What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Among other services, this program offers personal care to help elderly persons remain living at home.
The Multipurpose Senior Services Program (MSSP) waiver is designed to help California seniors who are at risk of nursing facility placement to remain living in their homes or in the community. The program achieves this objective by arranging assistance and managing a broad set of services, including adult day care, home modifications, and care management services. Please note, medical care is not covered under this waiver.
In particular, this waiver is an important lifeline for seniors who are ready to return home after a stay in the hospital or nursing home for rehabilitation. This program is not available statewide, but is available in all counties EXCEPT the following twelve: Alpine, Colusa, Del Norte, Inyo, Mono, Nevada, Plumas,, San Benito, San Luis Obispo, San Mateo, Sierra, Sutter.
Availability of the program within a county does not mean automatic enrollment. In some counties, there may be waiting lists. The program is structured to allow for approximately 11,370 concurrent participants.
Participation in the MSSP Waiver does not preclude beneficiaries from receiving assistance from the Medi-Cal funded In-Home Supportive Services program, although the additional personal care services may be not necessary.
The MSSP Waiver has age, geographic, functional and financial eligibility requirements.
Age – Applicants must be at least 65 years of age.
Residency – Program participants must live in (or be willing to move to) one of the 46 California counties where the waiver is available.
Functional Ability – Functionally, applicants must require the level of care typically provided in a nursing home. The financial requirements for the waiver are the same as the financial requirements for aging assistance programs under Medi-Cal.
In 2023, individuals with countable monthly income of less than $1,564 per month are eligible. Couples (with both spouses as applicants) can have monthly income up to $2,106. These figures are equivalent to 138% of the Federal Poverty Level.
The income of a non-applicant spouse is not counted toward the eligibility of an applicant spouse. In fact, an applicant spouse can transfer a portion of his/her income to the non-applicant spouse to prevent impoverishment. This is called a monthly maintenance needs allowance, and at the time of this writing, up to $3,435 / month (to bring the non-applicant spouse’s income up to this level) can be transferred to the non-applicant spouse.
Despite seemingly rigid income guidelines, there is some flexibility to the income requirement. Persons with income exceeding these amounts but who have high medical expenses may still be eligible through the spend-down program, in which they are required to pay a share-of-cost. Typically, share-of-costs enrollees can retain about $600 per month as an individual and $934 as a married couple (both spouses as applicants) for personal needs.
Individuals who are close to the income limit may be able to reduce their countable income by deducting the cost of supplemental health insurance. Given the complexity of the income rules for California residents, if you are concerned about how to qualify, consult with a Medi-Cal planning professional.
For 2023, a single applicant for Medi-Cal has an asset limit of $130,000. A married couple has an asset limit of $195,000, but only if both spouses are applying at the same time. If only one spouse is an applicant, the non-applicant spouse can retain up to $137,400 of the couple’s assets, and the applicant can keep up to $130,000. (Unlike with income, assets are always considered jointly owned.)
When determining the value of the applicant’s assets, many resources, including one’s home, household items, and vehicle, are not counted. While most states have an equity interest limit on one’s home for exemption purposes, California is an exception and does not have an equity interest limit. This means, regardless of the equity value of one’s home, it is not counted toward Medicaid’s asset limit.
In addition, under certain circumstances, Medi-Cal exempts the value of assets in a 401K account, and traditional or Roth individual retirement accounts (IRAs). Persons who have questions about how to navigate the retirement account exemption should contact a Medi-Cal specialist or their financial planner.
As with the income limits, persons who exceed the above-mentioned asset limits, and those who have questions as to whether they exceed the limits, should consider professional assistance to ensure they qualify.
Benefits and Services
The benefits of MSSP are intended to help individuals remain living at home. Once and individual is accepted into the program, staff will assess participants to make a final determination of their exact benefits. Benefits can include any of the following:
- Care Management
- Communication Services
- Community Transition Services
- Counseling and Therapeutic Services
- Home Modifications
- Meal Delivery / Congregate Meals
- Minor Home Repairs and Maintenance
- Money Management
- Personal Care Services and Homemaker Services
- Personal Emergency Response Service
- In-Home & Out-of-Home Respite Care (to provide a break for primary caregivers)
- Adult Day Care
Seniors are permitted to use both the Multipurpose Senior Services Program and In-Home Supportive Services (IHSS) at the same time. IHSS provides Medi-Cal recipients with personal care services in their home or in the home of a family or friend.
How to Apply / Learn More
Receiving services under this program is a two-stage process. First, one must be eligible for Medi-Cal (Medicaid). If not already enrolled in Medi-Cal, it can be done online through Covered California. Once enrolled in Medi-Cal, seniors will need to obtain a slot for services under the MSSP Waiver. Services are not entitlements, so waiting lists can exist.
One can learn more, begin the application process, or request to be put on a waiting list by contacting their Department of Health Care Services (DHCS) county office. Alternatively, one can apply online or call the CA Aging and Adult Information Line at 1-800-510-2020 for assistance.
Nearly 40 community health nonprofit organizations administer MSSP at the local level throughout the state. Once a senior is Medi-Cal enrolled, he or she can be referred to their local community service provider. To find a county-specific MSSP provider, one should contact their local area agency on aging (AAA) office here.
Additional information about MSSP can be found here.