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Home and Community-Based Programs Overview 
Below are links to Medicaid programs for the elderly, people with developmental, intellectual, physical disabilities and/or mental health issues who want to remain in their community.
The Medicaid Personal Care Program provides assistance with activities of daily living to Medicaid recipients who have a chronic illness, medical condition or disability. Services are provided in the eligible individual's home or community residence. 
The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. 
Maryland’s Community First Choice option provides community services and supports to enable older adults and people with disabilities to live in their own homes. 
Medical Day Care is a structured group program that provides health, social, and related support services to functionally disabled adults, age 16 and older.
-                Medical Day Care Waiver Fact Sheet   
-                Medical Day Care Services Waiver
-                Medical Day Care Waiver Application
The Rare and Expensive Case Management (REM) Program is a case managed fee for service alternative to HealthChoice Managed Care Organization (MCO) participation for recipients with specified rare and expensive conditions.
Hopkins ElderPlus is a voluntary health program designed to provide and coordinate all needed preventive, primary, acute and long-term care services so that older individuals can continue living in the community
Maryland’s Home and Community-Based Services Waiver for Individuals with Brain Injury provides services to individuals that must have experienced the (initial) traumatic brain injury after the age of 17.  Individuals must be inpatients in a State Mental Hygiene Administration facility, inpatients in a state owned and operated nursing facility, a Maryland licensed Special Hospital for Chronic Disease that is CARF accredited for Brain Injury Inpatient Rehabilitation, or individuals who have been placed by Medicaid in an out-of state facility.  Services included but are not limited to Residential Habilitation, Day Habilitation, and Supported Employment.  The Waiver is administered by the Mental Hygiene Administration. 
-                Brain Injury Waiver Fact Sheet (updated 5.7.14)
-                Brain Injury Waiver Application
This waiver targets medically fragile individuals including technology dependent individuals who, before the age of 22, would otherwise be hospitalized and are certified as needing hospital or nursing home level of care. Through the waiver, services are provided to enable medically fragile children to live and be cared for at home rather than in a hospital. Model Waiver services includes case management, private duty nursing, shift home health aide assistance, physician participation in the Plan of Care development, and durable medical equipment and supplies.
The EID Program provides Medical Assistance to working Marylanders with disabilities who meet the program’s eligibility criteria. 
Health Homes for individuals with chronic conditions will augment the State's broader efforts to integrate somatic and behavioral health services.  The program will target populations with behavioral health needs who are at high risk for additional chronic conditions, including those with serious persistent mental illness, serious emotional disturbance, and opioid substance use disorders.  Health Homes will offer participants enhanced care coordination services from  providers with whom they regularly receive care, including psychiatric rehabilitation programs, mobile treatment service providers, and opioid treatment programs.  This is a community-based approach, not a residential program.  Health Homes are designed to enhance person-centered care, empowering participants to manage and prevent chronic conditions in order to improve health outcomes, while reducing avoidable hospital encounters.
The Community Pathways waiver provides services and supports to individuals, of any age, living in the community through licensed provider agencies or independent providers under self-directed services.  All individuals must meet the criteria for a developmental disability per the Annotated Code of Maryland Title VII.   The services covered under Community Pathways include: Assistive Technology and Adaptive Equipment; Behavioral Supports; Community Learning Services; Community Residential Habilitation Services; Day Habilitation – Traditional; Employment Discovery and Customization; Environmental Accessibility Adaptations; Environmental Assessment; Family and Individual Support Services; Live-In Caregiver Rent; Medical Day Care; Personal Supports; Respite; Shared Living; Support Brokerage; Supported Employment; Transition Services; Transportation;  and Vehicle Modifications.  Individuals can receive one or more of these services depending on their specific needs.  The Community Pathways waiver is administered by the Developmental Disabilities Administration. 
Effective July 1, 2001, the Maryland State Department of Education began administering the Autism Waiver, targeted to children ages 1 through the end of the school year that the child turns 21.  As a part of determining eligibility, a child must be diagnosed with Autism Spectrum Disorder, meet an Intermediate Care Facility for Intellectually Disabled Level of Care, not be enrolled in any other waiver, and have an Individualized Education Program (IEP) or individualized Family Service Plan (IFSP) and receive at least 12 hours of special education and related services per week.  The services provided under the Autism Waiver are Intensive Individual Support Services, Therapeutic Integration, Respite Care, Family Training, Environmental Accessibility Adaptations, Adult Life Planning, Residential Habilitation and Targeted Case Management.
-                Autism Waiver Fact Sheet
-                Autism Waiver Application  


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What is a waiver?

Under Section 1915(c) of the Social Security Act, Medicaid law authorizes the Secretary of the U.S. Department of Health and Human Services to waive certain Medicaid statutory requirements. These waivers enable States to cover a broad array of home and community-based services (HCBS) for targeted populations as an alternative to institutionalization. Waiver services may be optional State Plan services which either are not covered by a particular State or which enhance the State’s coverage. Waivers may also include services not covered through the State Plan such as respite care, environmental modifications, or family training. 
The four basic types of 1915(c) HCBS waivers available for states based on the target population’s level of alternative long-term institutional care are:
·         intermediate care facility-intellectual disability (ICF-ID) level of care for intellectually and/or developmentally disabled individuals;
·         chronic or rehabilitative hospital level of care for individuals who are medically fragile, chronically ill, or severely disabled;
·         psychiatric hospital level of care for individuals who are severely or chronically mentally ill; and
·         nursing facility level of care for individuals who are elderly, physically disabled, and/or cognitively impaired.
To be a waiver participant, an individual must be medically qualified, certified for the waiver’s institutional level of care, choose to enroll in the waiver as an alternative to institutionalization, cost Medicaid no more in the community under the waiver than he or she would have cost Medicaid in an institution, and be financially eligible based on their income and assets.