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How Do I Get Autism Waiver in Arizona [A Guide]

Navigate 'how to get an autism waiver in Arizona' with ease, from eligibility to application, ensuring support.

steven zauderer
Steven Zauderer
March 13, 2024
8 min read
min read

Understanding Autism Waivers

Before diving into the specifics of securing an autism waiver in Arizona, it's essential to understand what autism waivers are and why they are important.

Definition of Autism Waivers

Autism waivers are programs that provide home and community-based services to individuals with autism to assist them in living in their homes or communities rather than in institutional settings. In Arizona, these waivers are managed by the Arizona Department of Economic Security (DES) under the Arizona Long Term Care System (ALTCS) Medicaid Waiver program.

To secure an autism waiver in Arizona, one needs to apply through the Mercy Care Website and meet the eligibility criteria, which includes an autism diagnosis before the age of 21 years old, among other requirements.

Importance of Autism Waivers

Autism waivers play a significant role in providing necessary care and support to individuals with autism while maintaining a sense of independence and staying connected to their communities.

These waivers are critical because they provide individuals with autism the opportunity to access essential services and supports that cater to their specific needs within a home or community setting. This approach not only promotes independence but also ensures that those with autism can lead fulfilling lives within their communities.

Navigating the process of securing an autism waiver can be complex; however, understanding the basics is the first step towards empowering families and individuals with autism to access the support and services they need. The following sections will provide a detailed guide on how to go about this process in Arizona.

Arizona Waivers for Autism

In Arizona, there are two primary programs available for families seeking support for individuals with autism: the Arizona Long Term Care System (ALTCS) and the Arizona Children's Rehabilitative Services (CRS).

Arizona Long Term Care System (ALTCS)

The ALTCS is a Medicaid program that provides long-term care services for individuals with developmental disabilities, such as autism. This program includes home and community-based services for those who require a nursing facility level of care but wish to stay in their homes or community.

To qualify for the ALTCS program, individuals must meet certain criteria. They must require a nursing facility level of care, meet financial eligibility requirements, and have a diagnosed developmental disability, such as autism. The waiver process involves an assessment to determine eligibility based on medical and functional needs.

Applications for the ALTCS program can be made directly through the Arizona Medicaid program or through a Division of Developmental Disabilities (DDD) case manager. The process involves submitting an application, providing necessary documentation, and participating in an in-person assessment to determine eligibility [2].

Once approved for the ALTCS program, individuals with autism can access a range of home and community-based services, such as habilitation, respite care, and behavioral health services. These services are designed to support their needs and enhance their quality of life.

Arizona Children's Rehabilitative Services (CRS)

The CRS program in Arizona is another valuable resource for families with autistic children. This program provides services to children under 21 with certain physical and developmental disabilities, including autism. The CRS program aims to help children maximize their abilities and reach their full potential.

The application process and eligibility requirements for the CRS program can vary, so it's recommended to consult with a healthcare provider or a DDD case manager for specific information.

Through the ALTCS and CRS programs, Arizona offers valuable resources to empower families and support individuals with autism. Securing an autism waiver is a critical step towards accessing these resources and enhancing the quality of life for autistic individuals and their families.

Eligibility for Autism Waivers in Arizona

For families in Arizona seeking support for loved ones with autism, understanding the eligibility requirements for autism waivers is critical. These requirements are twofold, encompassing basic eligibility requirements, and financial eligibility requirements.

Basic Eligibility Requirements

In Arizona, residents with a chronic disability attributed to cognitive disability, cerebral palsy, epilepsy, or autism that manifested before the age of 18 and result in substantial functional limitations in three or more major life activities may be eligible for developmental disability services under the Arizona Long Term Care System (ALTCS).

Children under the age of six years old may be eligible for services in Arizona if there is a strong possibility of having a developmental disability, whereas individuals must be at least three years old to receive services.

To qualify for the ALTCS program, individuals must require nursing facility level of care, meet financial eligibility requirements, and have a diagnosed developmental disability, such as autism. The waiver process involves an assessment to determine eligibility based on medical and functional needs [2].

Applications for an autism waiver in Arizona are processed through the Mercy Care Website. Eligibility criteria include an autism diagnosis before the age of 21 years old, among other requirements [1].

Financial Eligibility Requirements

The financial eligibility for autism waivers in Arizona is overseen by the Arizona Department of Economic Security (DES), which manages the ALTCS Medicaid Waiver program for individuals with autism.

It's important to note that financial eligibility is determined on a case-by-case basis. DES considers the applicant's income and assets, as well as the size and income of the applicant's family. Additionally, certain income and assets may be exempt from consideration, such as a primary residence or a vehicle used for transportation.

While the specific financial thresholds can vary, it's generally required that the applicant's income and assets fall below a certain limit to qualify for Medicaid waivers. Those who are unsure about their financial eligibility should consult with a Medicaid planner or a legal expert.

By understanding the basic and financial eligibility requirements for autism waivers in Arizona, families can navigate the application process more effectively. Securing an autism waiver can provide essential support services that can greatly improve the quality of life for individuals with autism and their families.

Applying for Autism Waivers in Arizona

Securing an autism waiver in Arizona involves a systematic and guided process. This section is designed to provide assistance in understanding the application process and the required documentation.

Application Process

Applying for an autism waiver in Arizona, specifically the Arizona Long Term Care System (ALTCS) program, can be done directly through the Arizona Medicaid program, or with the help of a Division of Developmental Disabilities (DDD) case manager. The process is not overly complicated but requires a series of steps. Here's a simplified breakdown of the application process (Get Goally):

  1. Application Submission: The first step is to fill out and submit the application. This can be done through the Mercy Care Website.
  2. In-Person Assessment: After the application is submitted and initial eligibility is determined, an in-person assessment is conducted to further establish the applicant's eligibility.
  3. Eligibility Determination: Based on the assessment, the eligibility for an autism waiver is determined.

It's important to note that the applicant must have a diagnosis of autism made before the age of 21 years old, among other requirements, to be eligible for an autism waiver in Arizona.

Required Documentation

Obtaining an autism waiver requires the submission of specific documentation to validate the information provided in the application. While the exact documents can vary depending on the individual's circumstances, they typically include:

  1. Proof of Diagnosis: Documentation from a recognized medical professional that confirms the autism diagnosis.
  2. Proof of Age: A birth certificate or any government-issued identification that verifies the applicant's age.
  3. Proof of Residency: Documents such as utility bills, lease agreements, or a state-issued identification that confirms the applicant is a resident of Arizona.
  4. Financial Documents: These may include bank statements, pay stubs, or tax returns to verify the financial status of the applicant.

Remember, the Arizona Department of Economic Security (DES) manages the ALTCS Medicaid Waiver program for individuals with autism. Therefore, any queries or concerns related to the application process or required documentation can be addressed with them.

Knowing how to correctly navigate the application process and what documentation to prepare can significantly simplify the process of obtaining an autism waiver in Arizona. While it may seem daunting, it's a crucial step in accessing the necessary care and support services for individuals with autism.

Services under Autism Waivers in Arizona

Once you've navigated the process of securing an autism waiver in Arizona, you'll have access to a range of services that can significantly enhance the quality of life for individuals with autism. These services fall into two main categories: Home and Community-Based Services, and Other Support Services.

Home and Community-Based Services

The Arizona Long Term Care System (ALTCS) is a Medicaid program that provides long-term care services for individuals with developmental disabilities, such as autism. It includes home and community-based services for those who require a nursing facility level of care but who wish to stay in their homes or community [2].

The availability of autism waivers in Arizona provides individuals with autism the opportunity to access essential services and supports that cater to their specific needs within a home or community setting. The ALTCS program aims to ensure individuals with autism receive necessary care and support while maintaining a sense of independence and staying connected to their communities.

Once approved for the ALTCS program, individuals with autism can access a range of home and community-based services, including:

  • Habilitation: Services designed to help individuals learn, maintain, or improve skills related to activities of daily living.
  • Respite Care: Temporary relief for primary caregivers, providing a short-term break that can also prevent the onset of caregiver burnout.
  • Behavioral Health Services: Therapies and treatments to help manage behaviors, teach skills, and improve mental health.

Other Support Services

In addition to the home and community-based services, the ALTCS program provides a range of other support services to cater to the unique needs of individuals with autism. These services are designed to provide comprehensive support that enhances the overall quality of life for these individuals.

While the specifics of these services can vary based on individual needs, they generally include:

  • Attendant Care: Services provided to assist individuals with daily tasks such as bathing, dressing, and eating.
  • Medical Equipment and Supplies: Provision of necessary medical equipment and supplies that are not covered by the Medicaid state plan.
  • Home Modifications: Changes made to the living environment to ensure the safety and comfort of the individual with autism.

By leveraging these services, individuals with autism can receive the necessary care and support while maintaining their independence and staying connected to their communities. The services provided under the autism waivers in Arizona are integral to empowering these individuals and their families.

Managing Waitlists for Autism Waivers

Understanding the reality of waitlists and preventing unnecessary institutionalization is crucial when seeking autism waivers in Arizona.

The Reality of Waitlists

One of the challenges experienced in Arizona, and other states, is the existence of waiting lists for Medicaid Home- and Community-Based Services (HCBS). These waiting lists come into existence when the number of individuals seeking services exceeds the number of available waiver slots. This imbalance can potentially lead to long wait times for services, averaging up to 36 months [4].

State Average Wait Time (Months)
Arizona 36

This is a significant issue for families and individuals seeking assistance, especially considering the largest Medicaid waiver programs for individuals with disabilities in Arizona are the Intellectual Disabilities (“ID”) Waiver and the Living at Home support waivers.

Avoiding Unnecessary Institutionalization

The existence of HCBS waiting lists often contributes to the risk of unnecessary institutionalization for individuals with disabilities in Arizona. This issue has prompted policymakers across political parties to propose solutions.

As the 25th anniversary of the Olmstead decision approaches, these waiting lists are seen as a reflection of the risk of unnecessary institutionalization for individuals with disabilities. This has led to the proposal of policy changes across parties to address this issue and ensure individuals receive the necessary support in a home or community-based setting rather than being unnecessarily institutionalized.

It's essential for those seeking autism waivers in Arizona to be aware of these realities and engage with the Division of Developmental Disabilities for more information on how to navigate the system effectively. By understanding the process, families and individuals can better manage the waiting lists and avoid unnecessary institutionalization.

References

[1]: https://getgoally.com/blog/state-medicaid-waiver-program-explanation-advice-and-guides/

[2]: https://getgoally.com/medicaid-waivers/medicaid-waiver-guide-arizona/

[3]: http://medicaidwaiver.org/state/arizona.html

[4]: https://www.kff.org/medicaid/issue-brief/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2023/

[5]: https://medicaidwaivernetwork.com/arizona-medicaid-waiver/

steven zauderer

CEO of CrossRiverTherapy - a national ABA therapy company based in the USA.

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