Washington’s Medically Needy In-Home Waiver (MNIW) and Medically Needy Residential Waiver (MNRW)
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.
Overview of Washington's Medically Needy Waivers
These two waivers are for individuals that require nursing home level care but choose to receive that care either in-home or in a residential care facility such as assisted living but not in a nursing home. They are offered on the condition that the care services can be obtained at a lower cost to the state then they otherwise would in a nursing home.
Under MNIW, individuals have the option of consumer direction of their personal care. This means they can choose their own personal care provider(s) instead of having the state select providers on their behalf. In this situation, the waiver participant acts as the “employer” of the personal care provider. This model is becoming increasingly popular as certain other family members can be hired to provide care.
Waiver Eligibility Guidelines
Eligibility for these waivers is complicated. While they do not have strict age requirements (persons 18 and over can qualify) and they do not have geographic requirements (they are available statewide), they do have functional, financial and other requirements.
Functionally, applicants must be assessed medically and found to be in need of the level of care provided in nursing homes. However, they must choose to receive that care either at home or in assisted living residences.
Financially, they cannot meet the eligibility criteria for other WA's Medicaid programs such as Medicaid Personal Care
or the COPES program
. However, they must still qualify for Washington's Medically Needy Medicaid program. To do so, the state will consider their care requirements and the associated costs. Then the state will look at their monthly income to determine if they can afford their care and if not, then they consider their financial assets as possible resources. Provided they exhaust all these resources through a spenddown, they can qualify for the Medically Needy program. A good rule of thumb for 2013 is persons with income under $2,130 / month and assets under $2,000 can qualify.
Medicaid eligibility is further complicated by home ownership and whether the applicant lives in their home. Married couples with one spouse applying can retain higher resources; up to $115,920. Washington residents in either of these situations should strongly consider getting Medicaid planning assistance
to help them arrange their personal finances to qualify.
Services / Benefits
Depending on the location of residence, individuals approved for these waivers can receive the following services:
-Durable medical equipment
-Home delivered meals / congregate meals
-Home health services
-Home modifications to improve accessibility
-Personal care at home or in assisted living
-Personal emergency response services at home or provided by their residential care program
-Skilled nursing, but not on a long term basis in a skilled nursing facility
-Transportation assistance for medical appointments
Program Availability / How to Apply
These waivers are available statewide across Washington. However, these are not Medicaid entitlement programs. One can read the latest waiting list guidelines on the State of Washington website
. To apply or learn more, elderly state residents should contact their local area agency on aging. County by county contact information is available here
Use our Locator Tool to Find Other Options for which You're Eligible
Page Reviewed / Updated - Jan. 2013