VA Building Independence Waiver Explained

The Building Independence Waiver (BI) is one of the three Medicaid Home and Community-Based Services (HCBS) waivers for individuals with developmental disabilities (DD) in Virginia. It is designed to support adults 18 or older who can live and work fairly independently but need drop-in support. The BI waiver helps them access services and supports that enable them to live in an integrated, independent living arrangement, such as their apartment or house.

Overview of the Building Independence Waiver

The BI waiver is a Medicaid program that covers a range of services and supports for adults with DD who want to live independently in the community. The BI waiver has limited slots available, and there is a waiting list for a waiver slot. The BI waiver is administered jointly by the Virginia Department of Medical Assistance Services (DMAS) and the Virginia Department of Behavioral Health and Developmental Services.

Eligibility Requirements

To qualify for the BI waiver, a person needs to meet the following criteria:

• Be 18 years or older.
• Have a diagnosis of a developmental disability that occurred before age 22
• Require an intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care.
• Meet the income and resource limits for Medicaid.
• Choose to receive services in the community rather than an institution.
• Have a person-centered plan identifying the services and supports needed to live independently.

Supports and Services

The BI waiver offers services and supports that help individuals achieve their goals and preferences in living, working, and participating in their communities. Some of the services available under the BI waiver are:

• Assistive technology: devices or equipment that help individuals perform daily activities or communicate
• Benefits planning: counseling on how work income affects benefits such as Social Security or Medicaid
• Center-based crisis support: short-term residential services for individuals who experience a behavioral or psychiatric crisis
• Community-based crisis support: short-term services for individuals who experience a behavioral or psychiatric crisis in their home or community
• Community coaching: training and assistance for individuals to develop skills for independent living
• Community engagement: activities that promote socialization, learning, wellness, and civic involvement
• Community guide: peer support for individuals to access community resources and opportunities
• Crisis support: emergency response and intervention for individuals who experience a behavioral or psychiatric crisis
• Electronic home-based support: remote monitoring or supervision of individuals in their home
• Environmental modifications: changes or adaptations to an individual’s home to improve accessibility or safety
• Group day service: structured group activities that promote skill development, socialization, and community integration
• Group and individual supported employment: assistance for individuals to find and maintain paid jobs in integrated settings
• Independent living support: personal assistance to complete daily living tasks such as bathing, dressing, eating, etc.
• Employment and community transportation: transportation for individuals to access work or community activities
• Peer mentor supports: peer mentoring for individuals to develop self-advocacy skills and achieve personal goals
• Personal emergency response system: electronic device that alerts emergency services in case of a fall or medical emergency
• Shared living: residential service where an individual lives with a paid caregiver who provides support and companionship
• Transition service: one-time service that helps individuals move from an institution to a community setting

Self-Direction Options

One of the options available under the BI waiver is self-direction, also known as participant-direction or consumer-direction. Self-direction gives individuals more choice and control over their services and supports. Self-direction is not mandatory under the BI waiver, but it is an option that individuals can choose if they want more flexibility and autonomy over their services. 

To learn more about self-direction under the BI Waiver, visit the Virginia Community Services Board website to contact the Community Services Board in your community. 

A note from Givers

If you are a caregiver for someone eligible for the BI waiver or another waiver, you may be able to get paid for the work you do. To find out if you may be eligible for caregiver compensation, please fill out this form, and we will get back to you as soon as possible.