Eligibility Criteria for the HCBS Waivers for adults with intellectual disabilities
To qualify to participate in one of these three waiver programs, an individual must meet the clinical and financial eligibility requirements:
- Have an intellectual disability as defined by the Department of Developmental Services (DDS);
- Meet the level of care needed for an Intermediate Care Facility for Intellectual Disability (ICF-ID);
- Be 22 years of age or older;
- Need a waiver service monthly;
- Be safe to serve in the community within the terms of the waiver in which the participant is enrolled; and,
- Meet the financial requirements to qualify for MassHealth Standard in the community. Special financial rules exist for waiver applicants and participants.
An individual must meet all of the requirements above in order to qualify for any of these three waiver programs. An individual may not participate in more than one waiver program at a time. Eligibility for each waiver program is determined by the level of support the applicant requires, based on their assessed needs.
The following information includes descriptions of the Adults Supports Waiver, Community Living Waiver, and Intensive Supports Waiver, along with any additional eligibility requirements that apply to each waiver program.
Adult Supports Waiver
The Adult Supports Waiver provides services to individuals who meet the eligibility criteria and require at least one home- and community-based waiver service per month. Participants do not require the levels of support provided under either the Community Living Waiver or the Intensive Supports Waiver. Participants live in family homes, adult foster care, or independently and do not require 24 hour care. Their health and welfare needs can be met in these community settings. Waiver services may vary depending on the living arrangement of the participant. Participants will only receive services through the waiver that are needed in order to remain safely in the community. Participants in the Adult Supports Waiver can choose to direct their services if they are interested. The Adult Supports waiver offers both budget authority and employer authority as options for participant direction.
Community Living Waiver
The Community Living Waiver provides services to individuals who meet the eligibility criteria and require at least one home- and community-based waiver service per month. Participants require more support than those in the Adult Supports Waiver, but less than those in the Intensive Supports Waiver. Participants live in the family home, adult foster care, with a live-in caregiver, or independently and do not require 24 hour care. Their health and welfare needs can be met in these community settings. Waiver services may vary depending on the living arrangement of the participant. Participants will only receive services through the waiver that are needed in order to remain safely in the community. Participants in the Community Living Waiver can choose to direct their services if they are interested. The Community Living waiver offers both budget authority and employer authority as options for participant direction.
Intensive Supports Waiver
The Intensive Supports Waiver provides services to individuals who meet the eligibility criteria and require supervision and support 24 hours a day, seven days a week due to significant behavioral, medical and/or physical support needs. Participants will only receive services through the waiver that are needed in order to remain safely in the community. Participants in the Intensive Supports Waiver can choose to direct their services if they are interested. The Intensive Supports waiver offers both budget authority and employer authority as options for participant direction.
Additional Resources
Services Offered to Participants in the HCBS Waivers for adults with intellectual disabilities
Services Offered to Participants in the HCBS Waivers for adults with intellectual disabilities
All participants in the HCBS waivers for adults with intellectual disabilities can receive traditional MassHealth services, non-waiver services available through DDS, and the services available in the waiver in which they are enrolled. All waiver participants work with a Service Coordinator to develop an individual service plan and plan of care that reflects the waiver and non-waiver services and supports they need in the community.
The following is a list of the services available in the Adult Supports waiver, the Community Living waiver, and the Intensive Supports waiver.
Yes means the service is available
No means it’s not available
|
Service |
Adult Supports |
Community Living |
Intensive Supports |
|---|---|---|---|
|
Adult Companion |
YES |
YES |
YES |
|
Assistive Technology |
YES |
YES |
YES |
|
Behavioral Supports and Consultation |
YES |
YES |
YES |
|
Chore |
YES |
YES |
YES |
|
Community Based Day Supports |
YES |
YES |
YES |
|
Family Training |
YES |
YES |
YES |
|
Group Supported Employment |
YES |
YES |
YES |
|
Home Modifications & Adaptations |
YES |
YES |
YES |
| Individual Goods and Services |
YES |
YES |
YES |
|
Individual Supported Employment |
YES |
YES |
YES |
|
Individualized Day Supports |
YES |
YES |
YES |
|
Individualized Home Supports |
YES |
YES |
YES |
|
Live-in Caregiver |
NO |
YES |
YES |
|
Peer Support |
YES |
YES |
YES |
| Placement Services (Shared Living)-24 Hour Supports | NO | No | YES |
|
Remote Supports and Monitoring |
YES | YES | YES |
|
Residential Habilitation |
NO |
NO |
YES |
|
Respite |
YES |
YES |
YES |
|
Specialized Medical Equipment and Supplies |
YES |
YES |
YES |
|
Stabilization |
YES |
YES |
YES |
|
Transitional Assistance Services |
NO |
NO |
YES |
|
Transportation |
YES |
YES |
YES |
|
Vehicle Modification |
YES |
YES |
YES |
|
24-Hour Self Directed Home Sharing Support |
NO |
NO |
YES |
Service Delivery Options
The three HCBS waivers for adults with intellectual disabilities offer participants the opportunity to have certain waiver services delivered under the participant-direction program (PDP) or using the Agency with Choice (AWC) option.
The Participant Directed Program (PDP) offers the most flexibility to arrange and customize supports based on the participant’s needs and preferences. The participant can hire their own support staff and make other decisions about how to use the service funding that has been allocated by DDS.
The Agency with Choice model allows individuals and families to choose and supervise their staff and to purchase goods and services, without having to be responsible for regulatory, accounting, legal and technical duties associated with being an employer and purchaser.
Waiver participants should speak with their DDS service coordinator to discuss these service delivery options.
Additional Resources
What you need to know about the HCBS Community Rule
The Centers for Medicare and Medicaid Services (CMS) published the HCBS Community Rule in the Federal Register on March 17, 2014. The Community Rule is intended to assure that individuals receiving long‐term services and supports have full access to the benefits of community living and the opportunity to receive services in the most integrated settings possible. The new rule creates a more outcome‐oriented definition of home and community based settings, rather than one based solely on a setting’s location, geography, size or physical characteristics.
Additional information about the Community Rule can be found here
Application Process and Applications
Eligibility determination for the HCBS waivers for adults with intellectual disabilities is a multi-step process. The waiver applications available below can be completed and submitted to the DDS Waiver Management Unit directly. However, it is strongly recommended that waiver applicants coordinate with their DDS Service Coordinator or DDS Area Office in order to facilitate and expedite the eligibility determination process.
Some key steps in the waiver application process:
- Apply for DDS eligibility (if you are not currently DDS eligible);
- Apply for the DDS waiver program;
- Submit your application to your Area Office (preferred) or directly to the DDS Waiver Management Unit.
If you are not currently DDS eligible, you may find important information at DDS Eligibility Information
You may submit an application to participate in the Adult Supports, Community Living, and Intensive Supports waivers at any time. To expedite the eligibility determination of your application, it is recommended you coordinate with your DDS Service Coordinator or Area Office to complete and submit your waiver application to the DDS Waiver Management Unit.
Send your completed application to your DDS Service Coordinator, your local DDS Area Office, or directly to the DDS Waiver Management Unit.
Find your local DDS Area Office
Additional Resources
Contact for HCBS Waivers for Adults with Intellectual Disabilities: Information for Individuals & Families
Phone
At prompt, please press 2 for the Waiver Management Unit