Maryland Medicaid Community Options Waiver (formerly Waiver for Older Adults)

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 state-specific "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

Until recently, the Maryland Community Options Medicaid Waiver was called the Waiver for Older Adults. That program and the Living at Home Medicaid Waiver are now merged under this new title. This waiver is also called the Home and Community-Based Options (HCBO) Waiver and, in this article, it is referred to as simply the CO Waiver.

The new CO waiver allows elderly individuals and those with physical disabilities who need nursing home level care to receive care services in their home or a group living community facility instead. Group living communities can include assisted living residences, provided they are participating in the program and willing to accept the Medicaid payment rates.

The CO Waiver is popular both with families and the state of Maryland, but for different reasons. Participants generally prefer to remain living at home for as long as possible; this waiver assists them in doing so. The cost of caring for someone at home is also less expensive for the state than it would be to place the individual in a nursing home. This is because home care utilizes caregiving assistance from family members.

Maryland Medicaid programs in general are sometimes referred to as Medical Assistance (MA).

Due to the popularity of this program, new applicants are added to the waiting list. Wait times can last multiple years. 

A waiting list, in Medicaid language, is referred to as the Waiver Services Registry. Persons who are currently residing in a Medicaid funded nursing home may be able to bypass the Services Registry, or may be placed on a different, shorter Registry.  *As of January 2018, the Community Options Waiver is only available to individuals who are in a nursing home and are getting Medicaid services.

Alternatively, a new Medicaid program in 2015, allows for similar services without waiting lists. Read about Maryland's Community First Choice (CFC) Program

 

Eligibility Guidelines

The CO Waiver considers age, income, assets and functional ability as qualifying criteria. Participants must be at least 18 years of age to be eligible and they must be assessed and found in need of nursing home level care. Those between the ages of 18 and 64 must be physically disabled.

Financially, the monthly income limit for 2018 is $2,250 (300% of SSI). The asset limit for a single applicant remains at $2,000 for 2018. While this limit might seem quite low, several assets are considered exempt (non-countable) and include an applicant’s home if that is where they reside, a vehicle, household items, and some personal belongings. Persons whose monetary resources are greater than the limits may still qualify in one of three ways.

1) If the applicant is married and their spouse is not seeking Medicaid, a certain amount of income and financial resources can be allocated to the non-applicant spouse as a living allowance. This can help lower the applicant's income and assets to an acceptable level. In 2018, a non-applicant spouse (sometimes called the 'community spouse') can have countable assets valued up to $123,600. Community spouses also often require a certain amount of the non-applicant’s income to pay living expenses. Up to $3,090 of the non-applicant’s monthly income can be given to a community spouse.

2) Persons with high medical costs can participate in Maryland's Medically Needy spend-down program. Applicants are conditionally accepted into Medicaid, provided they spend-down their excess income on their care needs / medical bills until they meet the eligibility limits. This program is often referred to as a “Spend Down” program.

3) Applicants can re-structure their finances to meet the limits. Excess assets can be converted from countable resources into exempt resources. One example would be updating the heating and / or plumbing in one’s home. The additional benefit of this approach is that certain resources are then preserved for future generations of the family.

Re-structuring one's finances typically requires professional expertise. There are various types of professionals available to aid families in need. The cost for services can range from free to several thousand dollars depending on the type of professional and the complexity of the case. Learn more here about advisory services.

 

Benefits and Services

The Community Options Waiver (for Older Adults) provides a variety of support services in assisted living or at home. In addition to individual case management, waiver participants may be approved for any of the following:

  • Adult medical day care
  • Assisted living services
  • Case management
  • Assistive technology
  • Behavior counseling
  • Environmental modifications
  • Family caregiver training
  • Home-delivered meals
  • Nutritionist services
  • Personal care
  • Personal Emergency Response Services (PERS)
  • Respite care
  • Transitional services

Waiver program participants can also receive medical care, home medical equipment, disposable supplies and pharmaceutical assistance. However, these benefits are provided as regular Medicaid benefits and are not under waiver services.

 

How to Apply / Learn More

The application process is different for individuals currently living at home versus those living in a Medicaid funded nursing home. Those living at home can call 866-627-5465 to add their name to a waiting list (Services Registry). Those living in a nursing home should contact their county's Area Agency on Aging or speak with the social worker at the facility. In addition, one may contact Medicaid’s Long Term Care and Waiver Services at 410-767-1739.

One can download a brochure about this program on the Maryland Department of Aging website.