OR Medically Fragile (Hospital) Model Waiver

Overview of Medically Fragile (Hospital) Model Waiver

The Medically Fragile (Hospital) Model Waiver, implemented in Oregon, is designed to assist children with significant medical needs. These children, scoring 45 on the Medically Fragile Children's Unit (MFCU) Clinical Criteria assessment, typically require hospital-level care. The waiver aims to enable these children, from birth through age 17, to live in or return to their family homes. Its critical goal is to preserve family caregiving capacities while ensuring the child's health and safety within the family environment. The Oregon Health Authority and the Department of Human Services manage the program, emphasizing family/person-centered planning and service provision.

Eligibility requirements

Eligibility for the Medically Fragile (Hospital) Model Waiver is primarily for children from birth to age 17 who meet the hospital level of care requirements and score 45 on the MFCU Clinical Criteria assessment checklist. These children have extensive medical needs requiring specialized services. The program sets specific eligibility criteria to ensure the services reach the intended target group, focusing on those who would otherwise require institutional care.

Services and supports

The services and supports available under the Medically Fragile (Hospital) Model Waiver include a range of options designed to cater to the needs of medically fragile children. These services are as follows:

1. Participant-Directed Waiver Service: This allows participants or their representatives to direct certain aspects of their care.
2. Specialized Medical Supplies: Provision of necessary medical supplies unavailable through standard health plans.
3. Individual Directed Goods and Services: This includes services, equipment, or supplies not covered by the waiver or Medicaid State Plan but identified as necessary in the service plan.
4. Supported Employment Services:
5. Small Group Employment Support: Assisting groups of individuals in employment settings.
6. Individual Employment Support: Tailored support for individual employment needs.
7. Employment Path Services: Providing learning and work experiences, including volunteer opportunities.
8. Discovery/Career Exploration Services: Aiding in career exploration and discovering employment opportunities.
9. Waiver Case Management: Coordinating and managing the care and services provided under the waiver.
10. Environmental Safety Modifications: Modifications to the home environment to ensure safety and accessibility.
11. Family Training: Training for family members to support the medically fragile child effectively.
12. Vehicle Modifications: Necessary vehicle modifications for accessibility and transportation needs.
13. Administrative Activity: Ensuring the proper administration and coordination of services and supports.

Compensation for caregivers

The Medically Fragile (Hospital) Model Waiver includes a participant-direction option, allowing recipients to choose their caregivers for some services. This option empowers families and guardians to select caregivers who meet their needs and preferences. Accessing compensation for caregivers involves specific documentation and reporting procedures, ensuring transparency and accountability in caregiver compensation.

Limitations and challenges

While the waiver provides essential services, there are inherent limitations and challenges. These may include constraints in service availability, administrative complexities, or challenges in meeting the diverse needs of all eligible children. Addressing these challenges is crucial for the effective functioning of the waiver program.

A note from Givers

If you believe your child could benefit from the Medically Fragile (Hospital) Model Waiver, complete this form to explore your family's support options.