While exploring your Medicaid options, you may have encountered two potentially confusing terms – “Medicaid waivers” and “traditional Medicaid.” These terms refer to two different benefit delivery systems under the same Medicaid umbrella. In this article, we’ll examine the main differences between Medicaid waivers and traditional Medicaid to help you decide which to pursue for your specific situation.
Traditional Medicaid and Medicaid Waivers: Overview and Benefit Snapshots
Let’s start with some quick overviews of traditional Medicaid and Medicaid waiver programs. We’ll also touch on their benefits. Quite a few of the main differences will come into focus right away.
Traditional Medicaid
Traditional Medicaid is a federal and state government-funded program that provides health insurance to low-income families. Participants can use the health coverage to obtain federally mandated medical services, including:
- Inpatient and outpatient medical services
- Services administered in rural clinics
- Lab and x-ray services
- Family planning services
- Home health
The states may also add optional benefits to their Medicaid plans.
To receive benefits, families must meet family size and income eligibility requirements.
Medicaid Waiver Programs
Medicaid waivers are state programs created for individuals who belong to specific populations (those with chronic illnesses, developmental disabilities, etc.). The goal is to enable those who might not qualify for traditional Medicaid to receive the services and benefits they need. Medicaid waivers run the gamut from home modifications to assistance with activities of daily living to transportation assistance and more.
Here are the Medicaid waiver programs offered through the Office for Citizens with Developmental Disabilities (OCDD) in the state of Louisiana:
There are other non-OCDD waivers, including but not limited to:
The Differences Between Medicaid Waivers and Traditional Medicaid
Medicaid waivers and traditional Medicaid may share some similarities, but there are some important differences:
Flexibility and Customizability
Medicaid waivers are more flexible and customizable than traditional Medicaid. The latter is more of a cookie-cutter health benefits solution covering the essentials for all qualified participants. In contrast, Medicaid waivers are tailored to highly specific populations to provide specialized support.
Eligibility Requirements
Eligibility for traditional Medicaid is determined partly by comparing the applicant’s income and family size to the standard federal poverty level (FPL) income limits.
Each Medicaid waiver comes with a unique set of eligibility requirements. For instance, the Louisiana Children’s Choice Waiver is for Medicaid-eligible children from 0 to 20 years old, and the Louisiana New Opportunities Waiver is for Medicaid-eligible individuals 18 and older (more eligibility requirements apply).
Services Available
Traditional Medicaid offers predetermined mandatory and optional benefits to qualifying applicants within your state. Medicaid waiver services usually fall outside the Medicaid umbrella, offering care that you wouldn’t otherwise be able to get. Home and community-based services (HCBS) like home modifications and personal care assistance are waiver-only benefits.
Which Should You Pursue?
Before deciding whether to pursue traditional Medicaid or a Medicaid waiver, take some time to determine what you really need. Traditional Medicaid tends to be the right choice for those who need essential coverage for medical services and treatments and meet the income requirements.
On the other hand, if you need more specialized services and have a financial need, a Medicaid waiver could be the right choice for you.
Support Coordinators Can Provide Additional Assistance
If you need help deciding which benefits to pursue, contact a support coordinator for assistance. They can further break down your options and provide direction specific to your case.
