Waivers

waiver overview

Virginia Medicaid Waivers

Medicaid waivers are programs that allow individuals with disabilities or complex medical needs to receive long-term services and supports in their home and community, rather than in an institution. Virginia offers several waivers, each designed to meet different levels of need.

CCC Plus Waiver (Commonwealth Coordinated Care Plus)

How to apply:

If the individual is under 18, call your local Department of Health.
If the individual is 18 or older, call your local Department of Social Services.
Ask for a “UAI Screening” (Uniform Assessment Instrument). This is the assessment used to determine eligibility for the CCC+ Waiver.
The process generally takes about two weeks from the date of screening to receive an approval or denial letter. If denied: You have the right to appeal within 30 days of receiving the denial letter.
When approved: Contact your local Department of Social Services at 855-242-8282 and request Long Term Care Medicaid. Be sure to let them know you were approved for the CCC+ Waiver.
Once approved for medicaid, you can continue with your waiver journey and if you choose the CD model, TTG would love to be your Service Facilitator!

Who is this for:

For individuals of all ages with significant medical needs or disabilities.
Provides personal care, respite, private duty nursing, adult day health, and assistive technology.
Often used for individuals with both medical and functional needs who would otherwise qualify for nursing facility level of care.

DD Waiver (Developmental Disability Waiver)

The Virginia Developmental Disability (DD) Waiver system is made up of three separate waivers, each designed to serve people with developmental disabilities based on their level of need and living situation. Each waiver has eligibility criteria (medical/functional need and financial criteria) and requires an assessment to determine qualification. Slots for DD waivers (FIS, CL, BI) are limited and allocated based on priority.

How to Apply:

Contact your local Community Services Board (CSB). They will gather documentation of your disability, complete a functional assessment (VIDES), and determine eligibility. If approved, you are placed on a waiting list with a priority level (1–3) based on your needs. Priority One cases may go through a critical needs review for slot assignment. Once a slot is offered, you’ll work with a support coordinator, apply for Medicaid if not already enrolled, and begin services.

Family and Individual Supports (FIS) Waiver
For individuals with intellectual or developmental disabilities (I/DD).

Offers services like in-home support, respite, assistive technology, and community engagement.
Intended to support individuals living with family or independently.

Community Living (CL) Waiver

For individuals with I/DD who require more intensive, 24-hour supports.
Provides residential services, day support, crisis services, and nursing.
Often for those living in group homes or supervised residential settings.

Building Independence (BI) Waiver

For adults with I/DD who do not require 24-hour care.
Supports independent living through services such as supported employment and skill-building.

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) Program

EPSDT is a federal Medicaid benefit available to all individuals under age 21 that already qualify for Medicaid. In Virginia, EPSDT is often described as “the gateway to medically necessary services” for children and youth.

How to Apply:

Must be under 21 years old and already eligible for Medicaid.
Must need help in at least 3 ADLs (bathing, dressing, eating, transferring, toileting)

A doctor (primary care physician, physician’s assistant, or nurse practitioner) will need to fill out a DMAS-7 completely along with a schedule requested. (See a sample DMAS-7 HERE).

Key Features:

Comprehensive coverage: EPSDT ensures children and youth receive all medically necessary Medicaid-covered services, even if those services are not included in the state’s standard Medicaid plan for adults.

Difference from Waivers:

EPSDT is not limited by waiver slot availability and is an entitlement for children under 21.
Waivers provide long-term support across the lifespan, while EPSDT covers medically necessary treatment and supports for children/youth.
Many families use EPSDT for children and then transition into waivers for continued support into adulthood.

In Summary:

Waivers = Long-term services to help people of all ages remain in the community instead of institutions.
EPSDT = Comprehensive Medicaid benefit for children under 21, covering all medically necessary services beyond standard Medicaid.