Page Reviewed / Updated - Feb. 2019
The Missouri Independent Living Waiver (ILW) provides home and community based services for adults who are physically disabled. With assistance via this program, individuals can continue to live independently in their homes, rather than require placement in nursing homes. Benefits include home modifications, personal care services, such as assistance with bathing, grooming, mobility, toiletry, and eating, and specialized medical equipment and supplies.
Under this program, personal care assistance is consumer-directed. This means an individual can hire the person of their choosing, including family members with the exception of spouses and legal guardians, to provide personal care, given they are qualified to do so. Financial Management Services provide assistance in carrying out the financial aspects of having an employee, such as processing timesheets and payments, and withholding taxes. Employees are paid the Medicaid approved rate for home care, which in 2019, is estimated to be approximately $18 an hour.
Though this program is not specifically for seniors, individuals who enroll in the ILW prior to the age of 64 may continue enrollment in this waiver, given they are still willing and able to self-direct their personal care services.
ILW is administered by the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) via the MO HealthNet Division.
In order to be eligible for the Independent Living Waiver, applicants must be Missouri residents who are between the ages of 18 and 64 and be physically disabled. If the individual also has a cognitive impairment, it must have manifested when the individual was 22 years old or older. In other words, this waiver is not intended for those persons with developmental disabilities. In addition, individuals must require a nursing home level of care, yet still be able to self-direct their own personal care.
Applicants must be Medicaid eligible and actively enrolled in the Missouri state plan. This means there are income requirements that must be met. As of 2019, a single individual is allowed income up to 85% of the Federal Poverty Level, which mean an applicant cannot have a monthly income more than $885. For married couples, with both spouses as applicants, the monthly income cannot exceed $1,198. However, Missouri does allow applicants that have an income greater than the allowable amount to “spend-down” in order to become eligible. For example, if an individual has $300 each month in recurring medical / care expenses, they are permitted to deduct that amount from their income, so their countable income is $300 less than their actual income.
There are also asset limitations, which are set at $3,000 for single applicants and $6,000 for married applicants, as of 2019. Some assets are considered exempt (non-countable), such as an individual’s primary home, given the applicant lives in it and it is valued under $585,000. A single vehicle and personal items, such as home furnishings, are also exempt. Married applicants whose spouses are not also applying for services can set aside more financial resources for their non-applicant spouses. As of 2019, non-applicant spouses can keep up to $126,420 in joint assets. Please make note, if applicants still have assets greater than the limits, one cannot simply give assets away or sell them for less than they are worth in order to meet Medicaid’s asset requirement. Doing so may violate Medicaid’s 5-year Look-Back Period and may result in a period of ineligibility.
Persons exceeding the income and / or asset limits and still cannot afford their cost of care, should consult with a Medicaid planner.
There is no hard cap on the amount of assistance persons can receive under this waiver. However, the total amount of assistance must be “cost neutral” when compared to the cost of maintaining the individual in a nursing home. Therefore, effectively, persons cannot receive more than approximately $4,300 per month in assistance.
To learn more about the Missouri Independent Living Waiver, call the Missouri Department of Health and Senior Services at 573-751-6400. One can also click here for limited information about the waiver.
All individuals interested in Missouri home and community based services must go through a pre-screening via phone to determine if they are eligible for a face-to-face assessment. To reach the Division of Senior and Disability Home and Community Based Services for a pre-screening, call 866-835-3505.
Applicants not already on the Missouri State Medicaid Plan must apply for Medicaid. This can be done by contacting one's local Missouri Department of Human Services office. To find your local office, click here.