To best understand how Medicaid can help with the cost of home modifications, it is helpful to begin with some definitions. Medicaid is a federal health insurance program for many different groups of Americans. This article focuses on Medicaid programs that specifically assist the elderly. While Medicaid is a federal program, each state administers their own Medicaid programs separately. By home modifications we are referring to changes made to a home to accommodate for aging or disability challenges. Typical modifications include bathroom & kitchen designs, wheelchair ramps and stair-lifts. But there are many other modifications for which Medicaid provides help. Medicaid tends to draw the line at modifications that increase the value or the square footage of the home.
Most states offer Medicaid programs that cover home modifications to enable elderly and / or disabled individuals to remain living at home. To best understand the benefits and limitations of these programs, it helps to provide a historic perspective. Initially, Medicaid assistance for the elderly was provided only in nursing homes. In time, lawmakers recognized that it was both less expensive to provide services at home and preferable for care recipients to remain at home rather than go into a nursing home. Thus, the concept of Home and Community Based Services (HCBS) was born. These programs are commonly referred to as Medicaid Waivers (or HCBS Waivers, 1915 Waivers and Section 1115 Waivers). Waivers offer a variety of in-home support benefits, and financial support for home modifications that enable “aging in place” is very often an included benefit.
Some waivers pay for assistive technologies such as special equipment for a washroom and adaptive lighting. Other waivers pay for physical modifications to the home, such as the addition of wheelchair ramps, stair-lifts, and walk-in or wheelchair accessible bathtubs and showers. These modifications are more formally referred to as Environmental Accessibility Adaptations. Further examples include widening of internal spaces, such as landings or doorways, to accommodate for wheelchair access. Some waivers include resources for both technologies and modifications. In other words, both the hardware and the services to install the hardware.
Please note, unlike nursing home Medicaid, waivers are not an entitlement. (An entitlement means that anyone eligible will receive care). Typically, waiver programs have limited participant enrollment. And sometimes waiting lists exist for services.
Some states have replaced their waivers with Medicaid Managed Care programs. These managed care programs are generally required to continue offering the same benefits as the waivers in which they replaced. Therefore, home modifications should continue to be a covered benefit even when a state switches to a managed Medicaid program.
These are Medicaid programs specifically intended for persons that are currently living in a nursing home, but who wish to return to living in a private home (their own home or the home of a family members or friends). These programs include support for home modifications that help the newly reintroduced individual to safely access the home. As of Sept. 2019, 44 states and Washington DC have Money Follows the Person (MFP) Programs. It should be noted that very often these programs are given different names in each state. For example, the MFP program in West Virginia is called “Take Me Home, West Virginia”.
Medicaid programs are state specific; they can also be condition-specific and / or age-specific. In each state, they have different names. Our organization has researched and found the following states to have Medicaid programs that include some level of assistance for home modifications / environmental adaptations. To be clear, this list is not comprehensive of all Medicaid programs that pay for home modifications. Rather, it is a comprehensive list of those programs that are relevant to the elderly. As an example, those waivers that strictly serve developmentally disabled individuals have been excluded from this list. Finally, some of the programs listed below are “consumer directed,” meaning the beneficiary has the freedom to choose how they spend the financial assistance they receive. Therefore, the funds can be used for home modifications even if the language of the waiver does not specifically state that it includes home modifications.
Long term care Medicaid programs for seniors have requirements that apply both to the financial situation and the health of the applicant. Eligibility criteria is specific to the state, the Medicaid waiver or program and even the living situation of the candidate. Having said that, typically Medicaid programs require that the individual need the level of care provided in a nursing home, intermediate care facility, or require assistance to manage their activities of daily living. Financially, in most states, applicants are limited to $2,313 per month in income and $2,000 in countable resources (in 2019). Worth noting is that one’s home is not included as a countable asset, provided the Medicaid applicant lives in the home. More information about Medicaid eligibility is available here, and assistance determining one’s eligibility is available here.