Waiver Funding Guide
Your Waiver Might Cover This App
Many Medicaid waiver programs allow families to request coverage for tools and resources that aren’t already being met by their services. Here is how to ask.
Email Jessie for Help ✉️What is an “Unmet Need”?
Every Medicaid Home and Community Based Services (HCBS) waiver has a category for services or supports your child needs but isn’t currently receiving. These are called unmet needs. In many states, families can request that waiver funds cover things like educational tools, communication supports, and digital resources — as long as they are tied to your child’s support goals.
Autism Pathways may qualify as a support tool that helps your family navigate services, prepare for IEP meetings, and manage your child’s care — all of which tie directly to common waiver goals.
How to Request Waiver Coverage
This process works best when you frame the request around your child’s waiver goals and your family’s documented needs.
- 1Find your waiver coordinator
Their contact info should be in your waiver approval paperwork. If you can’t find it, call your state’s Developmental Disabilities agency and ask for your “waiver support coordinator.” - 2Request a plan of care amendment
You don’t have to wait for your annual review. You can request a plan amendment at any time to add a new unmet need. Ask: “Can we add an unmet need to my child’s plan of care?” - 3Frame it around your child’s waiver goals
Connect the app to specific goals already in your child’s plan. For example: “This tool helps me track observations and prepare for IEP meetings, which directly supports [Child’s Name]’s communication and education goals.” - 4Ask your child’s provider for a supporting letter
A letter from your child’s therapist, developmental pediatrician, or case manager recommending a care coordination tool can significantly strengthen your request. - 5Get the approval in writing before subscribing
Ask for the approval in your plan of care document before paying for anything. If denied, you have the right to appeal — your state’s Protection and Advocacy organization can help for free.
What to Say to Your Coordinator
Not sure how to bring it up? Here is a script you can read directly off the phone or copy into an email.
“Hi, my name is [Your Name] and I am the parent of [Child’s Name], who is on the [State] [Waiver Name] waiver. I am reaching out because I would like to request an unmet need amendment to our plan of care.
I am using a care coordination app called Autism Pathways that helps me track daily observations, prepare for IEP meetings, navigate Medicaid and waiver services, and manage our providers. This directly supports [Child’s Name]’s goals around [communication / education / community participation].
The app costs $9.99 per month. I would like to request that this be added as an unmet need. Can you tell me what documentation you need from me to move forward?”
Tips That Make a Difference
Document everything
Keep a paper trail of every request, email, and phone call. Date and time stamp your notes. This is your evidence if you need to appeal.
Get a provider letter
A one-paragraph letter from your child’s therapist or developmental pediatrician recommending a care coordination tool goes a long way.
Don’t wait for annual review
You can request a plan amendment at any time. You do not have to wait until your next annual review to add an unmet need.
State rules vary widely
Some states have a pre-approved list of unmet needs; others give coordinators more flexibility. Ask your coordinator what category fits best in your state.
You Don’t Have to Figure This Out Alone
Talk to Jessie Directly
Book a 1:1 support call or send me an email. I will help you figure out the right approach for your state and your waiver.
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