The Model Waiver, a program started in Maryland in 1985, allows medically fragile individuals who would otherwise be hospitalized and are certified as needing either hospital or nursing facility level of care to receive medically necessary and appropriate services in the community. As a result, the Model Waiver clients can continue to live at home with their families. The maximum number of individuals who may be enrolled in the Model Waiver is 200.
To be eligible for the Model Waiver several conditions must be met. These conditions are:
- Admission must be completed before the individual becomes 22 years old.
- The individual must meet the definition of a disabled child at the time application for Model Waiver services is made. The term “disabled child” means “ a chronically ill or severely impaired child, younger than 22 years old, whose illness or disability may not require 24-hour inpatient care, but which, in the absence of home care services, may precipitate admission to or prolong stay in a hospital, nursing facility, or other long-term facility” (COMAR 10.09.27).
- The individual must be certified as in need of a hospital or nursing facility level of care. This level of care is determined by a state contracted reviewer using information supplied by the referring physician.
- The individual’s medically necessary and appropriate community based medical services must be cost neutral. That is, the cost of the community-based services must not exceed the cost of institutional care.
Under the Model Waiver, the parents’ income and assets are waived during the financial eligibility process. This means that the child is considered an eligibility unit of one even though he or she will live in the community with the parent(s).
To obtain further information, please call the Coordinating Center for Home and Community Care (CCHCC) at 410-987-1048 (Baltimore) or 301-621-7830 (Washington). The staff at CCHCC is available to answer questions concerning the Model Waiver’s referral and enrollment process.