Page Reviewed / Updated - November 23, 2020
Home and Community Based Services (HCBS) is a program that consists of a group of care and support services provided by Missouri Medicaid (MO HealthNet). The objective is to reduce nursing home admissions by providing services to individuals in their homes or in the community. HCBS are generally considered to be a win-win in that most individuals prefer to receive care at home and providing services at home usually costs the state less money than would full-time nursing home care.
Missouri Medicaid has a similar program called the Aged and Disabled Waiver. Both programs provide financial aid to individuals at home for their ongoing care costs. The difference is that HCBS are entitlements, while the Aged and Disabled Waiver has a limited number of available slots. It is usually possible for individuals to receive HCBS while on the waiting list for the Waiver.
HCBS are also referred to as the Missouri Care Options (MCO) program. This program is under the administration of the Division of Senior and Disability Services (DSDS) within the Missouri Department of Health & Senior Services (DHSS).
To be eligible for Home and Community Based Services, individuals must be enrolled in Medicaid / MO HealthNet, which is a program intended for low-income state residents. Program candidates are evaluated based on their income and assets. In addition, eligibility requirements vary depending on the age of the applicant. However, applicants must be a minimum of 18 years of age. What follows are the requirements for seniors, aged 65 and older.
As of February 2020, single, senior applicants are eligible if their monthly income is less than $1,370. Married couples (both spouses applying) are eligible if their income is under $2,740 / month. (Please note that MO changes their annual income limits in April of each year). Persons with incomes higher than these limits may still be eligible if they are married and their spouse, often called the community spouse, is not also applying for Medicaid. In this case, in simplified terms, the applicant spouse can allocate some of his / her income to their non-applicant spouse. This is called a Monthly Maintenance Needs Allowance (MMNA). As of 2020, up to $3,216 / month can be transferred to the community spouse. Alternatively, applicants can "spend-down" their income each month on their care needs / medical bills until they reach the Medicaid income limit level. Persons in any of these situations should consider consulting with a Medicaid planner before application.
The 2020 asset limit for a single applicant is $4,000 and $8,000 for a couple with both spouses applying for Medicaid services. It should be noted that there are many exceptions to what is counted as an asset. Most notably, the value of one's home, should the equity value be less than $595,000, is not counted towards Medicaid eligibility. Married couples, with only one spouse applying, have the option of allocating up to $128,640 to the non-applicant spouse. This is called a community spouse resource allowance (CSRA). The applicant spouse is still able to retain up to $4,000 in assets. Assets transferred out of the applicant's name during the 5 years preceding their application may impact eligibility. This is known as Medicaid’s Look-Back Period.
Medicaid planners are available to assist families in meeting the asset eligibility test. Learn more about how this may be an option for your family.
There is also a functional requirement. Applicants must also require a level of care consistent to that which is provided is a nursing home.
Each applicant is approved for different HCBS services depending on his or her needs. These can include personal or attendant care, which consists of aid with Activities of Daily Living, such as taking a bath, getting dressed, grooming, and mobility, homemaker services, like assistance with cleaning, laundry, shopping, and cooking, and respite care, both at home and in adult day care. Nursing services are also covered. However, nursing home care is not, as it would not be considered a "home and community" based service.
Individuals already approved for Missouri Medicaid can apply directly for Home and Community Based Services by calling 866-835-3505. Those who have not yet been approved for Medicaid should contact the Family Support Division (FSD) by calling 855-373-4636. More information about this program is available on their website.