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.
The Missouri Medicaid Aged and Disabled Waiver (ADW) provides in-home services to Missouri residents aged 63 or over who have been assessed to require nursing home care, but have chosen to receive care in their homes instead. This Waiver pays for a range of services, such as adult day care, chore services, and home delivered meals. Services are intended to make it easier for family members or a spouse to care for a loved one at home.
The Aged and Disabled Waiver is managed by the Division of Senior and Disability Services within the Missouri Department of Health and Senior Services, in coordination with MO HealthNet.
Did You Know? By 2030, 70 million Americans will be 65 or older, up 100% from the year 2000.
The Aged and Disabled Waiver considers the qualification criteria related to the applicant’s age, ability, and finances. Applicants must be at least 63 years of age and have a functional disability that necessitates the need for the level of care typically found in nursing homes. Those 63 and 64 years of age must be physically disabled.
MO HealthNet (another name for Medicaid in Missouri) considers both an applicant’s income and resources. For the A&D Waiver specifically, as of 2022, the most recent published information puts the monthly income limit for this waiver at $1,470. The asset limit is $5,301.85. Not all of an individual’s resources are included as countable assets. An applicant’s home, provided either the owner or his spouse lives in it, and the equity is valued under $636,000, is exempt. A primary vehicle, certain personal effects, household goods, and a prepaid funeral / burial plan are also exempt.
If an applicant is married and their spouse is not also seeking assistance from Medicaid, these limits go up considerably to provide the non-applicant spouse with an adequate living allowance. Income from the applicant can be shifted to the non-applicant spouse (also referred to as a community spouse) to effectively lower the applicant’s income to a Medicaid-complaint level. As of 2022, this figure can be as much as $3,435 / month and is called a monthly maintenance needs allowance. Shared assets — up to $137,400 — can also go to the non-applicant spouse. This is called a community spouse resource allowance. This figure is in addition to the $5,301.85 in assets the applicant spouse is able to retain.
If an applicant exceeds the financial limits, but still cannot afford their cost of care, it is possible he or she can still gain entrance to MO HealthNet by working with a Medicaid planning expert or through a spend-down program. (Please note; in Missouri, there is no medically needy pathway to reach Medicaid’s income limit. However, persons can deposit extra income into a Qualified Income Trust to become income eligible. There are both public and private financial experts who can help families qualify. Read more.
Benefits and Services
The ADW provides for a variety of services to help participants remain living in the community. Adult day care, which provides assistance with daily living activities, meals, and activities, is offered during daytime hours to enable caregivers and family members to work. Various types of respite care are available both in-home and in facilities. Chore services are included to help maintain the home in livable condition. Some homemaker services, such as assistance with housekeeping, laundry, and shopping, are also covered. Lastly, home delivered meals are also available.
How to Apply / Learn More
This Medicaid waiver program is available in all areas of the state and open to all legal Missouri residents. Enrollment levels for this waiver are high, but are well below the state caps. Therefore, new applicants who qualify can expect to be able to enroll and begin receiving services without delay. However, the application processing time is between 45 – 90 days.
To apply, one should contact their local Area Agency on Aging. Contact information is available here. Some additional information about the waiver is available on the Missouri Department of Social Services’ website.