Page Reviewed / Updated - Apr. 2016
The DC Office of Aging offers a single Medicaid waiver that is relevant to aging District residents; the Elderly and Persons with Disabilities Waiver, more commonly referred to as the EPD Waiver or the HCBS Waiver. This waiver is intended to allow beneficiaries who would otherwise require nursing home care to receive care services outside of that environment and to remain living in their homes or in assisted living communities. The waiver does so by providing for personal care, support services and assistive technology which increase the program participant’s independence.
The EPD Waiver contains an option called "Services My Way". Services My Way allows beneficiaries to "participant direct" their care or phrased another way, they have the option to choose from what care providers they receive care services. Family members, including the adult children, get be hired and paid to provider care services. It is worth noting this model of care is also referred to as Consumer Directed or Cash and Counseling.
Medicaid waivers, unlike regular Medicaid or nursing home care, are not entitlement programs. Each waiver is approved with a limited number of available slots. In previous years, a waiting list has existed for the EPD Waiver. In 2016, the number of available slots is approximately 4,700. Prioritization on the wait list is based on a first-come, first-serve basis not based on urgency of need.
EPD Waiver qualifications consider both the functional ability and the financial status of the applicant. Candidates must have a medically documented need for nursing home level care and be over 65 years of age or over 18 and be officially disabled.
From a financial perspective, the District considers the applicant's income, financial resources or "countable assets" and past asset transfers dating as far back as 60 months preceding their data of application. Monthly income for an individual applicant is limited to 3 times the Federal Benefits Rate. In 2016, monthly income cannot exceed $2,199 for a single, unmarried or widowed applicant. Countable assets, which exclude the value of the home and primary vehicle, cannot exceed $2,000.
Married couples with two applicants have higher limits and married couples with a single applicant are subjected to a different, more complicated rule set. These rules were created in order to enable the "well spouse" (the non-applicant spouse) to continue to live independently. Families in this situation and single applicants who are concerned they do not meet the DC Medicaid limits should consult with a Medicaid planner.
Finally, another option exists for persons over the Medicaid financial limits. An applicant can be considered "medically needy" and can qualify for Medicaid if their medical expenses exceed their incomes even though their incomes are over the published DC Medicaid limits.
Each beneficiary of the EPD Waiver has different care requirements and will be approved for different care and support services by their case manager. Under the EPD Waiver, the following forms of assistance are available.
To apply for the EPD Waiver, interested parties should contact the Washington DC Aging and Disability Resource Center at 202-724-5626. A detailed, step-by-step description of the application process is available on the District's Commission on Aging's website. A complete handbook for the program that offers very detailed information is available for download here.