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.
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 Supports (CDCS) . 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.
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.
2022 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 $2,523. 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 $2,523 / month in income. When only one spouse of a married couple is an applicant, the income of the non-applicant spouse is not considered in the income eligibility of the applicant spouse. In fact, if the non-applicant spouse has little to no income in his / her name, he / she can receive a transfer of monthly income, a spousal income allowance, of up to $3,435 from his / her applicant spouse.
The asset limit for a single applicant is $3,000, excluding the value of one’s home (given the equity value is $636,000 or less and the applicant or his or her 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. In the situation where just one spouse is applying for the waiver, the non-applicant spouse is entitled to a much larger share of the couple’s assets. This spousal resource allowance allows the non-applicant spouse to keep up to $137,400 in assets. This is in addition to the $3,000 the applicant spouse is allowed. Learn more here.
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 $1,133 per month. Medicaid program staff use a formula to deduct the applicant’s unreimbursed medical and care expenses from his or her income to determine whether he or she qualifies under the Medically Needy option. Couples can have up to $1,527 after medical and care expense deductions from their monthly income. (The medically needy income limits above are in effect from 7/1/22 through 6/30/23.)
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. But, 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, persons can 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 (including memory care for persons with Alzheimer’s and related dementias)
- Case Management
- Chore Services
- Family Caregiver Education / Training (including dementia care related)
- Home Delivered Meals
- Home Health Aides
- Home / Vehicle 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
How to Apply / Learn More
While this program is available statewide across Minnesota, there may be participation caps. Thus, waiting lists may exist. At the time of this writing, it was confirmed that there is not a waiting list.
Persons 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. Seniors can also contact the Senior LinkAge Line at 800-333-2433. Alternatively, seniors can consult the FAQs on this page to find links to the paper application for Medical Services.