States may choose to provide Medicaid coverage to specific groups of individuals.
Some groups need only be specified in the State’s Medicaid Plan (e.g., children kept
at home instead of being medically institutionalized). In other cases, the State may
request a waiver of the regular rules from CMS, which if approved, provides specified
services to members of the waiver group. Examples of both of these groups can be found
in the deeming instructions on children affected by State Home Care Plans, located
in SI 01310.201 through SI 01310.209.
Another example of a waiver group is severely disabled children in Indiana. Indiana
uses more restrictive eligibility requirements than those of the SSI program and only
provides Medicaid to nonblind children who meet the State’s AFDC - related standards.
Indiana has a waiver for its “Crippled Children” program. Having a waiver for this group permits the State to provide specified, limited,
services to individuals who might ordinarily not be eligible for any Medicaid coverage.
Waivers vary from State-to-State and over time within a State. Familiarity with whether
a State has medically needy coverage and what, if any, options a State has elected
under Medicaid promotes better referrals. FO’s follow RO and local guidelines for