residential provider agency, the family or the resource coordinator to gather information to make a determination about continued medical assistance eligibility. If this information is not returned by the timeframe stated in the request, the person will lose medical assistance.

Enrolling in the waiver means the provider is paid less for serving my family member.

Not true, because DDA pays the same rates for services whether the consumer is enrolled in the waiver or not.

Enrolling in the waiver results in individuals and/or their families being charged for their care.

Not true. Individuals receiving residential services who have earned or unearned monthly income are required to contribute to their cost of care whether they are in the waiver or not. The formula for calculating this contribution is the same for waiver participants as for non-waiver consumers.

Once a person is enrolled in the waiver, he/she is entitled to receive all services that theoretically could be available under the waiver.

Not true. A waiver enrollee's right to receive a service is dependent on a finding that the individual needs the service, based on appropriate assessment criteria that the State develops and applies fairly to all waiver enrollees.