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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. Not all services provided under this waiver are appropriate for consumer control, but those that require little or no medical skills training can be self-directed. Chief among these are personal care, homemaker services, unskilled respite care, and minor home adaptations.
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 2018, an unmarried applicant is allowed income up to 300% of the Federal Benefit Rate (FBR). In dollar terms, an individual must have $2,250 / month or less in income. If the applicant is married and their spouse is not also applying for Medicaid services, the applicant is able to transfer some of their income to their spouse (referred to as the community spouse) to prevent them from becoming impoverished. This is called the Maximum Monthly Maintenance Needs Allowance, and as of 2018, the applicant can transfer a maximum of $3,090 / month to their non-applicant spouse. Married applicants are each allowed up to $2,250 / month in income, as income is considered separately.
However, an exception to the income limit above exists for persons with unusually high care expenses. The Medically Needy (MN) Program evaluates the applicant's medical expenses and their income. If it is discovered they cannot afford their care and they spend-down their excess income on their medical care to meet the income limit, then they can qualify for Medicaid assistance.
Assets - For a single applicant, in 2018, 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 their home equity is valued at or under $572,000), primary vehicle, and certain other personal items are considered exempt from their countable resources. For applicants who are married, all assets are considered jointly owned. If only one spouse is applying for Medicaid, the non-applicant spouse may be allowed up to $123,600 in joint assets.
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.
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.