MFTD Waiver Families

Support for families of children in the Medically Fragile, Technology Dependent Waiver

MFTD Benefits

Children who are accepted into the MFTD Waiver receive a comprehensive benefits package, which includes full Medicaid coverage as guaranteed by federal EPSDT laws, as well as additional waiver-only services. Those over 21 receive a slightly smaller package of services.

Waiver Services

These services are available only to children in the MFTD Waiver, and go beyond what Medicaid normally covers.

  • Special medical equipment and supplies - non-covered items for those over age 21, including certain augmentative devices, monitors, positioning devices, etc. Limited to $25,000 (in combination with environmental modifications) every 5 years. Also includes coverage to repair or maintain patient-owned equipment.
  • Environmental modifications - includes home and vehicle modifications. Limited to $25,000 (in combination with special medical equipment) every 5 years. Some typically covered services include adding tie-downs to a van, adding a van lift or ramp, widening doorways, adding an exterior home lift/ramp, modifying a bathroom, adding a ceiling lift system, extermination (pest control) services, generators, or adding dedicated electrical outlets for medical equipment. See this tip sheet on home modifications and this tip sheet on vehicle modifications. Generators are now approved with  further information here.
  • Respite care in the child's home - typically limited to 336 hours per year.
  • Respite care center services - typically limited to 2 weeks per year.
  • Nurse training - training of nurses, typically on a child who is inpatient before coming home for the first time or with new equipment; limited to four hours per nurse.
  • Family training - training of family members to care for a child at home, including CPR-type courses.
  • Placement maintenance counseling - up to 12 sessions per year of counseling to help families keep a child/young adult at home.

Note that those over age 21 also receive private duty nursing services (nurse or CNA) through the waiver, as these are excluded from the regular state plan service for adults.

Some children in the MFTD waiver may be eligible for additional programs, such as electricity reimbursement. See our page on associated programs for more information.

Medicaid State Plan Services

These services are offered to all Illinois children covered by Medicaid. Children in the MFTD Waiver do not pay copays or premiums on any services. All services must be performed by a participating Medicaid provider. Note that adults over age 21 may not receive all services, as the covered benefits for children are greater than for adults.

  • Inpatient hospital services
  • Outpatient hospital services
  • EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services *children only*
  • Home health services *may be limited for adults*
  • Physician services
  • Rural health clinic services
  • Federally qualified health center services
  • Laboratory and X-ray services
  • Family planning services
  • Certified Pediatric and Family Nurse Practitioner services
  • Transportation to medical care
  • Prescription Drugs *may be limited for adults*
  • Clinic services
  • Physical therapy *may be limited for adults*
  • Occupational therapy *may be limited for adults*
  • Speech, hearing and language disorder services *may be limited for adults*
  • Respiratory care services
  • Other diagnostic, screening, preventive and rehabilitative services *children only*
  • Podiatry services
  • Optometry services
  • Dental Services *may be limited for adults*
  • Dentures
  • Prosthetics
  • Eyeglasses and Vision care
  • Chiropractic services
  • Other practitioner services
  • Private duty nursing services *may be limited for adults*
  • Personal Care *children only*
  • Hospice
  • Case management
  • Services in an intermediate care facility for the mentally retarded (terminology retained from the law)
  • Inpatient psychiatric services for individuals under age 21 *children only*

Benefits for Children with Private Insurance

If your child has private insurance, the waiver will provide secondary or wrap-around coverage. This means your private insurance is billed first, and any remaining amount is then billed to Medicaid.  These are the benefits your child will receive:

  • All waiver services
  • Secondary Medicaid coverage, including all Medicaid state plan services
  • Coverage for prescription/DME copays, if Medicaid covers the drug/supply/equipment
  • Coverage for physician/hospital copays, if they are a Medicaid provider
  • Coverage for therapy copays, if they are a Medicaid provider
  • Coverage for coinsurance and deductibles (for the waiver child only), if the provider is a Medicaid provider