This Medicaid Waiver for Home and Community Based Services is designed specifically to help elderly and disabled North Dakota residents remain living in their homes, or in the community, or to return to living in these locations after placement in a nursing home. States have found by allowing family caregivers to share some of the responsibility of caring for loved ones, they can create a win-win situation. Families want their aging loved ones to be in an environment in which they are familiar and be cared for by someone with whom they are comfortable, and the states can save money through reduced admissions to nursing homes. Accordingly, applicants must, at a minimum, require nursing home level care, but be willing and able to receive that care outside of a nursing home.
In addition to personal care at home, in adult day care, in adult foster care, or in memory care facilities (for those with Alzheimer’s Disease and other dementias), this program will cover minor home modifications for senior safety and improved access, as well as Personal Emergency Response Services to help monitor participants when no family members can be present.
ND’s Waiver allows some relatives to work in the capacity of a paid caregiver for their family member.
This waiver allows for consumer direction. This means participants are given the flexibility to choose their own care providers. Adult children can be hired as caregivers, and North Dakota is one of just a few states that allow spouses to be paid as caregivers. However, program participants are not given budgetary control. They cannot choose how much to pay their caregivers, only from whom they receive care. Typically, caregivers are paid between 50% and 75% of the going rate for home care in the state. As of 2020, it is estimated that personal caregivers receive an hourly rate of $13.50 to $20.25.
Note that this waiver is referred to by different names. Formally, it is called the Medicaid Waiver for Home and Community Based Services, but most persons, including state employees, simply call it the Aged and Disabled Waiver. This waiver is administered by the Aging Services Division within the North Dakota Department of Human Services.
The North Dakota Aged and Disabled Waiver considers both the applicant’s age and level of impairment as related conditions for enrollment. Applicants under 65 years of age must be designated as disabled by Social Security. However, those 65 and older must require nursing home level care, but need not be fully disabled.
The Aged and Disabled Waiver is a Medicaid program and therefore applicants must be financially eligible to receive Medicaid. ND factors in the applicant’s income and assets. Similar to age and level of impairment, the applicant’s finances are inter-related with their marital status.
Income Limits – Unmarried, widowed, or otherwise single applicants are limited to $883 in income per month. Married couples with both spouses as applicants can have up to $1,193 per month. (These figures went into effect April 1, 2020). Applicants are permitted to subtract from their countable income all of their monthly bills for doctors’ visits, medications, health insurance, and other out-of-pocket care costs. For example, if one’s income is $4,000 / month and their assessed, recurring medical expenses are $3,500 / month, they will very likely qualify as “Medically Needy” recipients.
If the applicant is married and his or her spouse is not seeking Medicaid assistance, the non-applicant spouse (called the Community Spouse) may be entitled to part, or even all, of his or her spouse’s income. In 2020, up to $2,550 of the applicant’s monthly income may go to the non-applicant spouse. This is referred to as the Maximum Monthly Maintenance Needs Allowance.
Asset Limits – A single applicant is permitted up to $3,000 in countable financial assets. Married applicants, with both spouses applying, can retain up to $6,000 in resources. Should they own a home and live in that home (not in assisted living, an adult foster care home, or a memory care facility), then the value of their home equity is not considered up to a value of $595,000. The spouse of a married applicant, who is not also applying for Medicaid benefits, in 2020, can hold up to $128,640 of joint assets. This is called the Community Spouse Resource Allowance. If the spouse lives in the home, regardless of if the applicant spouse lives in the home or not, the home is exempt.
A final note on eligibility, ND reserves the right to refuse acceptance into this waiver if the cost of care at home or in the community exceeds what it would have otherwise cost to care for the same person in a nursing home.
This Aged and Disabled Waiver is intended to help participants avoid nursing home placement. Therefore, the types of services available are chosen to help them and their caregivers in a home or group home environment.
This program is available throughout North Dakota. A fact sheet is available for printing. One can download it here. To apply for the Aged and Disabled Waiver, applicants should contact their local Aging and Disability Resource Center by calling 1-855-462-5465.
Waiting lists may exist, as the waiver is only intended to manage approximately 496 concurrent participants. Readers should also be aware that this Waiver might also be referred to as ND’s Home and Community Based Services Waiver. Limited information is also available on the ND Department of Human Services webpage.