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 is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of care outside of a nursing home needs to be less than the cost of care in a nursing home.
Under the Global Consumer Choice Compact Waiver, Medicaid-eligible, Rhode Island residents can receive a variety of assistance services in their homes, communities, or assisted living residences, instead of nursing homes. Some home and community based benefits/services offered under this waiver allow for consumer direction, also known as self-direction, and were previously part of the Personal Choice program. In other words, eligible applicants have the flexibility to choose which forms of assistance will best serve them and who will provide those services. In other words, the program allows participants their choice of care providers. This is relevant to caring for aging parents because the adult children or other relatives can be hired and compensated as caregivers. To better understand the wide-ranging benefits available under this Waiver, it is helpful to provide some background information.
In January 2009, the Rhode Island Global Consumer Choice Compact Waiver, also known as the Rhode Island Comprehensive Demonstration, was approved and merged Rhode Island’s state Medicaid plan and the state’s previous 11 Medicaid waivers. The new Waiver is intended to give the state more flexibility when it comes to Medicaid programs, and to be more cost efficient.
The states’ entire Medicaid program, including all the former home and community based senior programs were merged under this global waiver. This includes the Personal Choice Program, Home and Community Care Medicaid Wavier, and the Shared Living Program. Readers may wish to explore those pages to understand the breadth of services available, as these services continue to be offered under the Global Consumer Choice Compact Waiver.
This program also offers services to seniors that require home and community based assistance, but who are not fully eligible for Medicaid. This is similar to the earlier Home and Community Co-Pay program.
The Comprehensive Waiver is administered by the RI Department of Human Services (DHS). The RI Department of Elderly Affairs is the sister program to DHS and many of the programs for the elderly are administered under this agency.
Age and Functional Requirements
To be eligible for long-term care services under the Global Consumer Choice Compact waiver, applicants must be residents of Rhode Island and be at least 65 years of age. Exceptions exist for PACE (Program for All Inclusive Care), which requires applicants to be 55 years of age or older and require a nursing home level of care. This program is also relevant for persons who have a formal designation of disabled by the Social Security Administration. A patient assessment must be completed to determine need and level of functioning. Requirements may vary slightly based on the services/benefits.
As of 2022, seniors must have an income no greater than $2,523 a month or $30,276 a year. An individual must not have more than $4,000 in countable assets, such as banking accounts, stocks, and bonds. A home is considered exempt if the individual continues to live in the home and the equity in the home is not valued at more than $636,000.
Married couples face considerably more complicated financial criteria. This is especially true if one spouse is not seeking Medicaid assistance. Having only a single spouse apply can greatly relax Medicaid’s tight financial eligibility rules. It is recommended couples in this situation consult with a Medicaid planning professional. Learn more.
Another pathway to Medicaid benefits is through the co-pay program for seniors who are 65 years of age. To be eligible for this program, an applicant must meet the functional requirements, and have an income no greater than 250% of the Federal Poverty Limit. As of 2022, this means an applicant cannot have a yearly income greater than $33,975, or generate more than $2,831 per month in income.
An option for persons over these limits is to work with a Medicaid Planner who can help families to gain Medicaid eligibility for their loved one. Read more about Medicaid planning here.
Benefits and Services
As suggested by the program name, the Comprehensive Waiver covers a very wide array of in-home and in-community care and support services. However, not all beneficiaries are eligible to receive all benefits. There must be a functional need for the service and, usually, the state requires that individuals have no other means of obtaining the service or benefit. What follows is an exhaustive list of long-term care benefits, but not every participant is entitled to each benefit.
- Homemaker Services – light housekeeping, meal preparation, laundry
- Home and Vehicle Modifications – roll in shower, widening of doorways, installation of grab bars, lifts, and ramps
- Specialized Medical Equipment – durable/non-durable
- Home Delivery of Meals
- Personal Emergency Response System (PERS) – installation and monthly fee
- Transitional Service – from an institution back into the community
- Residential supports
- Assisted Living – supportive services, such as personal care, chore, homemaker, adult companionship, and monitoring of medication
- Adult Companion – non-medical assistance and supervision
- Respite Care
- Personal Care Assistant – assistance with bathing, dressing, eating, mobility, light housecleaning, preparation of meals
- Adult Day Services / Adult Day Care
- Physical Therapy
- Skilled Nursing / Private Duty Nursing
- Case Management
- PACE (Program for All Inclusive Care) – provides medical and supportive services
- Shared Living (Rite @ Home) – eligible seniors choose to live with a caregiver who assists with activities, such as dressing, eating, bathing, preparing meals, laundry, transportation, etc.
- Non-Medical Transportation
How to Apply / Learn More
For more information or to apply for services, contact the Rhode Island Division of Elderly Affairs at 401-462-3000. There may be a wait list for home and community based services. If this is the case, those who demonstrate a higher level of need will receive services prior to those who have a lower level of need for care.
More information, although outdated, is available on the state’s long-term care webpage. However, this waiver has been extended through December 31, 2023.