OK In-Home Supports Waiver for Children

The In-Home Supports Waiver for Children (IHSW-C) is one of the Medicaid waiver programs in Oklahoma that provides home and community-based services to children with intellectual disabilities who may otherwise require care in an intermediate care facility for individuals with intellectual disabilities (ICF/IID). The waiver aims to promote the well-being, growth, and development of the children and their families by allowing them to receive services and support in their own homes or other settings of their choice. 

Overview of In-Home Support Waiver for Children

The IHSW-C program serves the needs of children ages 3 through 17 with intellectual disabilities who meet the ICF/IID level of care. The program is administered by the Oklahoma Department of Human Services (DHS), Developmental Disabilities Services Division (DDS), in collaboration with the Oklahoma Health Care Authority (OHCA), which is the state Medicaid agency. The program operates under a federal waiver authority granted by the Centers for Medicare and Medicaid Services (CMS), which allows the state to waive certain Medicaid rules and provide services that Medicaid does not typically cover. The program has a limited number of slots available each year, and there may be a waiting list for enrollment. The program is expected to serve up to 1,600 participants in 2023.

Eligibility requirements

To qualify for the IHSW-C program, a child must:

• Be 3 through 17 years of age.
• Have an intellectual disability or a related condition that manifested before age 22
• Meet the ICF/IID level of care, meaning they need active treatment and supervision due to their disability.
• Be financially eligible for Medicaid.
• Reside in Oklahoma
• Reside in their own home, a family home, a DHS foster home, or a group home operated by the Children and Family Services Division.
• Have critical support needs that can be met within the annual waiver cap, which is $30,000 per year

Services and supports

The IHSW-C program offers various services and supports designed to help children live fully in their communities. Some of the services and supports include:

• Personal care: Assistance with activities of daily living, such as bathing, dressing, grooming, eating, toileting, etc.
• Advanced supportive/restorative assistance: Assistance with tasks that require more skill or training than personal care, such as medication administration, wound care, catheter care, etc.
• Habilitation training specialist: A worker who provides training and support to help children develop or maintain skills related to self-care, communication, socialization, behavior management, etc.
• Respite: Temporary relief for caregivers who are responsible for providing care to children
• Environmental modifications: Changes or adaptations to the child’s home or vehicle that are necessary to ensure their health, safety, or independence
• Adaptive equipment: Devices or items that are necessary to assist children with their functional limitations or enhance their abilities
• Transportation: Assistance with accessing community resources or activities
• Employment services: Services that help children find and maintain paid or unpaid work in integrated settings
• Nursing services: Skilled nursing care provided by a registered nurse or a licensed practical nurse
• Nutritional services: Assessment, counseling, education, or intervention related to the child’s dietary needs
• Occupational therapy: Services that help children improve or maintain their ability to perform daily activities
• Physical therapy: Services that help children improve or maintain their physical functioning
• Speech therapy: Services that help children improve or maintain their communication skills
• Audiology: Services that help children with hearing problems or hearing aids
• Dental services: Preventive and restorative dental care provided by a dentist or a dental hygienist
• Psychological counseling: Services that help children cope with emotional or behavioral issues
• Medical supplies and services: Supplies or services that are medically necessary and prescribed by a physician
• Family training: Education or training for family members or caregivers on how to provide care or support to children

Compensation for caregivers

One of the unique features of the IHSW-C program is that it allows children to choose the self-direction option for some of their services. Self-direction means that children have more control over how their services are delivered. They can recruit, hire, train, and supervise their workers and manage a budget for purchasing goods and services that support their independence. The services that can be self-directed under the IHSW-C program are:

• Personal care
• Advanced supportive/restorative assistance
• Environmental modifications
• Adaptive equipment
• Transportation
• Employment services

For young children, the self-direction option may be suitable if they have a family member or a friend who can act as their representative and help them with the self-direction process. The representative must be at least 18 years old and cannot be the paid caregiver or the DDS case manager. The representative must also complete mandatory training offered by Acumen, the financial management service provider for the self-direction option.

A legally responsible relative, such as a parent or a sibling, can care for a young child under the self-direction option as long as they are not the spouse or the legal guardian. They must also meet the qualifications and requirements for their specific service, such as background checks, certifications, and training. They must also agree to follow the rules and regulations of the waiver program and the self-direction option.

A note from Givers

If you think your child may be eligible for this program, or if you want to learn more about other Medicaid waiver programs in Oklahoma, we invite you to fill out this form. Caregivers are part of the healthcare system, and they deserve to be paid for the work that they do. Let us help you get the compensation you deserve.