The Assisted Living (AL) Waiver is a Mississippi Medicaid Home and Community Based Services (HCBS) Medicaid waiver program. It is designed to help both low-income adults with disabilities and the elderly that require significant assistance with completing Activities of Daily Living (ADLs), such as eating and maintaining personal hygiene. It assists eligible applicants by providing for personal care and other supportive services in assisted living communities, instead of placement into nursing homes.
Qualifying as “assisted living” includes state-approved assisted living residences that accept Medicaid, licensed personal care homes, community residential care facilities, and congregate housing. These residences are commonly referred to as Personal Care Home-Assisted Living (PCH-AL) facilities.
HCBS Waivers, including this one, are not entitlements. Unlike institutional or nursing home Medicaid, being eligible for services does not automatically mean that services will be available. For the past several years, a waiting list for the Assisted Living Waiver has existed, although the average time spent on the waiting list is less than in many states with similar waivers. There are three different regions within the state of Mississippi that have their own AL Waiver waiting lists, so depending on the area in which one lives, the wait time will vary from a few months to a few years.
In order to be eligible for the Assisted Living waiver, applicants must be residents of Mississippi. This state considers the applicant’s monthly income, countable assets, age, and level of impairment when determining eligible participants for this waiver.
Age – Applicants must be at least 21 years of age. If the applicant is not disabled, the applicant must be a minimum of 65 years of age. There is no maximum age limit.
Level of Impairment – Participants must require the level of care provided in a nursing home. Areas of screening to determine eligibility may include an individual’s capacity to perform Instrumental Activities of Daily Living (IADLs), such as the ability to prepare one’s own meal or to grocery shop, as well as ADLs, such as grooming, mobility, and toiletry. Other areas may include deficits in cognition, medical conditions, and sensory deficits.
Monthly Income – Individuals must meet the Mississippi Medicaid income limit for individuals who require nursing home care. For 2020, an applicant’s monthly income must be less than 300% of the Federal Benefit Rate (FBR). This means an applicant cannot have monthly income greater than $2,349. Married applicants, whose husband or wife is not seeking Medicaid, can allocate some of their income to their spouse who is not applying. As of 2020, this amount can be as great as $3,216 / month. This figure is known as the Maximum Monthly Maintenance Needs Allowance (MMMNA). This can effectively lower the applicant’s income to within the limits necessary for the Assisted Living Waiver. Alternatively, an applicant might utilize a special income trust, called a Miller Trust, to lower their income to within the limit.
Assets – Asset calculations are more complex than income. Medicaid defines assets as either “countable” or “exempt”. Countable assets include savings, stocks, second homes, land that one’s primary home isn’t on and doesn’t produce income, and most other things of value. It is perhaps easier to list those assets that are exempt (not counted towards the asset limit). These include personal items, home furnishings, burial plots, two motor vehicles, low-value life insurance policies (face value under $10,000), and most importantly, a home, provided the equity value is less than $595,000 in 2020. The countable asset limit for a single applicant is $4,000. For those who are married, assets are considered jointly owned. The non-applicant spouse of a married couple is permitted to have up to $128,640 in assets. This is called the Community Spouse Resource Allowance (CSRA). Joint assets can be allocated to the non-applicant spouse up to this amount. In addition, the applicant spouse is able to retain $4,000 in assets.
Beneficiaries of the Assisted Living Waiver can receive the following types of care and support. Be aware that waiver participants are expected to contribute financially to their room and board costs in assisted living.
The AL Waiver is available in all Mississippi counties. However, this is not an entitlement program; persons who meet the requirements may be placed on waitlists. The program’s webpage offers limited information on this program, but offers a downloadable PDF that provides more program details.
This Waiver is administered by the Mississippi Division of Medicaid (DOM), Bureau of Long Term Care. To apply, contact them at 1-800-421-2408 or by contacting your local area agency on aging.