Minnesota Medicaid Elderly Waiver (EW) Program: Qualifications and Services

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

 "Adult children of aging parents can be paid as caregivers"

Minnesota Medicaid’s Elderly Waiver (EW) pays for home and community-based services for people aged 65 years or older who require the level of medical care provided in a nursing home, but choose to reside in the community. This includes those residing in adult foster care homes and assisted living residences.

Under the Elderly Waiver, participants have the option of letting the state manage their care or they can self-direct their care through Consumer Directed Community v Supports. Under the Medicaid Cash and Counseling model, participants are given the flexibility to hire their own personal care providers, including family members. For example, the adult children of aging parents can be paid as caregivers. Financial Management Services providers are used to manage payroll services. In some cases, spouses and legal guardians can be paid to provide care.

Personal care is, by no means, the only service provided under this program. Other major benefits include assistance in making home modifications to better enable the participant to live independently and safely. Also included is support for adult day care, which can enable primary caregivers to work during the week.

Minnesota Medicaid is sometimes referred to as Medical Assistance, MA, or referred to incorrectly as MinnesotaCare. MinnesotaCare is a related, slightly more inclusive program.

 

Eligibility Guidelines

The EW has eligibility criteria related to the age, finances, and the health of the applicant. Applicants must be at least 65 years of age and have significant health challenges to the extent that they require aid to complete their daily personal tasks. This is equivalent to the level of care provided in nursing homes.

2018 Income and Asset Limits
Minnesota requires that elderly residents first qualify for Medical Assistance to access the benefits associated with this waiver. Waiver applicants have a monthly income limit of $2,250. This figure is equivalent to 300% of the Federal Benefit Rate (FBR). This is also referred to as the Special Income Standard (SIS). Married couples, with both spouses applying for the waiver, are considered as individual applicants when it comes to income. Therefore, each spouse is able to have up to $2,250 / month in income.

The asset limit for a single applicant is $3,000, excluding the value of their home (given the equity value is $572,000 or less and the applicant or their spouse lives in the home), primary vehicle, and irrevocable funeral trusts. Couples, with both spouses applying, can have up to $6,000 in assets, which includes savings and other near-cash resources. Unlike income, assets are considered jointly owned for married couples.

Options for Persons Exceeding the Limits
Persons over these financial limits can apply as 'Medically Needy' when they are unable to afford the cost of care for themselves or their loved ones. Often referred to as a “Spend-Down” program, the Minnesota Medically Needy Medicaid program allows individuals to become eligible once they've spent their income down to $804 per month. Medicaid program staff use a formula to deduct the applicant's unreimbursed medical and care expenses from their income to determine whether they qualify under the Medically Needy option. Couples can have up to $1,083 after medical and care expense deductions from their monthly income.

While the Medically Needy pathway allows an option for spending down excess income, it unfortunately does not provide a means to spend down excess assets. However, Medicaid planning is another option for individuals who exceed the program's strict financial criteria. It is possible to re-allocate some of one's financial resources into a Medicaid compliant annuity. By doing so, one effectively lower their assets to a Medicaid eligible level. Persons wishing to take this approach should find assistance qualifying for Medicaid before submitting application paperwork. Learn more.

 

Benefits and Services

Individuals are accessed upon enrollment and receive a customized plan of services. Waiver participants may receive any of the following benefits:

  • Adult Day Care
  • Adult Companion Services
  • Assisted Living
  • Case Management
  • Chore Services
  • Family Caregiver Education / Training
  • Home Delivered Meals
  • Home Health Aide
  • Home Modifications
  • Homemaker – housecleaning, laundry, grocery shopping, food preparation, etc. 
  • Personal Care Assistant – assistance with Activities of Daily Living
  • Residential and Adult Foster Care
  • Respite Care
  • Skilled Nursing
  • Durable Medical Equipment 
  • Personal Emergency Response Systems (PERS)
  • Transitional Services
  • Transportation

 

How to Apply / Learn More

While this program is available statewide across Minnesota, there may be participation caps and, therefore, waiting lists may exist. However, at the time of this writing, it was confirmed that there is waiting lists.

One can learn more about or apply for the Elderly Waiver by clicking here or contacting their long-term care consultant in their county health office. Use the state directory of county and tribal health offices here. Or, seniors can consult the FAQs on this page to find links to the paper application for Medical Services. 

There are other assistance programs available to Minnesota's elderly population. The Group Residential Housing Program and the Personal Care Assistance Program are two alternatives worth investigating.