Example

Ernie’s Story

Ernie is 45 years old and was diagnosed with multiple sclerosis (MS) 15 years ago. He’s been living on his own for most of his adult life and has always valued his independence.

A few years after he was diagnosed, Ernie went from working full-time to part-time and signed up for Medicaid for Employed People with Disabilities (MEPD) to get Medicaid health coverage. His MS has progressed over the years and he is having a harder time with cooking, cleaning, and other daily tasks. The regular services he gets under Medicaid just aren’t keeping up with his needs. He’s starting to think that he could use extra services but isn’t sure where to look.

A few friends tell Ernie he should think about moving into a nursing facility, but Ernie wants to keep living at home. He decides to call his Medicaid case worker and ask if there is any way for him to get the services he needs at home. His case worker tells him about Iowa’s Home and Community-Based Services waiver programs, which give extra benefits and services to qualifying people with disabilities to help them live in the community rather than in an institution. That’s exactly what he needs.

Learning about Waivers

Ernie learns that waiver programs are for people who need long-term care services that are at the same level as those provided in a nursing facility. Ernie probably would not have qualified a few years ago, but because his MS has progressed, now he does need that level of care.

Excited, Ernie starts reading about each waiver to see if one of them fits his needs. The Health and Disability Waiver and the Physical Disability Waiver are both for people under 65 who are determined disabled. Both of them offer Attendant Care, which is the main thing he needs to keep living on his own. Getting these services would be a huge help to Ernie.

Applying for the Waiver

Ernie asks his case worker how to apply. She tells him that he can officially request waiver services by going to his local Health and Human Services (HHS) office and filling out a one-page form. At the Health and Human Services (HHS) office, he fills out the form and applies for the Health and Disability Waiver.

After about 45 days, Ernie gets a letter in the mail that says he was denied for a waiver slot. He’s upset at first, but then he remembers that this just means there isn’t a slot available for him yet. He is on the waiting list and has to wait until a slot opens up. In the meantime, he keeps getting Medicaid through MEPD, which mean he’ll be financially eligible for a waiver when it’s available.

Eventually, Ernie gets a letter saying that he is off the waiting list. He’s ecstatic and responds to the notice right away. The next step is for the Department of Health and Human Services (HHS) to do an in-home assessment to make sure that Ernie needs waiver services to keep living at home. A worker named Eve comes to his home and they discuss his activities of daily living, like bathing, dressing, and eating, and how his mobility, cognition, and memory affect him.

Soon after Eve’s assessment, Ernie gets a letter from HHS that says he is finally approved for waiver services! He gets a new case manager for his waiver, and together they make a plan for the services that Ernie needs. Now he can keep living in his home and can continue working part-time. Ernie is thrilled that he can keep living and working in his community.