In the 2007 Legislative session the legislature changed the law to require a four-tier waiver system for individuals receiving Medicaid Waiver services from The Agency for Persons With Disabilities, (APD).
The Legislature created four waiver tiers for people who receive services under the Developmental Disabilities Waiver, the Family and Supported Living Waiver, or the Consumer Directed Care Program. The Legislature also created eligibility criteria for the waivers.
APD is currently identifying the likely tier for each person. APD plans to notify customers of their tier assignment any day now. Individuals and families should be looking for the letters to come in the mail.

The Legislature imposed annual limits on how much the state will spend for services for people in three of the tiers.

The Legislative spending limits are:
Tier 1 – no limit;
Tier 2 - $55,000;
Tier 3 - $35,000; and
Tier 4 - $14,792.


The Agency for Persons With Disabilities wrote a rule that further describes who will be placed in each Tier. The Division of Administrative Hearings upheld this information in a legal challenge. Therefore, the critiera below is being used to determine tier placement for individuals.

Tier 1 Waiver (Currently the Developmental Disabilities Waiver)
• The individual has intensive medical or adaptive needs that are essential for avoiding institutionalization, and the individual’s needs cannot be met in Tier Waivers 2, 3, or 4; or
• The individual has behavioral problems that are exceptional in intensity, duration, or frequency and present a substantial risk of harm to themselves or others, and the individual’s needs cannot be met in Tier Waivers 2, 3, or 4.

Tier 2 Waiver (A new waiver capped at $55,000 a year)
• The customer’s service needs include placement in a licensed residential facility and authorization for greater than five hours per day of residential habilitation services; or
• The client is in supported living and is authorized to receive more than six hours a day of in-home support services.

Tier 3 Waiver (A new waiver capped at $35,000 a year)
• The customer resides in a licensed residential facility and is not eligible for the Tier One Waiver or Tier Two Waiver; or
• The client is 21 or older, resides in their own home and receives In-Home Support Services, and is not eligible for Tier One Waiver or Tier Two Waiver; or
• The customer is 21 or older and authorized to receive Personal Care Assistance services at the moderate level of support as defined in the Developmental Disabilities Handbook; or
• The client is 21 or older and authorized to receive Skilled or Private Duty Nursing Services and not eligible for the Tier One Waiver or Tier Two Waiver; or
• The customer is 22 or older and is authorized to receive services of a behavior analyst and/or a behavior assistant.
• The client is under the age of 22, and authorized to receive the combined services of a behavior analyst and/or a behavior assistant for more than 60 hours a month and is not eligible for the Tier One Waiver or Tier Two Waiver.
• The customer is 21 or older and authorized to receive at least one of the following services: Occupational Therapy, Physical Therapy, Speech Therapy, or Respiratory Therapy.

Tier 4 Waiver (Formerly the Family and Supported Living Waiver, capped at $14,792 a year.)
• Clients who are currently assigned to receive services through the Family and Supported Living Waiver unless there is a significant change in condition or circumstance.
• The total budget in a cost plan year for each Tier Four Waiver client shall not exceed $14,792 per year.
• Customers who are not eligible for assignment to the Tier One Waiver, Tier Two Waiver, or Tier Three Waiver shall be assigned to the Tier Four Waiver.
• Customers who are under the age of 22 and residing in their own home or the family home.
• Clients who are dependent children who reside in residential facilities licensed by the Department of Children and Families.

Reprinted from The Agency for Persons With Disabilities Website


Information contained on this website does not represent legal counsel. Certain sections of information have been reprinted from other websites and from communication with individuals involved in the developmental disabilities field. As always, you should seek legal advice prior to undertaking any legal action.