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.
This waiver allows family members to receive payment for caregiving services provided in the home.
The Iowa Home and Community Based Services (HCBS) Elderly Medicaid waiver provides services and support to help the elderly who are medically qualified for nursing home care. It is designed to allow individuals to remain living at home or in communities and receive care in those locations instead of in nursing homes. This type of program is growing in popularity with the state and with families. Families prefer their loved ones to age in environments in which they are familiar and comfortable. And state officials appreciate the cost savings generated from reduced nursing home costs.
This waiver includes a Consumer Choices Option (CCO), as well as Consumer Directed Attendant Care (CDAC). These two options provide the beneficiary with a degree of freedom in terms of what type of care they require and from whom they receive that care. The beneficiary or their legal representative can choose whom to hire for services. They have the flexibility to hire friends, neighbors, and even some family members such as the adult children. Spouses and legal guardians cannot be hired as caregivers.
CDAC allows assistance with both skilled and non-skilled services, which includes post-surgical care, tube feedings, medication management, transportation, meal preparation, and assistance with daily activities, such as walking, eating, and dressing. CCO allows even more freedom, as an individual budget will be determined and the eligible applicant can work within this budget. Services covered under this option include chore and homemaker services, respite care, unskilled care attendant, vehicle and home modifications, meal delivery, senior companion, assistive devices, and transportation.
In 2016, Iowa changed how most Medicaid beneficiaries received services to a managed care program. To be clear, the available services have not changed, but the state no longer directly manages care providers. Instead they are outsourced to managed care organizations (MCOs). Waiver participants select from between 2 – 4 different MCOs and work with those organizations directly. This new program is called the IA Health Link Managed Care Program.
The HCBS Elderly Waiver has eligibility requirements related to the applicant’s age, functional ability, and finances.
Age – Iowa residents must be at least 65 years of age.
Functional Ability – Applicants must be assessed by a medical team and found to need the level of care provided in a nursing home on a long-term basis. However, they must be able to receive that care at home at a cost lower than it would cost in a nursing home.
Income Limits – Elderly waiver applicants must meet the Iowa Medicaid Financial Limits. In 2022, single applicants must have income less than $2,523 month. A married applicant whose spouse is not applying has increased flexibility as he or she can allocate some of his/her income to the non-applicant spouse. This is referred to as the Monthly Maintenance Needs Allowance. In 2022, the spouse is permitted a monthly maximum of up to $3,435.
Asset Limits – Single (non-married, widowed, divorced) applicants are subject to a countable asset limit of just $2,000. However, many assets are exempt. These include an owner-occupied home valued at less $636,000, home furnishings, personal items, and a single vehicle. Married applicants (with only one of the two spouses applying) are subject to a different set of rules. To enable a spouse to have the resources to remain living independently, he/she is permitted the Community Spouse Resource Allowance (CSRA). The CSRA, in 2022, is equal to $137,400. Simply stated, joint assets can be held by the non-applying spouse up to this amount.
Persons whose finances exceed Iowa’s income limits might qualify through a Qualified Income Trust. And those who are over the asset limit might “spend down” assets by purchasing an Irrevocable Funeral Trust. If over the financial limit(s),working with a Medicaid Qualification Expert is suggested. Learn more here.
Benefits and Services
The Elderly Waiver aims to prevent nursing home placement. Therefore, the types of services for which waiver participants are eligible are specifically selected to help seniors function in their homes. This can include any of the following, but each individual is allocated custom benefits.
- Adult Day Care – Daytime, weekday assistance in group environments
- Assistive Devices – Devices to assist with activities of daily living, for example, a long reach brush to reach and pick up items (maximum cost per device is $119.72)
- Assisted Living On-Call – 24 hour care access in residential care
- Attendant Care (Self Directed) – Assistance with eating, mobility, using the bathroom, housekeeping, medication management, etc.
- Case Management
- Chore Services – Lawn moving, snow removal, window washing, etc.
- Home and Vehicle Modifications –Ramps, keyless entry systems, vehicle lifts, etc. (lifetime benefit amount of $1,098.78 maximum; not included in the monthly total)
- Home Delivered Meals (up to 14 meals per week)
- Home Health Aide
- Homemaker Services
- In-home and Out-of-home Respite Care – Provides temporary relief from caregiving responsibilities for the primary caregiver
- Nursing Care
- Nutritional Counseling
- Personal Emergency Response System – Initial installation and monthly service, as well as location identifiers to help prevent wandering
- Senior Companions – Assistance with shopping, laundry, housecleaning, and making meals
- Transportation Assistance
- Mental Health Outreach
How to Apply / Learn More
This waiver is available statewide in all Iowa counties. Waivers are not considered entitlement programs. This means that it is possible to be fully qualified and still be wait-listed for services. This waiver has been approved for approximately 10,448 participants in 2022. That said, as of last check, there was no wait list.
To apply, one should contact his/her Iowa Department of Human Services county office. A detailed, although slightly dated description of benefits is available here. Persons can also call 800-338-8366 to reach Iowa Medicaid Member Services for assistance.