Page Reviewed / Updated - October 19, 2020
The Idaho Aged 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 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. Medicaid in Idaho is also referred to as the Idaho Health Plan or simply Medical Assistance.
Idaho’s Aged and Disabled Waiver has eligibility criteria related to both the physical health of the candidate and their financial situation.
Candidates who are 65 years of age or older must require nursing home level care. Applicants between the ages of 18 and 64 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 2020, individuals who are 65 years of age or older and require nursing home level care are limited to $2,349 / month ($28,188 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 that allows an applicant spouse to transfer a portion of his/her income to his/her non-applicant spouse. It is called called a monthly maintenance needs allowance. As of 2020, this figure can be as much as $3,216 / 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 called Miller 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 $893,000 and the applicant or his/her spouse lives in the home), a car, a burial contract, and personal effects. The 2020 asset limit for a single applicant is $2,000.
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. As of 2020, the non-applicant is permitted to keep up to $128,640 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.
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.
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. A very detailed and lengthy PDF is available for download here, which explains in legal language the terms of this program.