Overview of HIV/AIDS Waiver

The HIV/AIDS Waiver was developed in 1991. This waiver provides services to individuals who are diagnosed with the human immunodeficiency virus (HIV), who are experiencing the symptoms associated with acquired immune deficiency syndrome (AIDS), and who would otherwise require care provided in a nursing facility or a hospital.

Available services include:

• Nutritional supplements
• Personal Emergency Response System (PERS)
• Transition Services
• Private duty nursing
• Personal care (agency or consumer-directed options)
• Respite care (agency or consumer-directed options)

Individuals receiving Tech Waiver services have their care coordinated by a DMAS staff. Individuals receiving waiver services also receive other services offered through Medicaid. Examples include medications (for those individuals not covered by Medicare), physician visits, acute care hospitalizations, and certain therapies.

Who qualifies for services?

Individuals must have a diagnosis of HIV or AIDS and be experiencing medical and functional symptoms associated with the disease that require hospital or nursing facility care to receive services under the waiver.

Individuals must meet Medicaid eligibility criteria as determined by the local department of social services. Individuals who are found to be eligible for the HIV/AIDS Waiver and choose to receive services may apply for Medicaid using special rules which allow the individual to receive a higher income and still qualify for Medicaid.

Who can help initiate services?

Call the local department of social services in your area to schedule an appointment to be screened for long-term care services or if hospitalized, request a screening from the hospital social worker or discharge planner.

There is no cost to be screened to determine the eligibility for the waiver. Individuals found eligible for waiver services must apply and be found eligible for Medicaid. The DSS worker who processes the Medicaid application will use special rules that apply to individuals found eligible for the HIV/AIDS waiver.

Under Section 1915(c) of the Social Security Act, Medicaid law authorizes the Secretary of the U.S. Department of Health and Human Services to waive certain Medicaid statutory requirements. These waivers enable States to cover a broad array of home and community-based services (HCBS) for targeted populations as an alternative to institutionalization. Waiver services may be optional State Plan services which either are not covered by a particular State or which enhance the State’s coverage. Waivers may also include services not covered through the State Plan such as respite care, environmental modifications, or family training.

Medicaid (also called Medical Assistance) is a program that pays the medical bills of people who have low income and cannot afford medical care. Medicaid provides three types of critical health protection:

• Health insurance for low-income families, children, the elderly, and people with disabilities;
• Long-term care for older Americans and individuals
• Supplemental coverage for low-income Medicare beneficiaries (e.g., payment of Medicare premiums, deductibles, and cost sharing).

Medicaid is a joint federal and state program. Each state establishes its own eligibility standards, benefits package, provider requirements, payment rates, and program administration under broad federal guidelines. The Department of Health and Mental Hygiene (DHMH) runs Maryland’s Medicaid program.