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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.
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.
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.
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”.
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
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.