MaineCare Elderly and Adults with Disabilities Waiver: Eligibility and Benefits

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

Waiver Description

 This waiver helps persons who would otherwise require nursing home care, to remain living at home. 

This Maine Medicaid (MaineCare) 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, adult day care, medical alert systems, transportation and chore assistance (a complete list can be found further down the page).

This waiver may also be referred to as Home and Community Benefits for the Elderly and the Older Adults Waiver.

Individuals choosing this waiver can have the state manage their care services or they can choose to self-direct their care under the Family Provider Service Option (FPSO). Self or Consumer Direction is a concept based on the Medicaid model called Cash and Counseling in which the participant is 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. The FPSO Program 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.

 

Eligibility Guidelines

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.

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 2017, monthly income under $2,205 is necessary. If a married couple is applying, their income can be twice that amount. A more common scenario is for one spouse of a couple to apply. In this situation, their incomes will be considered separately and the $2,205 figure still applies. Joint monthly income up to $3,022.50 can be allocated to the non-applicant spouse. Furthering complexity is a different set of income rules for those living in non-nursing, residential care (such as assisted living or adult foster care). For these individuals, their incomes must be below the monthly cost of their residential care.

Assets - The effective asset limit for single MaineCare applicants in 2017 is $10,000 in countable resources. Married couples with two applicants are permitted $15,000. If one spouse is not seeking assistance, their limit rises to $10,000 + $120,900 (joint assets can be allocated to the non-applicant spouse up to this amount). Emphasis should be put on the fact that these limits are for countable assets. There are exempt assets that include a family home provided its value does not exceed $840,000, a vehicle, provided it is in use, 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 limits. MaineCare offers a Medically Needy exception for persons with high recurring medical costs that consume most of their income. 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 qualifying trusts and by converting resources into non-countable assets. These and other approaches are complicated and requires expertise. Read more here.

Confused by the Eligibility Requirements?
Assistance is available to sort through these complexities. Learn about Medicaid Planning Professionals

 

Benefits and Services

Each applicant receives a customized care plan that can include any of these benefits.  Certain services can be consumer directed.  

  • Adult Day Health
  • Assistive Technology
  • Care Coordination
  • Environmental Modifications
  • Home Health Services
  • Homemaker
  • Independent Living Assessment
  • Personal Care
  • Personal Emergency Response Systems
  • Respite Care
  • Transportation

 

How to Apply / Learn More

This 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.

One can apply online or contact their local Aging and Disability Resource Center for more information and to check on wait list status.

 Did You Know? Unfortunately, Maine has some of the highest eldercare costs in the continental United States.  However, free assistance is available to help families find affordable care. Read more.