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Texas Medicaid Community Based Alternatives Waiver
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
Community Based Alternatives (CBA) Waiver Overview
This Texas Medicaid waiver is designed to allow elderly individuals ages 65 and older that require a nursing facility level of care to reside at home or in assisted living residences instead of being placed in a nursing home. It should be noted that this is not a Medicaid entitlement program. Therefore even if individuals are qualified, there may be a waiting list to receive services.
Individuals receiving care services under this waiver can choose to allow the state administrators to manage their care or they can choose to self-direct their care. This is referred to as the Consumer Directed Services Option or CDS. Under the CDS option, participants are given the flexibility to choose their own personal assistance and respite care providers. Usually personal assistance and respite care can be provided by non-medical professionals and participating individuals can hire certain family members to provide this services. Spouses and legal guardians are usually excluded, but siblings, ex-spouses, friends and the children of aging parents can all be hired as paid caregivers.
Texas also offers a robust consumer directed program for non-Medicaid eligible individuals called the Texas Community Attendant Services (CAS) Program. In certain areas of the state, an alternative to the CBA Waiver exists called the Texas STAR+PLUS Waiver.
Individuals receiving care services under this waiver can choose to allow the state administrators to manage their care or they can choose to self-direct their care. This is referred to as the Consumer Directed Services Option or CDS. Under the CDS option, participants are given the flexibility to choose their own personal assistance and respite care providers. Usually personal assistance and respite care can be provided by non-medical professionals and participating individuals can hire certain family members to provide this services. Spouses and legal guardians are usually excluded, but siblings, ex-spouses, friends and the children of aging parents can all be hired as paid caregivers.
Texas also offers a robust consumer directed program for non-Medicaid eligible individuals called the Texas Community Attendant Services (CAS) Program. In certain areas of the state, an alternative to the CBA Waiver exists called the Texas STAR+PLUS Waiver.
Qualifications for the Community Based Alternatives Waiver
In addition to requiring nursing home level care, Texas residents must be financially qualified for Medicaid.
Qualifying for Medicaid is a complicated process involving a review of a family’s income, assets and asset transfers as far back as 5 years. The rules change in each state but typically monthly income cannot exceed $2,000 and one's countable assets must be valued at less $1,000 - $8,000. IMPORTANT* Even though, one's income or assets may exceed these limits, most individuals can still qualify for Medicaid.
Many families find themselves in an awkward position where their loved one has enough income and assets that they do not qualify for Medicaid but not enough so that they can afford to pay for their care. Fortunately, there are many exceptions to what is considered income and countable assets. For example, one's car and home can be considered exempt from their countable assets. Income in excess of the limit can be allocated to a pooled income trust thereby enabling the individual to meet the Medicaid limit and qualify for assistance.
Creating a funeral trust is another simple and common technique used to help qualify for Medicaid. Given the expense of funerals and the fact that everyone will eventually require one, it makes sense to allocate money in advance to cover the funeral and associated expenses. A funeral trust is considered an exempt asset from Medicaid, therefore by creating one, a family can prepare for an inevitable need without having to plan the details and lower their countable assets to help qualify for Medicaid. Learn more about establishing a funeral trust.
Not qualifying for Medicaid can be devastating to the comfort of an individual, their family’s finances and even their health. For these reasons, Medicaid planners exist to ensure families have the best chance of acceptance into the program. With care costing $1000’s / month, there is a strong incentive to use a Medicaid Planner. Find assistance applying for Medicaid.
Qualifying for Medicaid is a complicated process involving a review of a family’s income, assets and asset transfers as far back as 5 years. The rules change in each state but typically monthly income cannot exceed $2,000 and one's countable assets must be valued at less $1,000 - $8,000. IMPORTANT* Even though, one's income or assets may exceed these limits, most individuals can still qualify for Medicaid.
Many families find themselves in an awkward position where their loved one has enough income and assets that they do not qualify for Medicaid but not enough so that they can afford to pay for their care. Fortunately, there are many exceptions to what is considered income and countable assets. For example, one's car and home can be considered exempt from their countable assets. Income in excess of the limit can be allocated to a pooled income trust thereby enabling the individual to meet the Medicaid limit and qualify for assistance.
Creating a funeral trust is another simple and common technique used to help qualify for Medicaid. Given the expense of funerals and the fact that everyone will eventually require one, it makes sense to allocate money in advance to cover the funeral and associated expenses. A funeral trust is considered an exempt asset from Medicaid, therefore by creating one, a family can prepare for an inevitable need without having to plan the details and lower their countable assets to help qualify for Medicaid. Learn more about establishing a funeral trust.
Not qualifying for Medicaid can be devastating to the comfort of an individual, their family’s finances and even their health. For these reasons, Medicaid planners exist to ensure families have the best chance of acceptance into the program. With care costing $1000’s / month, there is a strong incentive to use a Medicaid Planner. Find assistance applying for Medicaid.
Services Provided under the Community Based Alternatives Waiver
The CBA Waiver will pay for a broad range of services and supports to individuals that choose to live in their homes or in assisted living. These include:
-Environmental Adaptive Aids (to increase the independence of the individual in their home)
-Durable Medical Equipment and Supplies
-Home Modifications
-Personal Emergency Responses Services
-Personal Assistance
-Home Delivered Meals
-Respite Care
-Transition Assistance
It should be noted that Waiver programs, in addition to providing individuals with options, are designed to save the state money and therefore the overall services provided may be limited to not exceed the cost for those same services were they provided in a nursing home.
-Environmental Adaptive Aids (to increase the independence of the individual in their home)
-Durable Medical Equipment and Supplies
-Home Modifications
-Personal Emergency Responses Services
-Personal Assistance
-Home Delivered Meals
-Respite Care
-Transition Assistance
It should be noted that Waiver programs, in addition to providing individuals with options, are designed to save the state money and therefore the overall services provided may be limited to not exceed the cost for those same services were they provided in a nursing home.
Availability of the Community Based Alternatives Waiver
The CBA Waiver was available statewide however there may be waiting lists to receive services and certain areas may now offer managed care through the STAR+PLUS Waiver instead. Interested individuals can learn more on the Department of Aging and Disability Services' website or confirm eligibility and apply for services by contacting their local DADS administrator.
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