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Massachusetts State Medicaid Waiver Program Application Guide

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  • Massachusetts State Medicaid Waiver Program Application Guide




    Waiver #1: Massachusetts Children’s Autism Spectrum Disorder Waiver


    Who Can Apply?

    Circumstances/Diagnosis: Any child under 9 who is diagnosed with autism. The state requires that individuals need at least an intermediate care facility level of care to qualify. This has a technical definition but essentially just means that the individual is unable to get through their day without a lot of supervision.

    Income: Household income cannot exceed 150% of the federal poverty line.

    What do I get?

    Expanded habilitation, education, in-home services and supports such as ABA therapy and floor time for 3 years. After three years families receive ongoing supplemental services like respite.

    How do I apply?

    Contact the Autism Division of the Department of Developmental Services (DDS) at 1-888-367-4435

    Waiver #2: Kaileigh Mulligan Waiver (also know as TEFRA)

    Who Can Apply?

    Circumstances/Diagnosis: Any child under 19 who is diagnosed with any type of severe disability. This includes intellectual and/or developmental disability like autism. The state requires that individuals need at least an intermediate care facility level of care to qualify. This has a technical definition but essentially just means that the individual is unable to get through their day without a lot of supervision.

    Income: Income eligibility is only based on the child’s income and not the parents income. This means that your child is financially eligible for the waiver if they don’t have an income.

    What do I get?

    The way TEFRA waivers work is that they allow families with higher incomes to receive medicaid benefits for their child because eligibility is based on the child income. This means that you will be able to receive dental care, emergency and non-emergency transportation, inpatient and outpatient treatment, medical equipment, occupational therapy, pharmacy, physical therapy, vision and in some states ABA therapy.

    How do I apply?

    Call the MassHealth Enrollment Center at 1-800-841-2900

    Waiver #3: MassHealth CommonHealth

    This waiver has the exact same basic eligibility requirements, provided services, and phone number to call to start the application as the Kaileigh Mulligan Waiver.

    We are not entirely sure what the difference between these two waivers is, but our inclination is that the Kaileigh Mulligan waiver is intended for more severe cases. If you know more about these waivers please comment below.

    What does the Goally Team Think?

    Massachusetts has an unorthodox waiver program because they don’t have traditional expanded services for families with disabilities; they just have two different main programs that waive income requirements for individuals so that they can have medicaid services. Other states have programs like ASD waiver that provide specialized services for thousands of individuals for life. Massachusetts’ ASD waiver only helps out 325 children for a short, albeit critical, period of time. We think the state is on the right track they just need a few extra specialized services to make them a top notch provider.

    Goally Waiver Scorecard

    Website clarity and ease of navigation: 4/5
    Access and requirements of qualification: 4/5
    Healthcare coverage: 2/5

    Other online resources for Massachusetts:

    A through guide on MassHealth CommonHealth Program.
    Find programs for people with developmental disabilities here.
    The Department of Developmental Services offers Family Support Centers that help with networking and parent training. Find out more here.
    The ARC of Massachusetts offers tons of different programs and services for families.

    Telephone Resources

    You can contact the Department of Developmental Services (617) 727-5608 to get more information on any of this information.
    Last edited by Nate; 07-13-2020, 08:51 AM.
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