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.
Nevada’s Medicaid Home and Community Based Waiver Program helps older state residents avoid institutional (nursing home) placement by offering a range of support services that help them to remain living in their homes or in the homes of family members. Health care, medical care, and nursing services are not included benefits of this waiver, as it is intended to provide non-medical care services only. Instead, services such as homemaker services (at home or in approved state assisted living communities), adult day care, and chore services help families care for loved ones at home or help frail, elderly persons maintain their independence.
This program is also referred to as simply the HCB Waiver, Home and Community Based Waiver for the Frail Elderly (HCBW-FE), and was formerly called CHIP. It is administered by the Aging and Disability Services Division (ADSD).
This waiver, which is statewide, has qualification requirements with regards to the applicant’s:
Residence – Individuals must be residents of the state of Nevada
Age – Individuals must be at least 65 years old.
Disability Status – Individuals are subject to a medical review, the outcome of which must qualify them for nursing home care. Without the waiver services, they would require nursing home placement within 30 days of the medical review.
Income – In 2022, a single, divorced or widowed applicant is permitted to have up to $2,523 in monthly income or annually $30,276. Married applicants can have their incomes considered separately when only one spouse is applying for Medicaid assistance. Applicants can transfer some of their income to their non-applicant spouses as a living allowance (formally called the Minimum Monthly Maintenance Needs Allowance (MMMNA)). In 2022, up to $3,435 / month can be transferred to the non-applying spouse. Please note that being over the income limit does not mean one cannot still qualify income-wise. In Nevada, Miller Trusts, also called Qualified Income Trusts, are an option that allow excess income to be deposited into such a trust, no longer counting towards the income limit.
Assets – As with income, asset limits vary based on marital status. Single applicants are permitted only $2,000 in countable assets. This amount has not changed in 2022. (There are exemptions, such as one’s home and vehicle). However, when just one spouse of a married couple applies for Medicaid; the non-applicant spouse can take possession of joint assets up to a value of $137,400 in 2022. (This is in addition to the $2,000 in assets the applicant spouse is able to retain). This rule is intended to prevent spouses from having to “going broke” to qualify their loved one for Medicaid. Since a home is such a substantial asset, some clarification on home ownership may be helpful. Homes are exempt if the owner lives in the home. For single persons entering a nursing home or assisted living, their home is not exempt since they will not be living in it. However, an exception exists if the home equity value is under $636,000 and they have intent to return to living in it. For married couples, as long as one spouse remains living in the home, it is exempt.
It is important to mention that assets should not be given away or sold for less than fair market value in an attempt to meet Medicaid’s asset limit. Doing so is in violation of Medicaid’s 60-month look-back period and can result in a denial or delay of Medicaid benefits.
Over these Limits?
For families who cannot afford the cost of care for a loved one but are financially ineligible for Nevada Medicaid, there is the option of working with a Medicaid planner. There is both public and private assistance available to help families re-structure their finances to become Medicaid compliant. Learn more.
Benefits and Services
Each Medicaid Waiver recipient is approved for a customized suite of services intended to meet their non-medical needs. These can include:
- Adult Companion
- Adult Day Care (but not Adult Day Medical Care)
- Case Management
- Chore Services (cleaning windows, minor home repairs, shampooing carpets)
- Homemaker Services (shopping, housecleaning, laundry, preparing meals)
- Augmented Personal Care (commonly referred to as assisted living)
- Personal Emergency Response System (fall and wandering notifications)
- Respite Care
Details about each benefit is available in this manual. Readers should be aware that this is a large file and not intended for mobile devices. Nor is the language written for a consumer audience. It is highly technical, but offers complete information.
How to Apply / Learn More
Nevada residents who qualify for Medicaid should contact their regional Aging and Disability Office to begin the application process. As of 2022, it has been reported that there is a wait list for this waiver. Interested persons should check with their local county office to find out the latest information on waiting and processing times.
Some limited additional information about this waiver is available on the Nevada Aging and Disability website.
Residents who do not qualify for Medicaid should consider working with a Medicaid planning professional to help them gain eligibility or investigate other programs such as the COPE, Homemaker, and the PAS Programs.