The only exception that can be made to the first-come, first-served Medicaid Waiver wait list policy, allowing waiver agencies to bypass others, is if a person meets a crisis criteria. These criteria are to be applied in all such circumstances and may not be modified or expanded by the county waiver agency. The only permissible reasons a person may bypass the Medicaid Waiver wait list and/or be served out of the first-come, first-served order are as follows:
Crisis conditions are present in the person’s life situation. The need shall be classified as a crisis if an urgent need is identified as a result of any of the following:
- Substantiated abuse, neglect or exploitation of the individual in his/her current living situation; or
- The death of the individual’s primary caregiver or the sudden inability of that caregiver/support person to provide necessary supervision or support and there is no alternative caregiver available; or
- The lack of an appropriate residence or placement for the person due to a loss of housing; or
- The person has a documented terminal illness with a life expectancy of less than six months, based upon the opinion of a medical professional appropriately qualified to make such a determination; or
- A sudden change in the person’s behavior or the discovery that the person has been behaving in a manner that places the individual or the people with whom the individual shares a residence or the community at large at risk of harm.
- An exception may also be made if there is a finding by the county waiver agency that there the health and safety of the individual is in jeopardy due to the primary caregiver’s physical or mental health status; or
- A determination by the county waiver agency that the person is at imminent risk of a more restrictive placement to an ICF-MR or nursing home or other institutional setting; or
- A finding by the county waiver agency that other emergency or urgent conditions exist that place the individual at risk of harm and a variance is approved by DHS.
When the county waiver agency intends to use one of these criteria to bypass the Medicaid Waiver wait list policy, the agency must request and receive approval from DHS prior to initiating county waiver services. A variance may be requested prior to, or as part of, the service plan application process. If approved, the county waiver agency must maintain documentation of the variance request and approval in the participant record for monitoring or audit purposes.
Completing the Variance Request
DHS expects requesting county waiver agencies to submit a completed F-00076 form, including identifying information about the applicant, the waiver program and a narrative summary outlining the reasons for the exception to the Medicaid Waiver wait list policy. The narrative need not be lengthy but should clearly describe the nature of the crisis situation. The simple insertion of one of the crisis criteria will not be acceptable.
Support Brokers or Transition Coordinators should forward completed Variance Requests to the Dane County DD Intake Unit. The Intake Unit will fill in the “date placed on wait-list” information when they receive the Variance Request form, as Brokers don’t typically have access to this information. The Intake Unit will then review the Variance Request, send to DHS and track its approval.
- Please use the following fillable form:
- Variance Request: www.dhs.wisconsin.gov/forms/f0/f00076.pdf
If you have any questions contact the DD Intake Unit at 608-242-6440.