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Idaho HCBS Aged & Disabled Medicaid Waiver: Qualifications and Services

Page Reviewed / Updated - Jan. 2019

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.

Waiver Description

This waiver pays for services, and other supports, in an individual’s home, as well as in an assisted living facility or adult foster home, in order to prevent nursing home placement. 

The Idaho Ages and Disabled (A&D) 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, in which the individual receiving care has the flexibility to choose who provides them with 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 Cash and Counseling and Consumer Direction. Not all services under this waiver are subjected to direction by the beneficiary; those that are include attendant care, homemaker and chore services, companion services, and skilled nursing. Friends and even some family members, 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. Medicaid in Idaho is also referred to as the Idaho Health Plan or simply Medical Assistance

Eligibility Guidelines

Eligibility requirements differ based on the age, disability, and marital status of the applicant.

Idaho’s Aged and Disabled Waiver has eligibility criteria related to both the physical health of the candidate and their financial situations.

Health Criteria
Candidates who are 65 years of age or older, they must require nursing home level care. Applicants between the ages of 18 and 64, he or she may still qualify, but require a designation of disabled by the Social Security Administration.

Financial Criteria - Income
The A&D Waiver requires participants to be financially eligible for Idaho Long Term Care or Nursing Home Medicaid. For this waiver, as of 2019, individuals who are 65 years of age or older and requires nursing home level care are limited to $2,313 / month ($27,756 annually) in income. This figure is 300% of the Federal Benefit Rate (FBR).

If married and only one spouse is applying, the non-applicant’s income is not considered when determining the eligibility of the applicant spouse. Stated differently, the healthy spouse’s income is disregarded. However, there is a spousal allowance in place, which allows an applicant spouse to transfer a portion of his/her income to his/her non-applicant spouse. As of 2019, this figure can be as much as $3,160.50 / month, and is intended to make sure the healthy spouse has sufficient funds in order to support himself / 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 to make applicants income eligible. Learn more.

Financial Criteria - Assets
Idaho Medicaid also considers the applicants' countable resources, also known as assets. “Countable resources” include the total value of their assets except for their home (given the home equity value does not exceed $878,000 and the applicant or his/her spouse lives in the home), a car, a burial contract, and personal effects. The 2019 asset limit for a single applicant is $2,000.

The rules differ for married couples with only one spouse seeking assistance from Medicaid. In this situation, a portion of their joint assets can be allocated to the non-applicant spouse for living expenses. As of 2019, the non-applicant is permitted to retain up to $126,420 in assets.

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/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.

Benefits and Services

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.  

  • Adult Day Care
  • Adult Residential Care – medication assistance, housekeeping, meal preparation, etc. This does not include room and board
  • Attendant Care - assistance with activities of daily living, such as eating, dressing, using the bathroom, etc. 
  • Certified Family Home Care - similar to adult foster care
  • Chore Services - home repairs that are minor, shoveling snow, washing windows, etc.
  • Home Delivered Meal Services
  • Homemaker Services – errands, meal preparation, laundry, housekeeping
  • Non-Medical Transportation
  • Personal Emergency Response Services (PERS)
  • Psychiatric Consultation Services
  • Residential Habilitation
  • Day Habilitation
  • Respite Care Services
  • Service Coordination
  • Specialized Medical Equipment and Supplies
  • Companion Services
  • Home Modifications – installation of ramps and grab bars, etc. 
  • Skilled Nursing
  • Transition Services - from living in an institutional setting back into the community

How to Apply / Learn More

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 prior or during application to manage their expectations regarding the availability of benefits.

To learn more, check wait time or apply, persons should contact their Idaho Department of Health and Welfare regional office. A very detailed and lengthy PDF is available for download here, which explains in legal language the terms of this program.