About the MFTD Waiver
The Medically Fragile and Technology Dependent Waiver (MFTD Waiver) is a home and community based services waiver, also called a 1915(c) waiver. It is a Medicaid program that the federal government has granted to the state of Illinois to prevent costly institutionalization and permanent hospitalization of children who need medical technology. It is called a "waiver" because it waives standard Medicaid rules by evaluating only the child's income when calculating eligibility. Under normal rules, children are eligible for Medicaid while living in an institution/hospital, but not once they return home unless their family qualifies financially for Medicaid. The MFTD Waiver is a federal-state partnership that allows children with medical technology to receive both Medicaid coverage and private duty nursing.
Most individuals on this waiver are ventilator-dependent, have tracheostomies, or have central IV lines, and require extensive care and services. Without this waiver, 95% of these children and young adults would require permanent hospitalization to receive their care. The remaining 5% could be cared for in a skilled nursing facility.
Children who have private insurance only receive supplemental Medicaid coverage to cover expenses their private insurance does not pay for, while uninsured children can receive full coverage. To learn about benefits, visit our MFTD Benefits page.
Children throughout the state are eligible for the waiver as long as they are under 21 when first appyling, meet medical eligibility, require ongoing home nursing, can safely be cared for at home, and the cost of care is less than it would be in a hospital or skilled nursing facility. The average cost for hospitalization in a pediatric hospital is $56,000 per month, while the average cost for private duty nursing at home is $8888 per month (2012 data). In other words, it is three times cheaper to care for these children at home than in hospitals and institutions.
Currently, the capacity of the waiver is 925 individuals, though the state has requested an increase to 1015. The average cost per child in fiscal year 2010 was $188,210 per year.
The program is run by Illinois' Department of Healthcare and Family Services, but the day-to-day operations are provided by UIC Specialized Care for Children (DSCC), which is part of the University of Chicago at Illinois. Children are assessed for the program using the Level of Care tool, and further assessed by a contracted agency using the MNNS checklist.