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FAQ Data Descriptions Waiver 

Select the Frequently Asked Question to view answer.
  1. What is a waiver?
    Illinois’ nine Home and Community Based Services (HCBS) waivers cover services that normally are not covered by Medicaid. Generally, waivers are intended to allow people with serious disabilities or illnesses to avoid institutionalization by increasing their access to services within their homes and communities. Waivers are a cost-saving measure, designed to provide care to a given population at a lower cost than care rendered in a hospital, nursing facility, or intermediate care facility.

    Each waiver offers a set of services specific to individuals who have a given disability or illness. Most, but not all, waiver populations are seniors or adults with disabilities. As such, they are considered priority populations for this solicitation. Various waiver programs include different types and levels of benefits.

    For a list of all waivers, please view our data dictionary, glossary, or you can view a list of all waivers online.
  2. How are waiver populations included in the data sets?
    Waivers are a category of benefits that cover services that normally are not covered by Medicaid. Generally, waivers are intended to allow people with serious disabilities or illnesses to avoid institutionalization by increasing their access to services within their homes and communities. Most waiver populations are seniors or adults with disabilities. As such, they are considered priority populations for this solicitation. (For more information on waiver definitions, please consult the Glossary.)

    All recipients of Medicaid waivers were first qualified to receive full Medicaid benefits. As a result, their healthcare data are included in both data sets. This includes information on any services they have received that do not require a waiver.

    We acknowledge a long-standing issue with waiver enrollments: recipients who are institutionalized, deceased, no longer eligible, or otherwise no longer using waiver services typically remain enrolled. This results in an overestimation of the total number of waiver recipients, and an underestimate of their average healthcare service use. We ask data users to consider interpreting those waiver recipients who have no claims during the year or who are institutionalized as possibly inappropriately enrolled.
  3. How are services given to waiver recipients included in the data?
    All recipients of Medicaid waivers were first qualified to receive full Medicaid benefits. As a result, their healthcare data are included in the data sets. This includes information on any services they have received that do not require a waiver.
  4. What information in the data set is provided on waiver enrollments?

    We supply three waiver enrollment data points for each waiver program: enrollment as of the anchor date, enrollment anytime during the experience period, and claims. This allows assessment of the total number of persons who received waivers during the year; those who retained their enrollment at the end of the period; and their pattern of healthcare service use. (We have an additional field that contains information on long-term care institutionalization as of the anchor date.)

    Please note that enrollment data may not represent all the people who are eligible for waivers, as some waivers have waiting lists. Additionally, the waiver enrollment process is separate from enrollment in Medicaid generally; some Medicaid recipients who are appropriate candidates for waiver services may not be enrolled in a waiver.

    Please refer to item 1 of the FAQ section “Solicitation and Policy Details” for more information on the term “enrollment.”

  5. What limitations are there in the data on waivers?
    We acknowledge a long-standing issue with waiver enrollments: recipients who are institutionalized, deceased, no longer eligible, or otherwise no longer using waiver services often remain enrolled. This results in an overestimation of the total number of waiver recipients, and an underestimate of their average healthcare service use. Our best advice to our partner organizations is to rely upon the waiver claim indicators to indicate who is using a waiver and who is not; those who are no longer enrolled will stop submitting claims even if their records are not properly updated. We ask data users to consider interpreting those waiver recipients who have no claims during the year or who are recorded as receiving services in an institution as possibly inappropriately enrolled.
  6. How might waivers change in 2012?

    Several waivers (Illinois HCBS Waiver for Persons with Brain Injury, Illinois Supportive Living Program waivers, and Illinois Waivers for Adults with Developmental Disabilities) will expire on June 31, 2012, and the Illinois HCBS Waiver for Children who are Medically Fragile, Technology Dependent expires on August 31, 2012. Due to the timing that coincides with CCIP's selection of proposals for new coordinated care entities.

    We currently anticipate that these waivers will be renewed, but in some cases they may be substantially revised to augment fraud protections, eliminate loopholes, or to increase cost-savings. Please note that age-based eligibility criteria for some waivers may change.

    We anticipate that significant updates will occur only after the close of the Solicitation period, and therefore we cannot advise partner organizations on impending changes. However, we will include any pertinent changes into the negotiation process for entities whose proposals are selected for contract.

  7. What is Money Follows the Person, and how is it included in the data sets?
    Money Follows the Person (MFP) is a program that assists persons in Nursing Facilities and other institutions to transition to living in the community. The program funds special care that is otherwise not available to Medicaid recipients for the transitional period. In this way, it is similar to a waiver. Additionally, the Types of Service available to waiver recipients are also available to MFP recipients. For these reasons, MFP is included with waiver services in the data sets, although it may be considered ‘not quite’ a waiver. We also provide three data points on MFP: enrollment as of the anchor date, enrollment at any point during the experience period, and a claims indicator.
  8. How are ages recorded in waivers, and how does this differ from age banding in the data sets?
    Age bands in the data are 0-18 years old, 19-20 years old, 21-44 years old, 45-64 years old, and 65+ years old.

    In some cases, waivers use different age brackets as eligibility criteria. These include ages 0 to 21 years (MFTD waiver), 3 to 21 years (residential and supportive Developmental Disability waivers for children and young adults), 19 and over (Developmental Disability waivers for adults), 0 to 59 years (Physical Disability waiver), 60 years and over (Supportive Living Facilities waiver), 65 years and over (Aged waiver), and all ages (Brain Injury and AIDS waivers).

    Some of these age brackets overlap the age bands available in our data sets. Therefore, partners wishing to compare waiver populations to non-waiver populations of similar age may wish to select the closest representative age band(s).
  9. How are waiver claims represented in the data?
    All waiver claims are indicated as such. Please see our Type of Service documentation for more information.

    Please note that some waiver claims are included in the data sets for persons who are not indicated as being enrolled at the anchor date or any point during the experience period. This is related to incorrect management of enrollment data. HFS is working to correct the issue, but is not able to retroactively apply these corrections to our experience period. We advise partner organizations to regard waiver claims data as the most accurate information on waiver recipients.
  10. Can a waiver recipient also receive non-waiver services?
    Yes, in some cases. A person may begin receiving waiver services during the experience period; any non-waiver services they received in the time prior to their enrollment will be included in the data sets in addition to their waiver services.

    A person may also receive non-waiver Types of Service in addition to waiver services. As it is impossible to enroll in a waiver without first having enrolled in full Medicaid benefits, all waiver recipients are also entitled to receive medically necessary non-waiver services. Please note that many services available as non-waiver services are also available as waiver services (often with specialized providers or extensions in Medicaid coverage); in these cases, the services that a waiver recipient receives are billed only as waiver services.
  11. Can a person who is not a waiver recipient receive waiver services?
    No. Our data may contain some instances in which waiver services claims are submitted by a person without a waiver. In these cases, the data is in error.