Autism Spectrum Waiver

The Medicaid Waiver for Children with Autism Spectrum Disorder provides one service, Early Intensive Behavioral Intervention.  This is a therapy service for children under the age of 9 with autism to assist them with certain skills.  

There may be a monthly premium eligibility requirement for each child based on the income of the financially responsible parent(s) and any income of the child on the Autism Waiver

KEY POINTS:

• Eligibility for the Autism Waiver is determined by UNMC-Monroe Myer Institute staff.
• The Medicaid program case should contain only the child eligible for the waiver.  
• The Autism Waiver program case should contain only the eligible child.

See Also:

Add Program Case (Mainframe)

Add a Program Case (expert)

To Activate the Autism Waiver:

If the Medicaid program case is a CMAP or AABD case for the child, a budget must be ran in expert to activate the waiver.

1. Double click on the Budgeting task.  Note:  If a benefit month has not been selected, the Select Benefit Month window will display first.
2. The Waiver Related Premium window will open.

• Enter the unit size: the unit size will be the total of the financially responsible parent(s) and the child.  If the child does not reside with a financially responsible parent, the unit size will be only the child.  No other individuals are counted in the unit size.
• Enter the total countable unearned income of the child and the financially responsible parent(s).
• Enter the total gross earned income of the financially responsible parent(s).

3. Click OK to process the waiver related premium information.
4. Authorize the budget to activate the waiver.

If there are two or more children in a single family who receive Autism waiver services and are subject to a premium, there is a fee for each child.  However, the total fee for all children can not exceed 5% of the income for the unit size.

Note:  If the Medicaid program case is a CFS program case for the child, the waiver is activated in the mainframe.

Premium Schedule for Parents of Children on Autism Waiver
Based on 2009 Federal Poverty Levels

If the gross income is higher than the amounts on this chart then the premium amount is 5% of the gross.

Premium Due Billing Cycle Information:

Monthly statements are sent out at the first of each month for clients in Premium Due (PD) status.  Payments must be postmarked by the 21st of the month.  The premium is submitted to the Economic Assistance Unit.    For example:  the monthly billing statement for March is mailed out February 1st, and must be postmarked no later than February 21st.

Premium Billing Cycle Information for the Initial Months of Eligibility:

When an application is received one month, and eligibility is not determined until the next month, the monthly billing cycle procedures are slightly different.

When the case is initially approved the billing statement will be created in the daily batch process and will be mailed the next day.   If they apply in December and the application is approved on January 20th, the first billing statement will be created in batch that night.  The billing statement will be mailed the next working day.  There would be one statement for December, one for January, and one for February.  All of these would be due February 21.  

The first monthly bill would be created on February 1.  It would be for March and it would also be due February 21.

(03-2009)