Home and Community-Based Services Waivers

Developmental Disabilities Waiver (DD) and Medically Fragile Waiver

Medicaid Home and Community-Based Services are provided under separate 1915 (c) waivers through the federal Centers for Medicare and Medicaid Services to allow state Medicaid agencies to cover home and community-based services for individuals that require long-term supports and services in order to enable recipients to reside in the community rather than in institutions.

Level of Care:
Annual Reviews - Medically Fragile and DD

Forms for Level of Care:
Medically Fragile Waiver: Use form DOH 378; this waiver is based on meeting the medically fragile criteria.

icon PDF DOH 378


ICF/MR Admission Criteria

icon PDF ICF/MR Admission Criteria

DD Waiver: Use form MAD 378; criteria for meeting this level of care are based on the ICF-MR criteria.

icon PDF Mad 378

Individual Service Plans:

Developmental Disability and Medically Fragile waiver recipients work with his or her Waiver case manager to develop the individual service plan (ISP). Molina Healthcare TPA is responsible for entering these prior approved ISPs into the Omnicaid system. A prior authorization (PA) number will be sent to the case management agency.


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