This waiver helps persons who would otherwise require nursing home care, to remain living at home.
This Maine Medicaid (MaineCare) Elderly and Adults with Disabilities Waiver is designed to help the elderly by funding services and supports to allow nursing home qualified individuals to remain living at home or in their communities. Typical services include home care, medical alert systems, transportation, and chore assistance (a complete list can be found further down this page).
This waiver may also be referred to as Home and Community Benefits for the Elderly and the Older Adults Waiver, and is administered by Maine’s Department of Health and Human Services’ Office of Aging and Disability Services.
Individuals choosing this waiver can have the state manage their care services or they can choose to self-direct their care under the Participant-Directed Option. Self or Consumer Direction is a concept based on the Medicaid model called Cash and Counseling in which participants are given the flexibility to choose their own personal care providers. Some family members, including the adult children of aging parents, can be hired to provide personal care; they can be paid caregivers. (Spouses cannot be hired to provide care). The Supports for Participant Direction option requires participants to use a third-party financial management company to assist in their role as “employers.” The financial management company helps with managing payroll and paying employer taxes.
To qualify for services under this MaineCare waiver, the state considers 4 factors; the applicant’s age and level of disability, which are inter-related and their income and assets, which are tied to Medicaid eligibility. In addition, applicants must be residents of Maine.
Disability and Age – Adults 18-64 must be disabled as determined by Social Security. Seniors, aged 65 and older, must require the level of care provided in a nursing home as determined during a medical review.
Income – Unmarried or widowed applicants must have income no higher than 3 times the Supplemental Security Income rate. In 2020, monthly income at or under $2,349 is necessary. If a married couple is applying, the spouses are looked at as if they are two separate applicants. This means each spouse can have monthly income up to $2,349. However, a more common scenario is for one spouse of a couple to apply. In this situation, the $2,349 / month income limit still applies for the applicant. To be clear, the non-applicant spouse’s income is not considered for the income eligibility of the applicant spouse. In addition, the applicant spouse is able to allocate some of his or her income to the non-applicant spouse in order to prevent that spouse from becoming impoverished. As of 2020, up to $3,216 / month can be allocated to the non-applicant spouse. (This is called a monthly maintenance needs allowance.)
Assets – The effective asset limit for single MaineCare applicants in 2020 is $10,000 in countable resources. Married couples with two applicants are permitted $15,000. (Unlike income, assets of a married couple are considered jointly. Learn more here.) If one spouse is not seeking assistance, the applicant spouse is permitted up to $10,000, and the non-applicant spouse can retain up to $128,640. (This figure that the non-applicant spouse can keep is called the community spouse resource allowance). Emphasis should be put on the fact that these limits are for countable assets. There are non-countable / exempt assets that include a family home provided its equity value does not exceed $893,000 (in 2020), household goods, and a vehicle, provided it is in use and not an investment or high-value collector’s item.
Qualifying When Over the Limit – Fortunately, there are options for residents whose finances are greater than the allowable income and / or asset limit(s). MaineCare offers a Medically Needy exception for persons with high recurring medical costs that consume most of their income. This option, which is often referred to as a Spend Down Program, it works similarly to a deductible program. Once the applicant spends down their excess income on medical bills and meets the income limit, the applicant is eligible for the Elderly and Adults with Disabilities Waiver for the remainder of the six-month “spend down” period.
Unfortunately, the medically needy option does not assist applicants with excess assets to meet the asset limit. Rather, applicants can spend assets that are over the limit on non-countable ones. This might be upgrading one’s heating and/or plumbing, adding a first floor bedroom for easier access, or paying off credit cards and other debt. When “spending down” excess assets, it is crucial that no assets are gifted or sold for under value. This is because Medicaid has a look-back period of 5-years. During this period of time, Medicaid reviews all transactions to ensure this rule has not been violated, and if it has, an applicant will not be eligible for Medicaid for a period of time.
Working with a Medicaid planner is another approach for families who cannot afford their care costs. Planners help families qualify for MaineCare by re-allocating their excess income into annuities (over simplified, an annuity takes a lump sum of cash and converts it into an income stream) and by converting resources into non-countable assets. These and other approaches are complicated and require expertise. Read more here.
Each applicant receives a customized care plan that can include any of the below mentioned benefits. Certain services, such as personal care and in-home respite care, can be consumer directed.
The Elderly and Adults with Disabilities waiver is available throughout Maine. However, applicants in rural areas may have difficulty finding approved care providers. In such a situation, a friend or family member might be approved to provide personal care. Applicants should also be aware that waiting lists may exist, as only a limited number of slots are available. However, as of Jan. 2020, no wait list existed.
One can apply online or in person at their local Office for Family Independence. Persons can also contact their local Aging and Disability Resource Center for more information. Very limited information about this waiver can be found on the State of Maine Aging & Disability Services website.