The Nevada Home and Community Based Waiver for Persons with Physical Disabilities (HCBW-PD), is often also referred to as the Physical Disability Waiver and formerly abbreviated as WIN. It is a program for low-income, physically disabled Nevada residents. This program allows individuals who require a nursing home level of care to remain living at home, in the home of a relative, or in an assisted living residence, by providing care and other supportive services, such as assistance with personal activities of daily living, housecleaning, errands, meal preparation, and more.
Under this waiver, participant direction of benefits, such attendant care, homemaker and chore services, and respite care as is permitted. In lieu of program participants self-directing their own care, they may designate a personal care representative to do so in their place. Friends and family, with the exception of spouses and legal guardians, can be hired and paid to provide care.
Another program that may be of interest to a broader spectrum of older Nevada residents is the Frail Elderly Waiver. This program provides services similar to the ones provided by the HCBW for Persons with Physical Disabilities. However, unlike the HCBW-PD, which has no age limitations, individuals must be 65 years of age or older to be eligible for the Frail Elderly Waiver. There is also no requirement of being physically disabled, only that an applicant requires a nursing home level of care. Make note, applicants are only able to receive services via one home and community based services waiver even if they are found to otherwise be eligible for both.
The HCBW for Persons with Physical Disabilities is operated by Nevada’s Department of Health and Human Services’ Division of Health Care Financing and Policy (DHCFP), while the Frail Elderly Waiver is administered by the Aging and Disability Services Division.
In order to be eligible for the HCBW for Persons with Physical Disabilities, there are both functional and financial requirements that Nevada residents must meet.
Applicants must be assessed and certified as disabled by a DHCFP physician. They must also require a nursing home level of care, and if not for the care provided by the waiver, be at risk of nursing home placement within 30 days.
Income – In 2022, a single applicant must not have monthly income in excess of $2,523. This amount is equivalent to 300% of the current Federal Benefit Rate (FBR). If both spouses of a married couple are applying for benefits, each spouse is considered as a single applicant. Stated differently, each spouse is allowed up to $2,523 per month in income. When one spouse of a married couple is not applying for Medicaid assistance, a part (or all) of an applicant spouse’s income may be transferred to the non-applicant spouse. In this situation, the non-applicant is permitted a higher income, up to $3,435 per month, as a living allowance. Another approach available in Nevada to reduce one’s income in order to qualify for Medicaid is to use a Miller Trust. Learn more.
Assets / Countable Resources – In 2022, assets are limited to $2,000 for a single individual and $4,000 for a couple. (Each applicant spouse is able to keep up to $2,000 in assets). If only one spouse of a married couple is applying for this waiver, the applicant spouse is able to keep $2,000 in assets, and the non-applicant spouse is allowed up to $137,400 in jointly owned assets. (Learn more here about Medicaid and jointly owned assets). However, certain assets are considered exempt, such as one’s home, provided the applicant, or his / her spouse, lives in the home and the owners’ home equity is not valued over $636,000. A vehicle, household items, personal effects, and a burial policy up to $1,500 are also considered exempt items. Persons whose assets exceed these limits or married couples in which only one spouse requires care, should consider working with a Medicaid planning professional, as certain assets of considerably higher value can be allocated to a non-applicant spouse.
Please note that Medicaid has a look-back rule, which prohibits the transfer of assets without payment or under fair market value for 60-months preceding one’s Medicaid application date. This rule is to prevent applicants from trying to meet the asset limit in this way. Violating this rule can result in a period of disqualification from benefits.
Benefits and Services
A variety of care and support services are available under the WIN / Physical Disabilities Waiver. These services must be approved in the beneficiary’s plan of care and can include the following:
- Assisted Living Services
- Attendant Care – assistance with activities associated with daily living, such as mobility, bathing, dressing, light cleaning, etc.
- Case Management
- Chore Services – minor home reparations, yard cleaning, window washing, etc.
- Home Modifications – addition of wheelchair ramps, grab bars, remodeling of bathrooms to allow wheelchair access, etc.
- Homemaker Services – housecleaning, grocery shopping, meal preparation, laundry
- Meal Delivery
- Personal Emergency Response Systems (PERS)
- Respite Care – up to 120 hours / year in the home or residence of the beneficiary
- Specialized Home Care Supplies / Durable Medical Equipment
How to Apply / Learn More
Although a bit technical and difficult to comprehend, one can download a file here to learn more about the HCBW for Persons with Physical Disabilities. Limited information can also be found here. Additionally, one can also obtain information or apply for services by calling the Division of Health Care Financing and Policy. To see a list of DHCFP’s district offices and relevant contact information, click here. Once accepted, program beneficiaries should expect annual reassessments of their functional ability and care requirements.