New Rules About EPSDT May Affect Waiver Services for Children

July 28, 2017

DBHDS and DMAS have published information about the requirement to use select EPSDT  services in lieu of Waiver services for children; these services are Private Duty Nursing, Personal Care/Personal Assistance and Assistive Technology.  New authorizations submitted after 1 August for services heretofore provided under one of the DD Waivers will be submitted as EPSDT Services to DBHDS through the WaMS system (See Medicaid Memo of 26 July, 2017).

The information which has not been widely publicized is the risk to the child for both losing their Waiver slot, or for losing their Medicaid coverage altogether!  While there is a relatively small number of children who do not have another DD Waiver service (eg respite), there are a few.  Once the services listed above become EPSDT services, the rule that if Waiver services are not being used the slot may be reassigned could apply.  Of even greater concern is that many children are only eligible for Medicaid by virtue of their enrollment on a Waiver because the financial rules allow for exclusion of the family’s income.

The CSBs will be strong advocates for the affected children on the DD Waivers; it is less clear how many children on the newly formed CCC+ Waiver (combined EDCD and Tech Waivers) will have a strong advocate to help them maintain services!