What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services outside of nursing home residences. Medicaid’s standard benefit is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.
Waiver Description
The Maryland Community Pathways Medicaid Waiver provides developmentally and intellectually disabled Maryland residents with home and community based services to enable them to continue residing in their homes.
This waiver is strictly for individuals who are developmentally or intellectually disabled, and is unfortunately not available to those who are physically disabled. Therefore, it does not serve seniors suffering from a physical disability related to aging. However, there is a Medicaid waiver program suitable for individuals who are physically disabled, as well as those seniors who need a nursing home level of care due to the process of aging: Community Options.
Services via Community Pathways are funded by Maryland’s Developmental Disabilities Administration (DDA) under the Department of Health and Mental Hygiene. Services can be delivered via licensed providers or one may choose a self-directed model. Self-direction means program participants can elect who provides their care services. As such, certain family members can be retained to provide some care services. However, spouses cannot be paid to provide services.
Eligibility Guidelines
Unlike many Medicaid waivers, the Community Pathways Waiver does not have an age requirement. To be eligible for services under the Community Pathways Waiver, candidates must meet the following criteria. (The participants’ eligibility must also be reevaluated annually).
- Be a Maryland resident.
- Have a developmental disability OR intellectual disability.
- Meet the Medicaid waiver’s income and asset requirements. In 2020, single applicants are permitted annual income of less than $28,188 ($2,349 a month). Applicants are permitted $2,000 in countable assets. Countable assets do not include the value of one’s home or vehicle. That said, in order for the home to be exempt, the equity value must be $595,000 or under. In addition, the program participant or his/her spouse must live in the home.
Note that persons who exceed these income limits may still qualify by “spending down” their income on their care / medical expenses and qualifying through what’s known as the “medically needy” pathway.
Unfortunately, this pathway to Medicaid eligibility does not help one reduce their extra assets. However, one can spend extra assets on ones that are not counted towards eligibility. For instance, one may add a first floor bedroom or make other home modifications that allow one to age in place. Important: Applicants must not give away assets or sell them cheaply in order to meet Medicaid’s asset limit. This is because Medicaid has a rule in place, a look-back period, that if violated, a period of Medicaid ineligibility will result.
A benefits adviser or an elder law attorney knowledgeable about Maryland Medicaid rules can provide guidance and strategies on the best ways of meeting the income and asset requirements. Learn more.
Benefits and Services
Among the many benefits, this waiver provides support for caregiving in the home, live-in caregiver food and rent, accessibility adaptations (up to $15,000 in a three year period, including vehicle modifications), and various types of housing arrangements and family/individual support. Participants are empowered to select and self-direct their own service providers. A list of other common services follows. Note that not every applicant is eligible for all of these services.
- Adult day health services
- Case management
- Community living (group home services) – set to begin July 2020
- Day habilitation and residential rehabilitation
- Live-in caregiver supports
- Assistive technology – voice activated lights, weighted utensils, video magnifiers, etc.
- Behavioral support services
- Family / Peer mentoring
- Family caregiver training
- Individual / Family directed goods / services
- Nurse consultation / health case management
- Home / Vehicle modifications
- Personal care
- Respite care
- Remote support services
- Shared living
- Supported living
- Non-medical transportation
- Transitional services
How to Apply / Learn More
One can learn more about this waiver on the Community Pathways webpage.
To apply, one should contact his/her Maryland Department of Health Area Agency on Aging. Look up the Area Agency on Aging for your region of the state using this search tool.
