Maryland’s Autism Waiver

By MSDE DEI/SES | October 14, 2021

Purpose

The Autism Waiver (AW) is designed to provide community-based, long-term, person-centered therapeutic services and support to eligible children and youth with Autism Spectrum Disorder (ASD) to enable home and community living as an alternative to institutional care.

Background

House Bill 99 was proposed by Delegate John Hurson during the 1998 legislative session. The General Assembly approved and required the Maryland Department of Health (MDH) to apply to the Centers for Medicare and Medicaid Services (CMS) for a Home and Community-Based Services Waiver under Section 1915(c) of the Social Security Act, to serve children with autism. In August 1998, MDH applied for this Waiver to allow children with autism, determined to be eligible for institutional services in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID), to receive AW services in their home and community. On September 1, 2000, MDH received confirmation from CMS that Maryland’s AW was approved and children began receiving services in 2001.

Administration

The AW is a partnership between the Maryland State Department of Education (MSDE) and the MDH. MSDE, through the local school system (LSS), is responsible for the day-to-day implementation of the AW. The MDH is charged with the administration of Maryland’s Medicaid program and oversight of the AW.

The number of slots allowable is determined by the CMS. The Governor and the Maryland State Legislature approve funding.

Eligibility

The AW Registry is a list of individuals interested in AW services. Families must contact the AW Registry at 866-417-3480 to be eligible to apply to the AW when a vacancy occurs.

Children and youth must meet the following criteria:

Have a current diagnosis of ASD;
Are ages 1 through the end of the school semester that the child turns 21 years old;
Reside in Maryland;
Have an Individualized Educational Program (IEP) or Individualized Family Service Plan (IFSP) with at least 15 hours per week of special education and/or related services;
Meet eligibility requirements for an ICF-IID institutional level of care;
Are able to be served and safely maintained in the home and community with AW services; and
Meet financial eligibility for Medical Assistance; their monthly income may not exceed 300% of SSI benefits, and their countable assets may not exceed $2,000 or $2500 (depending on eligibility category).

Autism Waiver Services

AW services are offered by providers who must be approved as Medicaid providers and be appropriately licensed or certified. Statewide, there are over 60 Autism Waiver provider agencies. Provider agencies are approved to provide as few as one or as many as all nine AW services and may serve fewer than five individuals and up to or over 100.

Adult Life Planning (ALP): Family-centered and focused on educating and supporting the family in accessing adult community services on behalf of the participant. This service will emphasize the development of a plan for decision-making in the autism/developmental disabilities system.
Environmental Accessibility Adaptations (EAA): Funding towards making physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual in the home environment and enable the child to function with greater independence.
Family Consultation (FC): Consultation and training supporting families of children and young adults served through the Autism Waiver.
Intensive Individual Support Services (IISS): One-on-one assistance based on the individual’s need for interventions and support as identified in an individualized treatment plan. These services use the home and community environment as a learning experience and as an opportunity to illustrate and model alternative ways of behaving for the child.
Residential Habilitation (Regular or Intensive): Community-based residential placement for those children who cannot live at home at the present time because they require highly supervised and supportive environments with the goal of returning the child to the home. Services are designed to assist children in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.
Respite Care: Short-term supervision and assistance with activities of daily living that are provided to individuals because of the absence or need for relief of those persons normally providing care.
Therapeutic Integration (TI: Regular or Intensive): A structured program during after-school hours, weekends, and non-school days that provides therapeutic services specially needed for children and adolescents who have problems with socialization, isolation, hyperactivity, impulse control, and behavioral or other related disorders.

Note: Each Autism Waiver participant also receives Service Coordination/targeted case management through their local school system. In addition, the Autism Waiver also qualifies the participant for full benefits through Medical Assistance to include health insurance, prescription coverage, dental care, physician and hospital care, home health, laboratory services, disposable medical supplies, durable medical equipment, mental health, and other services.