What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers and Waiver Funded Services, allow qualifying program participants to receive services outside of nursing homes. Medicaid’s standard benefit for seniors who need long term care is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.
The Missouri Independent Living Waiver (ILW) provides home and community based services for adults who are physically disabled. With assistance via this program, individuals can continue to live independently in their homes, rather than require placement in nursing homes. Benefits include home modifications, personal care services, such as assistance with bathing, grooming, mobility, toiletry, and eating, and specialized medical equipment and supplies.
Under this program, personal care assistance is consumer-directed. This means an individual can hire the person of their choosing, including family members with the exception of spouses and legal guardians, to provide personal care, given they are qualified to do so. Financial Management Services provide assistance in carrying out the financial aspects of having an employee, such as processing timesheets and payments, and withholding taxes. Employees are paid the Medicaid approved rate for personal care, which is estimated to be a max of $21.12 an hour for 2022.
Though this program is not specifically for seniors, individuals who enroll in the ILW prior to the age of 64 may continue enrollment in this waiver, given they are still willing and able to self-direct their personal care services.
ILW is administered by the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) via the MO HealthNet Division.
In order to be eligible for the Independent Living Waiver, applicants must be physically disabled Missouri residents who are between the ages of 18 and 64. If the individual also has a cognitive impairment, it must have manifested when the individual was 22 years old or older. In other words, this waiver is not intended for those persons with developmental disabilities. In addition, individuals must require a nursing home level of care, yet still be able to self-direct their own personal care.
Applicants must be Medicaid eligible and actively enrolled in the Missouri state plan. This means there are income requirements that must be met. As of April 2022 through March 2023, a single individual is allowed income up to 85% of the Federal Poverty Level, which means an applicant cannot have a monthly income more than $963. For married couples, with both spouses as applicants, the monthly income cannot exceed $1,297. However, Missouri does allow applicants that have an income greater than the allowable amount to create a Qualified Income Trust (QIT). In an oversimplified explanation, income over Medicaid’s income limit is deposited into a QIT and is no longer counted as income for Medicaid purposes.
There are also asset limitations, which are set at $5,301.85 for single applicants and $10,603.70 for married applicants, as of 2022. Some assets are considered exempt (non-countable), such as an individual’s primary home, given the applicant lives in it and the equity value is under $636,000. A single vehicle and personal items, such as home furnishings, are also exempt. Married applicants whose spouses are not also applying for services can set aside more financial resources for their non-applicant spouses. As of 2022, non-applicant spouses can keep up to $137,400 in joint assets. Please make note, if applicants still have assets greater than the limits, one cannot simply give assets away or sell them for less than they are worth in order to meet Medicaid’s asset requirement. Doing so may violate Medicaid’s 5-year Look-Back Period and may result in a period of ineligibility.
Persons exceeding the income and / or asset limit(s) and still cannot afford their cost of care should consult with a Medicaid planner.
Unfortunately, individuals who receive Home and Community Based Services via another waiver cannot receive services under ILW.
Benefits and Services
The following benefits are available via Missouri’s Independent Living Waiver.
- Self-Directed Personal Care Services
- Financial Management Services
- Case Management
- Home Modifications – ramps, grab bars, specialized electric systems
- Specialized Medical Equipment / Supplies – lift chairs, wheelchairs, shower benches, commode chairs, adult diapers
There is no hard cap on the amount of assistance persons can receive under this waiver. However, the total amount of assistance must be “cost neutral” when compared to the cost of maintaining the individual in a nursing home. Therefore, effectively, persons cannot receive more than approximately $5,300 per month in assistance.
How to Apply / Learn More
To learn more about the Missouri Independent Living Waiver, call the Missouri Department of Health and Senior Services at 573-751-6400. One can also click here for limited information about the waiver.
All individuals interested in Missouri home and community based services must go through a pre-screening via phone to determine if they are eligible for a face-to-face assessment. To reach the Division of Senior and Disability Home and Community Based Services for a pre-screening, call 866-835-3505.
Applicants not already on the Missouri State Medicaid Plan must apply for Medicaid. This can be done by contacting one’s local Missouri Department of Human Services office. To find your local office, click here.