Virginia Alzheimer's Assisted Living (AAL) Waiver

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 Virginia Medicaid waiver is intended to help aging Virginia residents who have been diagnosed with Alzheimer's disease or related memory disorders such as vascular or frontotemporal dementia (FTD), Lewy Body, or stroke. The waiver provides care and supports to help individuals in assisted living communities only. In addition to personal care, this waiver covers meals, transportation assistance, housekeeping services, and therapeutic activities offered by the participant chosen assisted living residence.

Begun in 2013, this pilot program will expire at the end of 2018, if not renewed by the state. This waiver is not available to persons who reside in homes or in skilled nursing residences. There are several other state assistance programs that do so help seniors to with aging in place or in other care settings. More information is available in our overview of all Virginia elder care benefits.

 

 

Eligibility Guidelines

In addition to being a resident of Virginia, there are four eligibility criteria for candidates:

1) Age - applicants must be at least 55 years of age.

2) Residential - applicants must live in or be willing to move into an assisted living residence that has been approved by the Virginia Department of Social Services.

3) Health - applicants must be diagnosed with Alzheimer's or one of the other previously mentioned types of dementia and be at the level of impairment where they cannot recognize a physical risk or make decisions to provide for their own safety.

4) Financial - applicants must qualify for Virginia Medicaid, which considers both the applicant’s income and assets. In 2017, persons who have income less than $804 per month qualify for full benefits. Persons over 65 whose monthly income exceeds $804 and is less than $2205 can qualify through a special income standard for seniors who require long term care. Individuals who have income over $2,205 can qualify through the Medically Needy pathway. Under this eligibility rule, an applicant is permitted to deduct both their out-of-pocket medical expenses and disregard wages from part time employment. Working with an independent adviser to re-structure assets and income could ensure that the applicant has maximized savings and benefits.

One's financial assets are also considered, with the exceptions of personal property, a home and a vehicle. Individuals must have countable resources valued at less than $2,000. However, if they are married and their spouse is not applying, joint assets up to $120,900 can be allocated to the non-applicant spouse. Medicaid planners can aid in helping married couples qualify while saving the most wealth possible for the healthier spouse. Learn more.

 

Benefits and Services

This waiver is intended to prevent the unnecessary institutionalization of the elderly in nursing home by providing services in less expensive assisted living communities. The state pays for the costs of care at the assisted living but is not permitted to pay for the room and board charges. Examples of care services covered include: 

  • Assistance with activities of daily living such as bathing, grooming, transferring and eating
  • Assistance with the instrumental activities of daily living such as laundry, housekeeping, meal preparation and medication administration
  • Therapeutic, social and recreational activities provided in or by the assisted living residence
  • Transportation assistance for medical appointments

Very low income seniors who have dementia and may not been able to afford the basic room and board costs for an assisted living facility may also consider applying to the Auxiliary Grant Program to supplement their income. Waivers participants can receive the grants at the same time.
 

How to Apply / Learn More

This program is available statewide across Virginia. However, only 200 participants will be able to into the program in any period. Persons may fully qualify but find themselves on a waiting list for services. In official terminology, this is not a Medicaid entitlement program. There’s no guarantee to receive the services.

To check waiting list status, learn more about the program or to apply, one should contact their local department of health.  More information about the program is available here and a list of eligible assisted living residences can be downloaded here.

 Virginia seniors can receive free assistance finding affordable assisted living.  Be sure to confirm with the residence that they accept the AAL Waiver as not all assisted living residences do.  Start here.