The Idaho Aged and Disabled Medicaid waiver program provides an alternative to nursing facility admission for people who are aged, blind, or disabled by providing nursing-home-level care services to participants in their homes and communities. The Aged and Disabled Waiver will also pay for services in assisted living communities and adult foster homes, which in formal language are referred to Residential Assisted Living Facilities and Certified Family Homes, respectively.
This waiver allows for participant-direction, which means the individual receiving care has the flexibility to choose who provides their care. While the participant selects their own care providers, they are required to use a third party financial management organization to manage payroll to their care providers.
It is worth mentioning that “participant-direction” is also referred to as “consumer-direction.” Not all services under this waiver are able to be directed by the beneficiary. Those that are include attendant care, homemaker and chore services, companion services, and skilled nursing. Friends and even some family members, with the exception of spouses, can be hired to provide these services. However, they must be qualified to do so and pass a background check / screening by the administering agency.
This waiver is operated by the Idaho Department of Health and Welfare, which is a division of Medicaid.
Candidates who are 65 years of age or older must require a nursing home level of care. Applicants between the ages of 18 and 64 may still qualify, but require a designation of disabled by the Social Security Administration.
The A&D Waiver requires participants to be financially eligible for Idaho Long Term Care or Nursing Home Medicaid. For this waiver, as of 2023, single seniors are limited to $2,762 a month in income. Married couples with both spouses as applicants can have up to $5,504 a month in income. This figure is 300% of the Federal Benefit Rate (FBR) plus $20.
If married and only one spouse is applying, the non-applicant’s income is not considered when determining the eligibility of the applicant spouse. In addition, there is a spousal allowance that allows an applicant spouse to transfer a portion of their income to their non-applicant spouse. This is referred to as a monthly maintenance needs allowance. As of 2023, this figure can be as much as $3,715.50 a month, and is intended to make sure the healthy spouse has sufficient funds in order to support him- or herself.
As rigid as these figures are, persons exceeding these limits might still gain eligibility by working with a professional Medicaid planner who can utilize special trusts called Miller Trusts to make an applicant’s income eligible. Learn more.
Idaho Medicaid considers the applicant’s countable resources, also known as “assets.” However, some assets are not counted, including their car, a burial contract, personal effects, and their home (if the applicant’s home equity interest does not exceed $750,000 and he or she lives in it or has intent to live there.)
The 2023 asset limit for a single applicant is $2,000. For married couples with both spouses as applicants, the limit is $3,000.
The rules differ for married couples with only one spouse seeking assistance from this Medicaid waiver. In this situation, a portion of their joint assets can be allocated to the non-applicant spouse (often called the community spouse) for living expenses. (Unlike with income, Medicaid considers the assets of a married couple jointly owned. Learn more here.)
As of 2023, the non-applicant is permitted to keep up to $148,620 in assets. This is called a community spouse resource allowance. Please note that the applicant spouse is still able to keep up to $2,000 in assets. Furthermore, in this situation, the home is exempt regardless of the applicant spouse’s circumstances.
Other strategies exist for helping families reduce their countable assets to gain Medicaid eligibility. It should be noted that families cannot simply give away assets in an attempt to meet Medicaid’s asset limit. This is because Medicaid considers all financial transactions for 60 months preceding one’s application date. This is known as Medicaid’s look back period, and if one is found to have violated this rule, he or she may be ineligible for Medicaid benefits for a period of time.
Those whose financial holdings exceed the limits, but who cannot afford their cost of care, might still be eligible for Medicaid and receive assistance from the Aged and Disabled Waiver. Professional assistance is available in Idaho to help individuals with the Medicaid application process. Learn more.
Each applicant is approved for a different suite of benefits. These can include any services from the list below. Some, but not all, of these services can be self-directed by the program participant.
Although the Aged and Disabled Waiver is available throughout Idaho, it is not considered a Medicaid entitlement program where benefits are guaranteed. Qualified applicants may be put on a waiting list until participant slots become available. It is recommended one check the waiting list status before or during application to manage their expectations about the availability of benefits.
To learn more, check wait time, or apply, persons should contact their Idaho Department of Health and Welfare regional office.