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Utah Department of Health Banner

Medically Complex Children's Waiver

Utah Medically Complex Children's Waiver

After reviewing program costs relative to the funding provided, the Department has determined that current program funding will support an additional 150-180 children to be served through June 30, 2018. Applications for the Medically Complex Children’s Waiver will be accepted during an open application period May 1-31, 2017. In addition, parents will be required to provide a copy of the child’s most recent history and physical by the Primary Care Provider. Please view the PowerPoint presentation to familiarize yourself with the application process prior to submitting the application.

Applications will be accepted online through this webpage, via fax or mail. The application process will require parents to answer some questions about their child’s medical conditions and services.

  1. MCCW Online Application
  2. MCCW Paper Application
  3. Solicitud de extención
  4. Authorization to Release Information (114AR)
  5. Authorización de revelar información (114AR)
  6. Medicaid Disability Addendum (354)
  7. Apéndice para solicitud de descapacidad de Medicaid (354)

Purpose: This program provides medical assistance to children who are medically complex. This waiver serves the following population:

  • Children ages 0-18
  • Children who have 3 or more specialty physicians
  • Children who have 3 or more organ systems involved in their disability
  • Children who have a SSI Disability Designation through the SSA or a disability determination by the State Medical Review Board, this will be coordinated as part of the MCCW application process.

Answers to frequently asked questions about the application process and other program details are now available at: FAQ Sheet

Please enroll in the MCCW listserv by following the instructions found here.

For more information, please contact the Utah Department of Health.
Toll-free Phone: 1-800-662-9651, option 5