Sections 1902(e)(3) and 1915(c) of the Social Security Act allow States to develop
medical assistance programs for certain groups of individuals to provide them with
home or community based care.
In the Dallas Region, only Arkansas had previously provided Medicaid assistance to
disabled children under the authority of section 1902(e)(3) of the Act. However, effective
October 1, 2005, the State of Oklahoma began providing Medicaid under section 1902(e)(3)
of the Act. These children are sometimes referred to as “TEFRA 134 children,” and
they receive regular Medicaid benefits under the State’s Medicaid State Plan (i.e.,
this is not a Medicaid “waiver” but part of the State’s approved Medicaid plan). Essentially,
section 1902(e)(3) permits States to provide Medicaid assistance to children living
at home if it is less expensive than providing similar care in an institution.
In the Dallas Region, all five States provide Medicaid to children under approved
1915(c) home or community based waivers. In addition, there are other 1915(c) waivers
that cover disabled and aged individuals. These programs are separate from the normal
State Medicaid program and are commonly referred to as "home or community based waivers."
Medicaid does not pay for room and board under these waivers. Such programs have been
approved by the Centers for Medicare and Medicaid Services as a mechanism for States
to provide home or community based services, not commonly covered under Medicaid,
as an alternative to institutional care. Such home or community based programs are
usually limited to a certain number of recipients that can be served at any one time.