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
KanCare is another name for the state of Kansas’ Medicaid program. In 2013, Medicaid in Kansas switched to a managed care program. Managed care integrated nearly all of the states’ Medicaid programs, including those providing Home and Community Based Services, such as the Frail Elderly (FE) waiver. This does not change the benefits of the program, only who provides the services.
The Frail Elderly Waiver is designed to help the elderly who require a nursing home level of care. Qualifying participants are provided with services and support to enable them to remain living in their homes, in family homes, or otherwise in their communities, such as in an assisted living facility or an adult foster care home, instead of in a nursing home.
Under this program, friends and family can be hired to provide personal care.
Some of the services provided under this waiver are open to self-direction. Self-direction, also called consumer direction, is based on a Medicaid demonstration project called Cash and Counseling in which participants have the flexibility to select their own care providers. Most notable among the services that can be self-directed is attendant or personal care. As little to no professional training is required to provide this type of care, a wide variety of persons can be hired including friends and family members. However, spouses and legal representatives cannot be hired as care providers, with the exception of very unique situations.
KanCare is administered by the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE). KanCare has a contract with three managed care organizations. These are Sunflower Health Plan, Aetna Better Health of Kansas, and United Healthcare Community Plan of Kansas, all of which coordinate care for eligible recipients.
Another HCBS program under KanCare that may be of interest to the young elderly is the Physically Disabled Program. This program is for adults 16 years of age to 65 years of age who are disabled. Click here to learn more.
Did You Know? Kansas is in the top 5 states for the highest percentage of persons living past the age of 100.
Eligibility Guidelines
Along with the requirement to be a resident of Kansas, the Frail Elderly Waiver considers the age, level of impairment, and finances of its applicants.
Age – Applicants must be at least 65 years of age.
Level of Impairment – Applicants must be assessed by a medical team and determined to require the level of care typically provided in a nursing home. In simple terms, this means most applicants require assistance with at least 2 or 3 activities of daily living and 3 instrumental activities of daily living.
Income – Single applicants in 2022 are permitted monthly income of up to $2,349. However, those persons with income exceeding $1,177 / month will be responsible for some portion of their care expenses.
When only one spouse of a married couple requires services via the FE waiver, the applicant’s income limit remains the same ($2,523 / month). The income of the non-applicant spouse is not relevant and is not considered when calculating income eligibility of the applicant spouse. Non-applicant spouses that have income under $2,288.75 / month (effective July 2022 – June 2023) can receive an income allowance from their applicant spouses to bring their income up to this level each month. If shelter expenses are high, non-applicant spouses may be entitled to a monthly income allowance as great as $3,435 / month (effective January 2022 – December 2023).
Assets – There are two categories of assets according to Kansas Medicaid: countable and non-countable (exempt). The countable asset limit in 2022 for a single applicant is $2,000. Items that are exempt (their value is not counted towards the limit) include a home, vehicle, personal belongings, and household items. However, there are some additional complexities for home exemptions. First, the value of the owner’s home equity cannot be more than $636,000 (in 2022). Second, the owner of the home must live in the home or have an “intent” to return to the home. Since this waiver allows persons to live in assisted living, they cannot simultaneously live in their homes. Therefore, for single applicants who live in an assisted living residence, their home will only be exempt if they express the “intent” to live in it again in the future. This rule does not apply to married applicants if a spouse remains living in the home. Said another way, if a non-applicant spouse continues to live in the home, it remains exempt.
For married couples with only one applicant, a greater amount of the couple’s countable joint assets can be allocated to the non-applicant spouses. As of 2022, the resource allowance for non-applicant spouses can be as much as $137,400. This is in addition to the $2,000 the applicant spouses are able to retain in countable assets.
Qualifying When Over the Limits
In Kansas, it is still possible to qualify for medical assistance through KanCare and the Frail Elderly Waiver when one’s financial holdings exceed the monetary limits. There are two ways in which to do this.
1) Individuals with very high, recurring medical expenses that consume the majority of their income may qualify under the Medically Needy program if their medical and care expenses reduce their disposable income to less than $475 / month. This program is often referred to as a “Spend Down” program, and the amount one has to “spend down” is often thought of as a deductible. In simple terms, after one has “spent down” his or her income to the medically needy income limit for the spend down period (6 months in Kansas), he or she is eligible for the waiver for the rest of the spend down period.
2) Persons can re-organize their assets to meet the limits. Medicaid planners help to re-structure assets into non-countable ones, such as purchasing irrevocable funeral trusts. And persons may “spend down” excess assets by making home modifications for aging in place and paying off debt.
By using planning strategies, one’s income and assets can be effectively lowered to a Medicaid compliant level. Learn more.
Benefits and Services
The services available to FE waiver participants can include those listed below. Applicants are assessed and re-assessed periodically to ensure their care needs are being met by their approved benefits. The services listed below with an asterisk can be self-directed.
- Adult Day Care
- Assisted Living Care Services
- Assistive Technology – lift chairs, toilet risers, bath benches, etc.
- Attendant Care Services*
- Comprehensive Support*
- Durable Medical Equipment
- Enhanced Care Services* – supervision / personal assistance (during a participant’s usual sleeping hours)
- Financial Management Services – for those opting for self-direction of available services
- Home Tele health
- Home Modifications for mobility purposes– wheelchair ramps, walk in showers, etc.
- Medication Reminder – i.e., medication dispenser
- Nursing Evaluation Visit
- Oral Health Services
- Personal Emergency Response System
- Wellness Monitoring
Did You Know? Seniors are eligibile to receive free, non-binding quotes for bathroom safety modifications.
Assisted Living Clarification – Care services provided to individuals living in assisted living can be paid for by this Medicaid waiver. However, the room and board portion of assisted living fees is not covered. Assisted living is defined as a residence with 6 or more individuals. Services can also be provided to individuals in smaller board and care homes and those in adult foster care situations. However, the same no room and board rule applies.
How to Apply / Learn More
This program is available statewide to all Kansas residents. One can find a local office of their Aging and Disability Resource Center to apply or call 1-855-200-2372 for more information. Learn more about the waiver here.
Wait lists for Medicaid waivers are common, but at the time of this writing, the Frail Elderly Waiver does not have a wait list.
