Mental Health Waiver

This Medicaid Waiver program, operated by the Department of Mental Health and Addiction Services (DMHAS) with oversight by the Department of Social Services (DSS), serves individuals with serious mental illness and provides an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutional care.

Mental Health Waiver services complement and/or supplement services available to participants through the Medicaid State plan and other federal, state and local public programs as well as natural supports provided by families and communities.

It encompasses a combination of recovery-oriented services and new directions in the community treatment of people with serious psychiatric disabilities. It emphasizes:

  1. Intensive psychiatric rehabilitation provided in the participant’s home and in other community settings
  2. Attention to both psychiatric and medical needs
  3. Emphasis on wellness and recovery
  4. Person-Centered Planning leading to development of an Individualized Recovery Plan
  5. Use of peer supports provided by people trained and certified in rehabilitative care, who know from first-hand experience about recovery from mental illness

Eligibility Criteria

To be eligible for the Mental Health Waiver, individuals must be 22 years of age or older, eligible for Medicaid and be diagnosed with a serious mental illness. In addition, they must be living in an institutional setting or meeting the level of care requirement for nursing home care and express an interest in transitioning into the community. 

Types of services and supports that can be used for Mental Health Waiver

Rehabilitative and Support Services Covered:

  • Residential Based Services
  • Community Support Program (CSP): A flexible, team-based approach to community rehabilitation.
  • Peer Support: An alternative or “step-down” and follow-up to CSP provided by a trained and certified peer specialist.
  • Recovery Assistant: Homemaker, companion, personal care and in-home respite services designed to help a participant maintain their home.
  • Supported Employment: An effective array of mental health supports designed to help participants find and sustain competitive employment.
  • Transitional Case Management: Services provided during the weeks prior to and immediately following discharge from a nursing home to help locate and set up a suitable apartment or other living arrangement.
  • Brief Episode Stabilization: Services designed to stabilize a participant in an emerging crisis situation or following discharge from an institutional level of care.
  • Personal Emergency Response System: Electronic device worn by an individual to secure help in an emergency. May include an electronic medication management system.
  • Assisted Living Service Agency: Personal care and services are provided in a licensed community care facility to residents of the facility. This service includes 24-hour on-site response staff.

Other Ancillary Services:

  • Specialized Medical Equipment
  • Home Accessibility Adaptations
  • Non-medical Transportation
  • Adult Day Health
  • Home-Delivered Meals
  • Chore Services

Apply

Call 1-866-548-0265 or go to the Department of Mental Health and Addiction Services site. Or, download the form here. The completed form and clinical information must be faxed to 860-262-5852.