At times, your loved one may require additional care, but you don't want to consider a nursing home. Perhaps your loved one wants to stay at home or you want your loved one to receive care in a place that is familiar to him. Whatever the case may be, there is government financial assistance available to those who choose to stay at home.
In the past, Medicaid only paid for long-term care services in an institutional setting such as a nursing home or group home. However, the Medicaid waiver is a program available to those who choose to stay at home. This program "waives" the eligibility requirement that you be in an institution in order to receive Medicaid benefits.
Indiana has eight Medicaid Home and Community-Based Services (HCBS) programs for various groups of people. HCBS programs allow members to live in a community setting and avoid institutional placement. To be eligible, you must meet Medicaid guidelines and HCBS program-specific eligibility guidelines. This post specifically discusses the Aged and Disability (A&D) Medicaid waiver.
The A&D Medicaid waiver pays for services that are provided in a person's home or another community setting rather than a facility or institution. It offers an alternative to nursing facility admission for adults and persons with a disability. By offering waivers, the state can improve the quality of life of the individual and save money by decreasing nursing home costs.
An applicant must qualify for institutional care in order to be eligible for the Medicaid waiver. This means that your loved one has been assessed as needing the level of care that a nursing home would provide. For nursing home level of care, a person must have one of the following:
An unstable, complex medical condition, which requires direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain
Need for direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, or central intravenous access (I.V.)
Need for direct assistance for special routines or prescribed treatments from others, such as tracheotomy, acute rehabilitation conditions, or administration of continuous oxygen
Need for medical observation and physician assessment due to a changing, unstable physical condition
Other substantial medical conditions.
Waivers are for applicants who are willing to live in an approved location besides a nursing home. The applicant can live at home or in an assisted living facility. There are certain Medicaid-approved assisted living residences or adult family care homes that will qualify for waiver services.
The Medicaid waiver can help people remain in their own homes. It can also help individuals currently residing in a nursing home to transition back to the community, such as their own home, an apartment, or assisted living. It pays for services to supplement informal support at home or in the community that the applicant would otherwise require in a nursing home.
In order to be eligible, an applicant must be aged (65 and older), blind, or disabled. The applicant can have income no greater than 300% of maximum Supplemental Security Income (SSI) amount. For 2019, this means an individual applicant cannot have a grossincome that exceeds $2,313 per month. Also, the applicant cannot have more than $2,000 in countable resources.
Eligible individuals may receive authorized waiver services in conjunction with traditional Medicaid. Authorized waiver services may include:
Adult Day Service
Adult Family Care
Assisted Living
Attendant Care
Self-Directed Attendant Care
Case Management
Community Transition
Environmental Modifications
Environmental Modification Assessments
Health Care Coordination
Homemaker
Home Delivered Meals
Nutritional Supplements
Personal Emergency Response System
Pest Control
Respite
Specialized Medical Equipment and Supplies
Structured Family Caregiving
Transportation
Vehicle Modifications
The Medicaid waiver is an excellent option for elders who can remain in their home or in assisted living or who can transition back into a community setting. If you think your loved one could benefit from the Medicaid waiver now or in the future, schedule an appointment with one of our attorneys. Our knowledgeable attorneys can help you qualify for Medicaid while protecting your assets.