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 program aids individuals at home, in foster homes, or in assisted living. Persons receiving care at home can hire family members as care providers.
The Indiana Aged and Disabled (A&D) Medicaid Waiver is intended to help elderly or disabled state residents that need the types and level of care provided in nursing homes. By offering services and support to help these individuals live at home instead of in nursing facilities, the state can both improve the quality of life of the individual, as well as save money by decreasing its nursing home costs. Services provided under this waiver are also extended to individuals in certain Medicaid-approved assisted living residences and adult family care homes, also referred to as adult foster care. This wavier can also assist individuals currently residing in a nursing home facility transition back into the community.
Associated with this waiver is a self-directed care option called the Consumer-Directed Attendant Care Program or CDAC Program. Individuals who choose this option are given the flexibility to select their own personal care providers, monitor them, as well as fire them. Since no medical training is required to provide most forms of personal care, a broad range of individuals can be hired to provide these services, including friends and some family members of the care recipient. To be clear, spouses cannot be hired to provide care. The hourly rate that caregivers are paid is determined by the state Medicaid office. It is typically is between 50% and 60% of the average hourly rate private caregivers receive in Indiana.
Eligibility Guidelines
Applicants must meet the 5 main criteria for qualification:
1) Residency – must be a resident of the state of Indiana.
2) Place of Residence – must be willing to live in an approved assisted living residence, adult foster care home, home of a family member, or one’s own home, instead of in a nursing home.
3) Functional – must be assessed and found to require at least the level of care provided in nursing homes (assistance with 3 activities of daily living, such as bathing, grooming, and mobility).
4) Monthly Income – to be eligible for the A&D Waiver, the candidate must fall within the financial guidelines for Indiana Medicaid long term care. In 2022, single applicants are allowed monthly income up to $2,523. If married and the applicant’s spouse is not seeking Medicaid services, the non-applicant’s income is not counted toward the applicant spouse’s eligibility. When the non-applicant spouse has low income, some of the applicant’s income can be allocated to the non-applicant spouse as a living allowance. As of 2022, this spousal income allowance may be as much as $3,435 / month. Candidates should be aware that re-allocation of income is a complicated process and may require the assistance of a medicaid planning professional.
5) Countable Assets – also referred to as “resources”. As of 2022, a single applicant’s countable assets must not exceed $2,000 in value. However, some assets are exempt (not counted toward the $2,000 limit). Exempt assets include one’s home equity up to $636,000, a vehicle, home furnishings, and personal items. Married couples with only one applicant can allocate joint assets to the non-applicant spouse up to a value of $137,400. This is called a community spouse resource allowance. Again, the re-allocation process is fraught with potential ways to violate Medicaid’s strict eligibility rules. So one should consider working with an outside professional.
Benefits and Services
The range of services that are paid for by this waiver have been specifically chosen to help individuals remain living outside of nursing homes. Applicants are evaluated individually. And in addition to case management, their customized plan of services may include any of the following. Certain services listed below can be consumer directed, most notably attendant / personal care.
- Adult Day Services / Adult Day Care
- Adult Family Care / Adult Foster Care – caregivers cannot be related to the care recipient
- Structured Family Caregiving – caregiver can be related to the care recipient. Learn more.
- Assisted Living Services
- Attendant Care – Assistance with activities of daily living, such as mobility, dressing, toileting, etc.
- Case Management
- Community Transition
- Home Modifications and Assessment – Addition of walk in tubs, grab bars, widening of doorways, etc.
- Home Delivered Meals
- Homemaker Services – Laundry, housecleaning, meal preparation, etc.
- Specialized Medical Equipment and Supplies
- Personal Emergency Response System (PERS)
- Respite Care – In-home and out-of-home
- Transportation Assistance
- Vehicle Modifications
- Nutritional Supplements
- Pest Control
- Health Care Coordination
How to Apply / Learn More
Although this waiver is available throughout the state, it is not an entitlement. This means there are limited participant enrollment slots and a waitlist may exist. More detailed information is available here. To learn more or to apply for the A&D waiver, one can call the Division of Aging at 1-888-673-0002 or contact their local Indiana Area Agency on Aging. The AAA will start the application process with a telephone interview.
Currently there are no waiting lists for qualified applicants to begin receiving services. But candidates may be able to put themselves on a waiting list in advance of the need for services. Discuss this option with your local Area Agency on Aging.
