Medicaid Waivers for Military Families

Many military families with special needs know the ins and outs of applying for state Medicaid waivers and the frustration of reaching or getting closer to the top of the waiting list, only to PCS and start the process over. In fact, families report waiting for years on these lists and never being able to receive Medicaid funding benefits during the service member’s active-duty career.

Because of this, the Defense Department created the TRICARE ECHO program to provide coverage for sponsored family members with condition-specific needs. ECHO offers a full range of services, including rehabilitative or assistive services, equipment, home health care, residential services and respite. Unlike Medicaid waivers, ECHO benefits move with the family. However, military families lose ECHO support when the sponsor separates or retires from the military.

The Department of Defense-State Liaison Office has been working hard to improve the availability of Medicaid waivers for military families in preparation for the time when they no longer have Tricare ECHO available due to separation or retirement. The DSLO Military State Policy Source website indicates that 38 states and the District of Columbia have either no waiting list or policies that support military members on the waiting list in their state of legal residence while on active duty.

How waivers work

Waivers are state-specific Medicaid programs that provide funding for long-term care services to be provided in the community instead of in nursing homes or hospitals. Each state receives Medicaid funding from the federal government and chooses how to spend it through its state Medicaid program, which set guidelines on who gets assistance and how they qualify. In many states, the community need for a particular waiver outweighs available funding, and a waiting list is created of approved applicants. It can take several years before an applicant receives federal aid-supported services.

How the military waiver benefit works

States already agree to work with military families on many topics so they can receive the same priorities as other eligible state residents. For many states, that consideration is now extended to include Medicaid waiver waiting list placement. Service members who are legal residents of a state where applicable policy has been enacted may enroll an eligible family member on the state waiver list as early as possible so they can progress towards the top of that list prior to separation/retirement. Families can enroll at any time and service members have the flexibility to change their state of legal residence as long as they meet the state requirements.

• State actions. Families begin the process by notifying the state where they are planning to move upon separation or retirement. Military families may be able to retain their wait list position in their state of legal residence during military-directed moves outside the state.
• Using state of legal residence. States may allow active-duty service members to use their state of legal residence (where they pay taxes, vote, register their vehicles, hold a driver’s license, etc.) to register their family member with special needs for a Medicaid Home and Community Based Services waiver.
• Modifying existing waiver category. States may consider modifying one of their existing waiver categories (such as individuals with critical need). This would allow military families transferring into a state (or transitioning out of the military) to be placed on the expedited list to receive services through HCBS. The military family member must have been receiving services at the last location to qualify.

According to the DSLO Military State Policy Source website, the following states either have no waiting list (*) or agree to the policy of allowing active-duty military families to enroll in their state of legal residence and be placed on the wait list, or retain their wait list position despite a military-directed move out of state:

Alabama, Alaska, Arkansas, Arizona*, California, Connecticut, Delaware*, District of Columbia*, Florida, Georgia, Hawaii*, Idaho*, Illinois, Indiana, Kansas, Louisiana, Massachusetts*, Maryland, Michigan, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Jersey*, New Mexico, New York, Ohio, Oklahoma, Oregon, Rhode Island*, South Carolina, South Dakota, Tennessee, Texas, Virginia, Vermont, Washington* and Wyoming.

The following state has modified an existing waiver category: Florida.

Get more information

Find more information and resources to help you become your family’s best advocate. If you have questions about Medicaid waivers or need to know more about available services and supports, contact your installation EFMP Family Support Staff or a Military OneSource special needs specialty consultant through Military OneSource at 800-342-9647 or by live chat.