Medicaid Programs that Pay for Home Modifications for Aging & Disabilities 

Introduction

To best understand the content that follows it helps to have some definitions of the major content areas.   Medicaid is a federal health insurance program for many different groups of Americans.  This article focuses on Medicaid programs targeting the elderly.  While it is a federal program, each state administers their 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.  

 

Overview of Medicaid Programs

Medicaid Waivers

Most states offer Medicaid programs that cover home modifications to enable elderly and / or disabled individuals to remain living in 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 expense 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 1115 Waivers). Waivers offer a variety of in-home support programs, 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, 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.

Nursing home Medicaid is an entitlement, anyone eligible will receive care. Waivers, on the other hand, are not entitlements. Typically, these programs have limited enrollments and sometimes waiting lists exist for services.

Medicaid Managed Care Programs

Over time some states have replaced their waivers with Medicaid Managed Care programs. These managed care programs were usually required to continue offering the same benefits as the waivers they replaced. Therefore, home modifications continue to be a covered benefit even when a state switches to a managed Medicaid program.

Money Follows the Person Programs

These are Medicaid programs specifically designed for nursing home residents who wish to return to living into private homes (their own homes or the homes of family members or friends). These programs include support for home modifications that help the newly reintroduced individual to safely access the home. As of May 2017, 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”.

 States with Money Follows the Person Programs in 2017 - AL, AR, CA, CO, CT, DE, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, VA, VT, WA, WI, WV and the District of Columbia. 

 

List of State Medicaid Programs that Cover Home Modifications

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 but rather a comprehensive list of those programs that are relevant to the elderly.   As an example, those waivers which 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 and therefore can be used for home modifications even if the language of the waiver does not specific state that it includes home modifications. 

2017 State Medicaid Programs with Coverage for Home Modifications

Alabama SAIL Waiver
Alaskans Living Independently (ALI) Waiver
Alaska Adults with Physical & Developmental Disabilities Waiver
Arkansas Independent Choices Program
Arizona Long Term Care Services (ALTCS)
Arizona Self Directed Attendant Care
California’s Multipurpose Senior Services Program
California Medi-Cal Nursing Facility / Acute Hospital (NF/AH) Waiver
Colorado Medicaid Waiver for the Elderly, Blind and Disabled
Connecticut Community First Choice Option
Connecticut Personal Care Attendant
Delaware (Diamond State) Health Plan Plus
District of Columbia EPD Waiver
Florida Statewide Managed Long Term Care
Hawaii Med QUEST Expanded Access (QExA)
Idaho HCBS Aged & Disabled Medicaid Waiver
Illinois My Choices Project
Indiana Aged and Disabled Medicaid Waiver
Iowa Medicaid HCBS Elderly Waiver
Iowa Health and Disability Waiver
Kentucky’s Home and Community Based (HCB) Waiver Program for Aged and Disabled
Louisiana Community Choices Waiver
Maine Older Adults and Adults with Disabilities Waiver
Maryland Medicaid Waiver for Older Adults
Maryland Community Pathways
Maryland Community First Choice Program
Mass-Health Frail Elder Home and Community-Based Services Waiver
Michigan Medicaid Choice Waiver Program
Michigan Health Link Program
Minnesota Medicaid Elderly Waiver Program
Minnesota Consumer Support Grant (CSG) Program
Minnesota Community Access for Disability Inclusion Waiver
Missouri Independent Living Waiver
Mississippi Independent Living Waiver
Montana Medicaid Home and Community Based Services Waiver
Nebraska Aged & Disabled Waiver
Nevada HCBW for Persons with Physical Disabilities
New Hampshire’s Choices for Independence Waiver
New Jersey Medicaid Managed Long Term Services and Supports (MLTSS)
New Jersey Personal Preference Program
New Mexico Centennial Care Community Benefit
New York Medicaid Managed Long Term Care
North Carolina Community Alternatives Program for Disabled Adults Waiver
North Dakota Medicaid Waiver for Aged and Disabled
Ohio MyCare Plan
Ohio PASSPORT Waiver
Oklahoma’s ADvantage Program Waiver
Oregon’s Aged and Physically Disabled Medicaid Waiver
Oregon Independent Choices Program
Oregon K Plan
Pennsylvania Services My Way
Rhode Island Medicaid Personal Choice Program
Rhode Island Global Consumer Choice Compact Waiver
South Carolina Community Choices Healthy Connections (Medicaid) Waiver for the Aged
South Carolina Community Supports
South Dakota HCBS Waiver for the Elderly
Tennessee CHOICES in Long-Term Care
Texas Star Plus Medicaid Waiver
Utah Medicaid Aging Waiver for Individuals Age 65+
Utah New Choices Waiver
Vermont Global Commitment to Health Waiver
Virginia Technology Assisted Medicaid Waiver
Virginia Elderly or Disabled with Consumer Direction Waiver 
Washington’s New Freedom Program
Washington Community Options Program Entry System Waiver
Washington Community First Choice Option
West Virginia Aged and Disabled Waiver
Wisconsin Community Options Program
Wisconsin Medicaid’s CIP-II and COP-W Waivers
Wisconsin Medicaid IRIS Program
Wisconsin Family Care 

 

Qualifying for Medicaid and HCBS Waivers

Long term care Medicaid programs for seniors have requirements that apply both to the financial and health status of the applicant.  These are state specific but a general rule of thumb is that, in 2017, an unmarried applicant must have less than $2,000 in assets (excluding their home) and less than $2,205 / month in income.   They also must require the level of care typically provided in a nursing home, intermediate care facility or require assistance to manage their activities of daily living.