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 program helps the elderly avoid nursing home placement and can compensate family caregivers for their assistance.
Kentucky’s Home and Community Based Services Medicaid waiver provides care and support services to the elderly in their homes, allowing them to avoid institutionalization in a nursing home should they choose to do so. This waiver achieves dual objectives of allowing individuals to age in place and saving money for the state of Kentucky. Caring for the elderly at home is considerably less expensive than doing so in a nursing home, largely because it leverages family members as primary caregivers. Of course, the additional benefit is individuals typically prefer to remain living in their homes whenever possible.
There is a Consumer Directed Option (CDO) for this waiver that allows participants to choose their own care providers for the non-medical care services they receive under this waiver. Certain family members and friends can be hired as paid caregivers, including spouses and adult children. One might hear "consumer direction" referred to as "Cash and Counseling," as that was the original grant name that tested the concept of consumer control (or direction) over their caregivers. In Kentucky, it is also referred to as Participant-Directed Services (PDS). Not all services provided under this waiver are appropriate for consumer control, but those that require little to no medical skills training can be self-directed. Chief among these are personal care, homemaker services, unskilled respite care, and minor home adaptations.
Did You Know? Kentucky has some of the least expensive assisted living in the country with costs approximately 25% below the national average. Free assistance is available to residents to find affordable local care. Learn more.
The Home and Community Based Waiver for the Aged considers the applicant's residence, age, functional ability, income, and assets.
Residence – an applicant must be a resident of the state of Kentucky.
Age - participants must be at least 65 years of age. This waiver is also open to those designated as disabled by Social Security who are 64 years of age or under.
Functional Ability - participants must require nursing home level care and be willing and able to receive that care in their home or community.
Income - In 2019, an unmarried applicant is allowed income up to 300% of the Federal Benefit Rate (FBR). In dollar terms, an individual must have $2,313 / month or less in income. Married applicants (both spouses applying) are each allowed up to $2,313 / month in income, as income is considered separately. If the applicant is married and his/her spouse is not also applying for Medicaid services, the applicant is able to transfer some of his/her income to the non-applicant spouse (also referred to as the community spouse) to prevent them from becoming impoverished. This is called the Maximum Monthly Maintenance Needs Allowance (MMMNA), and as of 2019, the applicant can transfer a maximum of $3,160.50 / month to the non-applicant spouse.
However, an exception to the income limit above exists for persons with unusually high care expenses. The Medically Needy (MN) Program evaluates an applicant's medical expenses and their income. If it is discovered an applicant cannot afford his/her care and he/she spends-down their excess income on their medical care to meet the income limit, then he/she can qualify for Medicaid assistance.
Assets - For a single applicant, in 2019, countable resources must be valued at less than $2,000. Married couples that apply together can have up to $4000 in savings. The home in which the applicant lives (as long as the home equity is valued at or under $585,000), a primary vehicle, and certain other personal items are considered exempt from his/her countable resources. For applicants who are married, all assets are considered jointly owned. Learn more here. If only one spouse is applying for Medicaid, the non-applicant spouse may be allowed up to $126,420 in joint assets. In Medicaid-speak, this is called the Community Spouse Resource Allowance (CSRA).
Individuals who exceed the financial limits may still qualify for this waiver (and Kentucky Medicaid). A variety of options exist that can help individuals or families lower their monthly income or their countable assets so that they meet the program’s requirements. One can do this by working with a Medicaid Planning professional. This approach may not be appropriate for everyone. Learn more.
Benefits and Services
Not all applicants will be approved for the same services. Follows is a list of possible services that are covered by this waiver. Note that beneficiaries can choose their providers for some of these services, such as personal care, but not for others, such as assessments. Consumer direction allows participants to choose their providers but does not allow them to choose how much to compensate them.
Assessments / Reassessments - for medical and personal care requirements
Case Management - for all waiver participants
Minor Home Adaptations - intended to increase the independence of the recipient. Can be consumer directed.
Adult Day Health Care / Adult Day Care- group care during normal business hours
Homemaker Services - includes laundry, housekeeping, and shopping services for the waiver participant only. Can be consumer directed.
Home Delivered Meals
Personal Care - can be consumer directed
Personal Emergency Response Services (PERS) – included under Home Modifications
Respite Care - temporary caregiving relief for the primary caregiver. Can be consumer directed.
Attendant Care - provides assistance with daily tasks, such as dressing, eating, and moving from one location to another. Can be consumer directed.
How to Apply / Learn More
Kentucky’s Home and Community Based Services Medicaid waiver is available throughout the state. To learn more about this program and to apply, one should contact the local office of the Cabinet for Health and Family Services (CHFS) or visit the webpage for this program. Once enrolled in this program, individuals are re-assessed, at a minimum, of one time per year to ensure their care needs have not progressed beyond the services they are receiving.
It is very likely that waiting lists for services exist. Another assistance option that may be relevant and more immediately available is the Adult Day Care and Alzheimer's Respite Program.