If you are a family caregiver of an adult with a serious and complex medical condition, you may wonder how to access the resources and assistance you need to provide quality care. In this article, we explore one of the options available to you in Missouri: the Medically Fragile Adult Waiver.
The Medically Fragile Adult Waiver is a Medicaid program offering service coordination and authorization for medically necessary services to adults with serious and complex medical needs who are no longer eligible for Healthy Children and Youth programs. The waiver aims to prevent or delay institutionalization and promote home and community-based care. The waiver can serve individuals 21 or older and meet specific eligibility criteria. The waiver has an annual service cost limit of $40,000 per participant.
The Medically Fragile Adult Waiver is one of the four waivers administered by the Missouri Division of Developmental Disabilities (DD). The waiver began in July 2003 and serves over 1,000 individuals as of 2023. The waiver is partly funded by federal dollars through the Centers for Medicare and Medicaid Services (CMS).
The waiver aims to provide an alternative to institutional care for adults with serious and complex medical needs who are at risk of needing intermediate care facilities for individuals with intellectual disability (ICF/ID) services if waiver services are not provided. The waiver allows participants to receive services and support in their own homes or other community settings that are less restrictive and more integrated than institutional settings. The waiver also gives participants more choice and control over their services and supports through self-direction options.
The target population of the waiver is adults with serious and complex medical needs who have a place to live in the community, usually with their families. A serious and complex medical need requires ongoing skilled nursing care or monitoring by a licensed healthcare professional. Examples of such conditions include ventilator dependency, tracheostomy care, tube feeding, seizure disorder, etc.
To be eligible for the Medically Fragile Adult Waiver, an individual must meet the following requirements:
The Medically Fragile Adult Waiver offers a range of services and supports designed to meet each participant's individual needs and preferences. The services and supports are intended to help participants achieve their personal goals and outcomes related to health, safety, independence, community participation, and quality of life. The services and supports include:
One of the benefits of the Medically Fragile Adult Waiver is that it allows participants to choose self-directed support for some of the services they receive. Self-directed supports give participants more choice and control over their services and supports by hiring and managing their own workers. Participants can use a fiscal intermediary agency to handle the payroll and taxes for their workers.
Self-directed supports also allow participants to hire their family members as paid caregivers, as long as they are not legally responsible for the participant (such as a spouse) or living in the same household as the participant (unless an exception is granted). Family caregivers can be paid for personal or nursing care to the participant. The payment rates vary depending on the type and level of service provided, but they are generally based on the prevailing wage in the area.
Family caregivers who are interested in becoming paid workers for their loved ones must meet the following requirements:
Family caregivers who become paid workers must also comply with the rules and regulations of the waiver program, such as submitting timesheets, keeping records, reporting incidents, etc. They must also respect the participant's rights and preferences and provide quality care.
Suppose you are a family caregiver of an adult with a serious and complex medical condition who lives in Missouri. In that case, you may be eligible for this waiver program that provides valuable services and supports, including compensation for your caregiving work. To find out if you qualify, please fill out this form, and we will contact you soon.
