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The Medicaid Waiver Program and In-Home Nursing Facility Care

It might be worth reconsidering whether Medicaid’s strict income and asset limits will prevent you from receiving benefits. If you currently demonstrate the need for nursing home facility services, you may meet health eligibility rules for a Medicaid waiver program to support the costs of in-home care instead. Each state has a level of care requirement and its own criteria to determine if you qualify. Home and Community-Based Services (HCBS) allow individuals with physical disabilities and certain medical conditions to receive care in their homes rather than nursing home facilities, hospitals, or rehabilitation centers. However, complicated terms and processes are not always clear.

Your level of health care is usually based on:

  • Your need for help with for two or more activities of daily living, including bathing, toileting, dressing, eating, and mobility.
  • Your frequency of medical care for things like IVs or other injections, medications, or other treatments.
  • Your behavioral problems such as aggressiveness and wandering from home.
  • Your cognitive ability which may be impaired by Alzheimer’s disease or another form of dementia, creating problems with making decisions and correctly processing information.

The state evaluates the health of each Medicaid applicant and, in many cases, will require a doctor’s diagnosis. The assessment generally requires the applicant to answer a series of questions about their abilities, behavioral issues, or cognitive problems. They will also ask about family members and their ability to provide physical and financial support.

Understanding Medicaid Basics

Medicaid covers medical services beyond nursing care when you are over 65, blind, or disabled and meet the income eligibility requirements. When applying for Medicaid benefits, consider the following:

  • If you are married and both applying for Medicaid, the program combines your assets and income. If only one of you is applying, you can transfer a certain amount of countable assets and income to a trust to protect your spouse’s standard of living from the costs of long-term care and Medicaid Estate Recovery.
  • You will still be able to keep a portion of your income, and the amount varies by state. Local Medicaid offices can provide more information, or you can talk to an elder law attorney to understand how much of your income will pay for nursing home care.
  • There is a Medicaid look-back period of up to five years in most states. When determining your eligibility, your state will count any assets you have transferred or gifted to others in the past five years. If Medicaid determines any transfers violate eligibility rules, you may be penalized. They may only pay a portion of your nursing home stay or none at all. This is why legal guidance can be extremely important.
  • Owning your home affects Medicaid eligibility and coverage. An elder law attorney can explain how the equity in your home may count as an asset. They will present options, such as trusts, to protect your property and keep it for your family after you have passed.

Using Medicaid for Nursing Facility Care at Home

Medicaid is initially designed to help those with low incomes afford the cost of long-term care. If you or a loved one still have some autonomy but are no longer completely independent, you may seek services for in-home care and assisted living facilities. Keep in mind that Medicaid benefits cover costs for skilled nursing or home health care, but not assisted living costs. If you have long-term care insurance and other financial resources, assisted living may still be an option. As independence declines, you will be facing a nursing home facility eventually.

Since nursing homes often have limited capacity, the waitlists can be years. Check out local facilities as soon as possible. In the meantime, Medicaid has adapted to provide nursing home level of care at your residence instead. Medicaid evaluates applicants to ensure they don’t pose a danger to themselves or others in a home environment. You may be able to use this solution until a nursing home facility becomes available.

There are many medical and financial aspects to consider when applying for Medicaid benefits. Filling out applications on your own can lead to rejection due to insufficient or incorrectly filed forms. This can create delays and diminish your estate as assets are used to pay for care. Timing is critical.

Proactive Medicaid Planning

An elder law attorney can help you navigate your state’s eligibility requirements, properly fill out forms and supporting documents, and prepare you for health assessments and reviews. They evaluate your estate, inventory assets, preserve assets for family members, and discuss powers of attorney should you become unable to handle your financial and medical decisions. The more time they have to develop your Medicaid and long-term care strategy, the better the outcome.

The potential need for long-term care in a nursing home is high. Your elder law attorney will help you qualify for care when you need it and achieve your family goals. Please contact us today at (570) 288-1800 to schedule a free consultation to discuss Medicaid Planning and long-term nursing home care.

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