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. Waiver services complement and/or supplement the services that are available to participants through the Medicaid state plan and other federal, state and local public programs as well as the supports that families and community provide.

The Centers for Medicare and Medicaid Services (CMS) recognizes the design and operational feature of a waiver program will vary depending on the specific needs of the target population, the resources available to the state, service delivery system structure, state goals and objectives, and other factors. A state has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services.

The MFAW Program will provide home and community–based services for participants with serious and complex medical needs who have reached the age of 21 and are no longer eligible for home care services available through SHCN’s HCY Program.

The waiver is administered by the Bureau of Special Health Care Needs (SHCN) through an interagency agreement with the Single State Medicaid Agency, Department of Social Services, MO HealthNet Division (DSS, MHD). SHCN provides service coordination services for participants served by the Waiver. The SHCN SC completes assessments for waiver eligibility. A committee comprised of the SHCN Bureau Chief, Associate Bureau Chief, and PM makes the final determination of eligibility and services available.

The objectives of the MFAW Program are to:

• Provide individual choice between ICF/IID institutional care and comprehensive community based care in a cost effective manner;
• Maintain and improve a community based system of care that diverts participants from institutional and residential care;
• Ensure the adequacy of medical care and services provided through case management;
• Monitor each participant’s condition and continued appropriateness of participation through quarterly home visits by the SHCN SC; and
• Monitor provider provision of services through care plan reviews and documentation that identifies the participant’s progress, implementation of services, and appropriateness of the services provided.

Waiver services are accessed through referral to SHCN for those participants who reach the age of 21, meet the criteria of the waiver, and desire to remain in their homes.  Referrals are also accepted from health care providers, families, other state agencies, and other sources. Participant, parent(s) and/or responsible party(ies), are provided with a list of service providers available in the area in which they live. Participant, parent(s) and/or responsible party(ies), may choose their provider and may change providers at any time.  Services are prior authorized by the SHCN SC and are subject to approval by the State Medicaid Agency, MHD. Providers are paid directly though the MO HealthNet MMIS system.