Question

waiver services:

• are available to everyone who has medicaid coverage
• are available to individuals without further evaluation
• use different eligibility criteria than other medicaid services
• waiver services require that an individual live in an institution

Explanation:

Analyze Medicaid Waiver characteristics

Medicaid Home and Community-Based Services (HCBS) waivers are designed for specific target populations who meet institutional level of care criteria but wish to receive services in their homes or communities. Consequently, they do not require individuals to live in an institution (in fact, they prevent institutionalization), they are not automatically available to everyone with standard Medicaid coverage, and they require a rigorous clinical and functional evaluation rather than being available without further evaluation.

Evaluate the options

• Option 1: Incorrect. Having standard Medicaid coverage does not automatically qualify someone for waiver services; they must meet specific level-of-care criteria.
• Option 2: Incorrect. Individuals must undergo functional and clinical evaluations to determine eligibility.
• Option 3: Correct. Waiver programs use distinct, often more specific, eligibility criteria (such as requiring an institutional level of care) compared to standard state plan Medicaid services.
• Option 4: Incorrect. The primary purpose of a waiver is to allow individuals to receive care in the community instead of living in an institution.

Answer:

• Are available to everyone who has Medicaid coverage
• Are available to individuals without further evaluation
• Use different eligibility criteria than other Medicaid services (Correct answer)
• Waiver services require that an individual live in an institution