Psychological Evaluation 101: What is A Waiver?

A Waiver Evaluation (or Medicaid Waiver) refers to a specific psychological evaluation that determines an individual’s need for government-funded support and services. These are usually requested for adults, but sometimes children are referred for Waiver Evaluations also.

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Typically, these evaluations assess for Intellectual Disability, as adults with this diagnosis might need extra support in tracking finances or finding and keeping jobs. (Not everyone with this diagnosis will need this support, but the purpose of these assessments is to ensure that those who need or want these services have access.)

An evaluation for Intellectual Disability has two components: an assessment of the individual’s IQ and an assessment of the individual’s functioning.

There is a lot of debate over IQ tests, partially because even psychologists can’t seem to agree on a working definition of “intelligence” (one professor in graduate school said, “The best definition we have of intelligence is it’s what gets measured by an IQ test”). There is also significant evidence of cultural and racial disparities in IQ scores, particularly because these tests have traditionally been developed by white professionals based on white standards. This is why those of us in the field need to keep pushing for more culturally relevant standards to measure intelligence and make sure that we take these factors into consideration when doing these tests.

The functional component of a Waiver Evaluation looks at an individual’s ability to do the things needed to complete tasks or participate in jobs, relationships, and other areas of their lives. This helps determine appropriate service recommendations because it tells us what areas require support and how much support might be needed. A major issue with scoring functional assessments is that many provide scores known as “age equivalencies,” which essentially indicate what age tends to get that same score. Of course, there are serious problems with using age equivalencies, the most obvious of which being that they infantilize adults by literally equating them to children. This is why I only note these scores when they are required and make sure to explain thoroughly what they mean.

So basically, if someone’s IQ is below a certain threshold (usually 70 or below) and their functioning is below average in one or more areas, they meet criteria for an Intellectual Disability, which qualifies them for supportive services.

However, people with other diagnoses might need added support as well, including some Autistic individuals, people with certain psychotic disorders, or those who have experienced a traumatic brain injury. Again, not everyone with a certain diagnosis will need these services – that’s part of why we test, to match the services to the individual’s need.

If someone doesn’t meet criteria for an Intellectual Disability but could still benefit from services for another reason, I can use a personality assessment to determine diagnosis.

Waiver Evaluations, while problematic in some ways, are often necessary in gaining access to support and services. If you’re applying for services, finding a psychologist who is culturally aware and can meet your needs is essential.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

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