OK In-Home Supports Waiver for Adults

Published on
August 31, 2023
Last updated
February 29, 2024
Written by
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Katie Wilkinson
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Learn about the IHSW-A, a Medicaid waiver program in Oklahoma that provides services and support to adults with intellectual disabilities and allows them to self-direct their care.
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The In-Home Supports Waiver for Adults (IHSW-A) is one of the Medicaid waiver programs in Oklahoma that provides home and community-based services to individuals with intellectual disabilities who would otherwise need care in an intermediate care facility for individuals with intellectual disabilities (ICF/IID). The waiver aims to promote the independence, choice, and dignity of the participants and their families by allowing them to receive services and support in their own homes or other settings of their choice. 

Overview of In-Home Support Waiver for Adults

The IHSW-A program serves the needs of people 18 and older with intellectual disabilities who meet the ICF/IID level of care. The program is administered by the Oklahoma Department of Human Services (DHS), Developmental Disabilities Services Division (DDS), in collaboration with the Oklahoma Health Care Authority (OHCA), which is the state Medicaid agency. The program operates under a federal waiver authority granted by the Centers for Medicare and Medicaid Services (CMS), which allows the state to waive specific Medicaid rules and provide services that Medicaid does not typically cover. The program has limited slots available each year, and there may be a waiting list for enrollment. The program is expected to serve up to 4,800 participants in 2023.


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Eligibility requirements

To qualify for the IHSW-A program, a person must:

  • Be 18 years of age or older.
  • Have an intellectual disability or a related condition that manifested before age 22
  • Meet the ICF/IID level of care, meaning they need active treatment and supervision due to their disability.
  • Be financially eligible for Medicaid.
  • Reside in Oklahoma
  • Live in their own home, a family home, a DHS foster home, or a group home operated by the Children and Family Services Division.
  • Have critical support needs that can be met within the annual waiver cap, which is $30,000 per year

Services and supports

The IHSW-A program offers various services and supports to help participants live independently in their communities. Some of the services and supports include:

  • Personal care: Assistance with activities of daily living.
  • Advanced supportive/restorative assistance: Assistance with tasks that require more skill or training than personal care, such as medication administration, wound care, catheter care, etc.
  • Habilitation training specialist: A worker who provides training and support to help participants develop or maintain skills related to self-care, communication, socialization, behavior management, etc.
  • Respite: Temporary relief for caregivers who are responsible for providing care to participants
  • Environmental modifications: Changes or adaptations to the participant’s home or vehicle that are necessary to ensure their health, safety, or independence
  • Adaptive equipment: Devices or items that are necessary to assist participants with their functional limitations or enhance their abilities
  • Transportation: Assistance with accessing community resources or activities
  • Employment services: Services that help participants find and maintain paid or unpaid work in integrated settings
  • Nursing services: Skilled nursing care provided by a registered nurse or a licensed practical nurse
  • Nutritional services: Assessment, counseling, education, or intervention related to the participant’s dietary needs
  • Occupational therapy: Services that help participants improve or maintain their ability to perform daily activities
  • Physical therapy: Services that help participants improve or maintain their physical functioning
  • Speech therapy: Services that help participants improve or maintain their communication skills
  • Audiology: Services that help participants with hearing problems or hearing aids
  • Dental services: Preventive and restorative dental care provided by a dentist or a dental hygienist
  • Psychological counseling: Services that help participants cope with emotional or behavioral issues
  • Medical supplies and services: Medically necessary supplies and services that are prescribed by a physician
  • Family training: Education or training for family members or caregivers on how to provide care or support to participants

Who are you caring for?

Compensation for caregivers

One of the unique features of the IHSW-A program is that it allows participants to choose the self-direction option for some of their services. Self-direction means that participants have more control over how their services are delivered. They can recruit, hire, train, and supervise their workers and manage a budget for purchasing goods and services that support their independence. The services that can be self-directed under the IHSW-A program are:

  • Personal care
  • Advanced supportive/restorative assistance
  • Environmental modifications
  • Adaptive equipment
  • Transportation
  • Employment services

Participants who choose the self-direction option may be able to compensate a family caregiver as their worker, as long as the family member is not legally responsible for the participant or living in the same household. However, some exceptions may apply for spouses or adult children who provide care under certain circumstances. Participants interested in hiring a family caregiver should contact their DDS case manager for more information and guidance.

A note from Givers

If you want to learn more about your eligibility for caregiver pay under this waiver or other Medicaid waiver programs in Oklahoma, we invite you to fill out this form. We are here to help you navigate the complex and confusing world of Medicaid and caregiving. 

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