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.
This program helps nursing home qualified persons to remain living at home or in assisted living communities.
The Elderly, Blind and Disabled Medicaid waiver is designed to help the elderly who have physical impairments that could qualify them to receive nursing home care. Individuals elect to receive care services at home or in alternative care facilities, such as assisted living, instead of in a nursing home environment. In addition to choosing their care environment, under this program individuals have the option to “consumer direct” or self-direct their own personal care services via Consumer-Directed Attendant Support Services (CDASS). This means they can hire and manage some of their own care providers, including relatives, with the exception of spouses. As an example, they can elect from whom they receive personal care, but not necessarily who provides them with non-medical transportation.
Services covered under this waiver are selected to enable participants to maintain their independence outside of nursing homes. As such, personal emergency response systems (PERS), adult day care, respite care, and home modifications are covered. A broad category of assistance referred to as In-Home Support Services (IHSS) is another available benefit under this waiver. It also allows for consumer direction of care providers. IHSS includes help with home-related tasks, such as laundry, house cleaning, and personal care, such as bathing and eating.
This waiver’s full, official name is Home and Community-Based Services waiver for Persons who are Elderly, Blind and Disabled (HCBS-EBD). It is administered by the Colorado Department of Health Care Policy & Financing.
To be eligible for this waiver, an applicant must be a resident of Colorado. This waiver also considers age, income, financial assets, and functional ability as eligibility criteria.
Age and Functional Ability – while open to persons 18 and older who are disabled, those 65 years of age and older need not be designated officially as having a disability. Rather, they must be assessed and found in need of nursing home level care. Persons over 18 living with HIV or AIDS automatically meet the functional criteria even if they are not over 65 or legally defined as having a disability by the Social Security Administration.
Single applicants are limited to a gross monthly income of $2,742. This is equal to an annual income of $32,904.
If married, and the applicant’s spouse is not also seeking Medicaid assistance, some of the applicant’s income can be allocated to their spouse as a living allowance. This is called a Minimum Monthly Maintenance Needs Allowance (MMMNA). It allows an applicant spouse to transfer up to $2,288.75 / month (effective July 2023 – June 2024) to his/her healthy spouse. However, if the non-applicant spouse has high shelter costs, an applicant spouse may be able to transfer as much as $3,715.50 / month (effective January 2023 – December 2024) to his/her non-applicant spouse. This income allowance not only prevents non-applicant spouses from becoming impoverished, but also assists applicants in lowering their countable income.
Another option to lower countable income when an applicant is over the income limit is to allocate excess income into a Miller Income Trust (also called Qualified Income Trusts). Money deposited in the trust does not count towards Medicaid’s income limit. Furthermore, it can only be used for very specific reasons, such as contributing towards the cost of long-term care.
Both spousal income allocation and Miller Trusts are complicated, and one should consider consulting with a professional Medicaid planner should they choose to take this route to qualify for Medicaid.
Single applicants may have up to $2,000 in countable assets, which includes bank accounts, investment accounts, and retirement accounts. One’s primary home, up to $688,000 in equity interest, is an exempt asset (meaning its value is not counted toward the asset limit), given the applicant lives in the home or has intent to return home.
If the applicant is married, and his/her spouse is not applying, then the non-applicant spouse is permitted to keep up to a maximum of $148,620 of the couple’s joint assets. (Learn more about Medicaid and joint assets here). This is called the Community Spouse Resource Allowance. Furthermore, the couple’s primary home is exempt, regardless of applicant circumstances, given the non-applicant spouse lives in it.
Countable assets in excess of the limits may be converted to exempt assets, such as modifying a home for aging in place or paying off debt. An applicant may also convert a lump sum of cash into annuity income, which no longer will count as an asset. These techniques both will likely require expert guidance from a Medicaid planning professional. Interested individuals should find help in advance of applying. Incorrectly implementing a planning strategy can violate Medicaid’s 60-month look back period, resulting in a period of Medicaid ineligibility. Find assistance qualifying for Medicaid.
Benefits and Services
As the objective of the Elderly, Blind and Disabled Waiver is to prevent unnecessary nursing home placements, the benefits are selected to enable individuals to continue living in the community and to support their family members who provide caregiving assistance. Some services such as Personal Care and Homemaker Services can be participant directed. This means the beneficiary can choose their own provider of services. A complete list of services follows.
- Adult Day Care / Adult Day Health Care
- Alternative Care Facilities / Assisted Living Residence – Assistance with activities of daily living, laundry, housecleaning, etc. Room and board costs are not covered.
- Transition Setup – Payment of one time fees, such as security deposit, utilities deposits, and essential household items, associated with moving from a nursing facility back home.
- Personal Emergency Response System (PERS)
- Home Modifications to Increase Access -Widening of doorways, addition of ramps, etc.
- Homemaker Services – Cleaning, laundry, preparation of meals, shopping, etc.
- In Home Support Services (IHSS) – personal care assistance and homemaker services
- Meal delivery
- Non-Medical Transportation Coordination and Assistance
- Personal Care – Assistance with bathing, dressing, eating, etc.
- Respite Care for Family Caregivers – In-home and out of home
- Medication Reminders
- Life Skills Training
How to Apply / Learn More
This waiver is available statewide in all counties. It has been structured to aid approximately 29,040 state residents. However, because it is not an entitlement program, eligibility does not ensure availability of services. Qualified applicants may have to wait to start their benefits if there is an interest list.
To apply, contact the Colorado Single Entry Point agency in your local region. Limited information about this waiver is also available on the Colorado State Government website.
Colorado families might also be interested in receiving caregiving assistance from Colorado Respite Coalition.