ID Eligibility
An individual is deemed eligible for ID Waiver services based on three factors:
Diagnostic Eligibility
Individuals six years of age or older must have a psychological evaluation completed by a licensed professional that states a diagnosis of mental retardation (also know known as intellectual disability) and reflects the individual’s current level of functioning. Individuals under age six must have a psychological or standardized developmental evaluation that states that the child has a diagnosis of mental retardation (intellectual disability) or is at developmental risk and reflects the child’s current level of functioning.
Functional Eligibility
All individuals receiving ID Waiver services must meet the ICF-MR (Intermediate Care Facility [for persons with] – Mental Retardation/Intellectual Disability) level of care. This is established by meeting the indicated dependency level in two or more of the categories on the “Level of Functioning Survey” that is used to screen an individual’s eligibility by a qualified professional.
Financial Eligibility
An eligibility worker from the local Department of Social Services determines an individual’s financial eligibility for Medicaid. Some individuals who would not ordinarily qualify financially for Medicaid may be eligible by receipt of MR Waiver services. Medicaid regulations specify that, once an individual has been determined eligible by the CSB/BHA case manager, he or she must be offered a choice between institutional and Waiver services.
