AIDS Waiver
Virginia Department of Medical Assistance Services
600 E. Broad St, Suite 1300
Richmond, VA 23219
(804) 786-7933
dmasinfo@dmas.virginia.gov
The AIDS Waiver is a Medicaid program that provides eligible individuals with services in their home and community. This waiver provides a variety of services to individuals with the diagnosis of AIDS who choose home and community based services as an alternative to nursing home care. While assistance with the cost of room and board is not available through Medicaid waivers, waivers provide supports that help individuals to live as independently as possible in the community.
Who qualifies for services?
Individuals must have a diagnosis of AIDS and be experiencing medical and functional symptoms associated with the disease that require hospital or nursing facility care to receive services under this waiver.
Individuals must meet Medicaid eligibility criteria as determined by the local department of social services. Individuals who are found eligible for the AIDS Waiver and choose to receive services may apply for Medicaid using special rules which allow the individual to receive a higher income and still qualify for Medicaid.
Who can help initiate services?
Call the local department of social services (DSS) in your area to schedule an appointment to be screened for long-term care services or if hospitalized request a screening from the hospital social worker or discharge planner.
Will there be a fee?
There is no cost to be screened to determine eligibility for the waiver. Individuals found eligible for the waiver must apply and be found eligible for Medicaid. The DSS worker who processes the Medicaid application will use special rules that apply to individuals found eligible for the AIDS Waiver.
Is there a waiting list?
Currently, there is no waiting list for individuals found eligible to receive AIDS Waiver services.
If someone doesn’t qualify for services, is there an appeal process?
Yes, individuals denied eligibility may appeal within 30 days to:
Recipient Appeals Unit
DMAS, Suite 1300
600 E. Broad St.
Richmond, VA 23219
More information on the appeal process can be found at http://www.dmas.virginia.gov/app-home.htm.
What type of services are available in the AIDS Waiver?
The following services are available based on the individual’s needs and may be provided alone or in combination:
Personal Care (agency or consumer directed) - help with ADL’s (bathing, dressing, grooming, toileting, transferring, ambulation) and IADS’s (using the phone, light housekeeping, shopping).
Respite (agency or consumer directed) - Temporary services which allow an unpaid live-in caregiver to receive breaks from care giving.
Private Duty Nursing - Nursing care provided by a RN or LPN, when a skilled need is determined and the primary caregiver is not able to provide this care.
Enteral Nutrition Products - nutritional supplements needed as the primary source of nourishment due to malnutrition (wasting syndrome) or dehydration.
In addition, individuals receiving AIDS Waiver services have a case manager who will conduct assessments and coordinate and monitor services. Individuals receiving AIDS Waiver services also receive other services through Medicaid. Examples include medications (for those individuals not covered under Medicare), physician visits, acute care hospitalizations, and certain therapies.
Information on Choice
- Eligible individuals have the right to choose between institutional care or receiving waiver services at home and in the community.
- Services that are provided are supports that are needed, that the individual chooses, and that the individual agrees are needed.
- Individuals have the right to choose from among waiver service providers and change providers as needed.
- Individuals have the right to participate in service planning and choose others to assist in service planning if needed.
Who can be called for more information?
For more information, you may talk to your social worker or discharge planner if hospitalized or you may contact the Department of Medical Assistance Services (DMAS) at (804) 786-1465.
This document was developed under Grant No. 91599/3 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. However, the contents herein do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not infer endorsement by the Federal government. Please include this disclaimer whenever copying or using all or any part of this document in dissemination activities.