Head and Spinal Cord Injury Waiver and Mental Retardation/Related Disabilities Waiver  

• A person must be informed of the available alternatives covered by the Medicaid Waiver
• A person must be offered a choice between institutional services or home and community-based services
• and, A person must choose to receive Home and Community Based Medicaid Waiver services
• You have the Right to Appeal

Section 1915(c) of the Federal Social Security Act enables the SC Department of Health and Human services to collaboate with the South Carolina Department of Disailities and Special Needs (SCDDSN) to provide Home and Community-Based Waiver programs.

A Waiver is a provision in the Federal Medicaid guidelines that allows people who meet specific criteria the opportunity to receive services and supports that enable them to live in their community or at home with their families.   There are two types of waivers administered by SCDDSN:  Mental Retardation/Related Disabilities (MR/RD) Waiver; and Head and Spinal Cord Injuries (HASCI) Waiver.

Waiver participants can receive Medicaid-funded services and supports in their own home and other community settings instead of in a nursing facility or ;institution.  The cost of Medicaid Waiver services must be less expensive than or equal to the costs of institutional care.

Health and Safety are Priorities

Head and Spinal Cord Injuries Medicaid Waiver (HASCI)

The HASCI Waiver is limited to people up to age 60 years, with the following conditions:

• traumatic brain injury
• spinal cord injury
• both traumatic brain injury and spinal cord injury
• a similar disability not associated with the process of a progressive degenerative illness, disease, dementia or a neurological disorder related to aging

Persons enrolled prior to age 60 continue to be eligible after their 60th birthday if all other eligibility factors are met

To qualify for HASCI waiver services a person must:

• Be eligible for HASCI Division services
• Request HASCI waiver services through his/her Service Coordinator
• Be eligible for Medicaid or already covered by Medicaid
• Meet Level of Care criteria for Intermediate Care Facility for the Mentally Retarded or Nursing Facility
• Have urgent circumstances affecting his/her health or functional status and which could be life-threatening
• be dependent on others to provide or assist with critical health needs, basic activities of daily living or require daily monitoring or supervision to avoid institutionalization
• Need services not otherwise available within existing community resources, including family, private means and other agencies/programs, or for whom current resources are inadequate to meet the basic needs of the individual to allow him/her to remain in the home
• Be able to live safely in a home setting

HASCI Waiver Services

• Attendant care/personal care assistance services
• Communication services
• Habilitation services, including day, prevocational, supported employment, and residential
• Occupational therapy
• Personal emergency response system
• Physical therapy
• Prescribed drugs
• Private nursing services
• Psychological services
• Respite care
• Specialized Supplies and Adaptations

Mental Retardation/Related Disabilities Waiver (MR/RD)

To qualify for MR/RD Waiver services a person must:

• Be eligible for the MR/RD Division services (have mental retardation or a related disability)
• Be eligible for Medicaid or already covered by Medicaid
• Meet Level of Care criteria for Intermediate Care Facility for the Mentally Retarded (ICF/MR)
• Have needs that can be met through the provision of MR/RD waiver services
• Be given the option of receiving services in his/her home and community or in an Intermediate Care Facility for the Mentall Retarded (ICF/MR)

MR/RD Waiver Services

• Homemaker services
• Habilitation, including residential and day
• Prevocational services
• Supported Employment services
• Personal Care services
• Respite Care
• Environmental Modifications (lifetime monetary cap of $7,500 per recipient)
• Specialized Medical Equipment, Supplies and Assistive Technology
• Adult Companion services
• Psychological services
• Behavior Support services
• Physical Therapy
• Occupational Therapy
• Prescribed Drugs
• Speech/Language Pathology
• Audiological services
• Private Vehicle Modifications (lifetime monetary cap of $4,000 per recipient)
• Adult Dental services
• Adult Vision services
• Nursing services
• Adult Day Health

Freedom of Choice & Service Providers

You have a CHOICE...

Individuals or families are allowed to choose qualified providers for their services and supports.  These providers are either enrolled with the Department of Health and Human Services or they have met requirements as set forth in the Medicaid waivers.  Federal regulations require that providers or waiver services meet minimum qualifications prior to providing services which are funded by Medicaid.

Richland/Lexington Disabilities and Special Needs Board is committed to helping families utilize the provider of their choice.  Training sessions are offered on a continuing basis to accommodate new providers and to help them to meet waiver requirements.

• Consumers can contact providers to evaluate their service quality and to gather other information to assist them in making an informed choice.

• Consumers can change a provider at anytime if they choose to do so.  They must notify their Service Coordinator or Early Interventionist to ensure appropriate authorization of service.

• You have a CHOICE OF PROVIDERS Consumers can receive a copy of an approved Medicaid Provider list at any time.  You can also choose a provider from SCDDSN's Qualified Provider List.

Medicaid Appeal Process

You have the Right To Appeal...

As a Medicaid applicant/recipient you have the right at any time to request a fair hearing from the SC Department of Health and Human Services regarding a decision affecting Medicaid eligibility or services. To initiate the appeal process, you or your representative must submit a written request to the following address no later than thirty (30) calendar days from the receipt of written notification of any action adversely affecting your Medicaid coverage

Division of Appeals and Hearings

SC Department of Health and Human Services

                                        P.O. Box 8206

Columbia, SC 29202-8206

You may be eligible to receive continued Medicaid benefits pending a hearing decision.  If the hearing decision is not in your favor, you may be required to repay Medicaid benefits received during the appeals process.

Please attach a copy of the written notification with your appeal request. In your request for a fair hearing, you must state with specificity which issue(s) you wish to appeal.

Waiver Services and Requirements are subject to change. To ensure you have current information contact the Richland/Lexington DSN Board.

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