Waiver Description
Aging residents and disabled individuals of King and Pierce Counties have an additional option to help pay for home care. The New Freedom Medicaid waiver program is for individuals who require a nursing home level of care, but choose to receive in-home services instead of moving into a skilled nursing facility.
The goal of this program is to prevent costly institutionalization of the elderly and disabled. This program allows residents to safely continue residing at home while providing them a care services budget and a great deal of flexibility with regards to its allocation. (Financial Management Services are in place to provide budget assistance, help with accounting, and to pay for services and goods).
This model of program is based on the Medicaid principle of self-directed care, which is also referred to as consumer direction and participant direction. With the New Freedom program, participants may elect to have a representative, who is not also their paid caregiver, to direct their care.
With New Freedom, the state and the individual in need of care work collaboratively to determine the care needs and the budget to fulfill those needs. Participating individuals are then given the control and flexibility to spend their budget on the goods and services they require and to choose care providers, who are often referred to as Individual Providers.
Because this program allows an elder to hire a family member as a caregiver, it is popular. (Please make note, spouses and legal guardians cannot be hired as care providers.) This model has the dual benefit of empowering the individual and reducing the administrative costs for the state.
New Freedom is similar in services to the COPES and Community First Choice programs and has some overlap with Medicaid Personal Care. However, under New Freedom, the program participant is given even greater flexibility with regards to how their care budget can be allocated. New Freedom is an alternative to these programs. Participants cannot be concurrently enrolled in two or more programs.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
In addition to being at least 65 years of age, or between 18 and 64 years old and physically disabled or blind, there are three types of requirements to participate in the New Freedom program: residential, functional, and financial.
General Requirements
Age
Residential
Currently, program participants must reside in King or Pierce County and live at home or in an assisted living facility (as opposed to residing in a nursing facility).
Functional
Participants must be assessed to require the level of care typically provided in a nursing home. A state social worker will conduct a standardized in-person interview with all new applicants to determine their needs. This assessment is known as the Comprehensive Assessment Report and Evaluation, or CARE, for short.
Financial Requirements
Participants must be eligible for Washington Medicaid, which considers income and assets.
Income Limits
The current 2023 gross income limit for an individual applicant is $2,742 per month. When an applicant is married and his or her spouse is not also applying for services, the non-applicant spouse’s income is not an eligibility consideration. Furthermore, in some cases, the applicant spouse can transfer income in his or her name, up to $3,715.50 a month, to the non-applicant spouse as a monthly maintenance needs allowance.
For couples when both spouses are applying, each spouse is allowed $2,742 in monthly income.
Asset Limits
In 2023, an individual applicant is allowed $2,000 in countable assets. When both spouses are applying, the asset limit is $3,000.
Unlike with income, when only one spouse is an applicant, the assets of both spouses are still considered. In this case, the applicant spouse is permitted $2,000 in assets, while the non-applicant spouse is able to keep up to $148,620 of the couple’s assets. This is called a community spouse resource allowance and is in addition to the $2,000 in assets the applicant spouse can retain.
Over the Financial Limits?
Married individuals and persons with finances over these limits should consider finding Medicaid planning assistance. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their resources appropriately. Learn more.
Please Note It is vital that persons do not give away assets or sell them for less than fair market value within 60 months of one’s Medicaid application date. This is because doing so is a violation of the Medicaid look-back period and can result in Medicaid denial.
Benefits and Services
The objective of the New Freedom Program is to enable program participants to spend their care dollars as they best see fit. That said, the development of a care plan is a collaborative effort between the program participant and their Case Manager. It can include the following types of expenses:
Personal Assistance Services – Help with Activities of Daily Living (ADL), such as bathing, grooming, mobility, and eating, as well as the Instrumental Activities of Daily Living (IADL), such as housekeeping, cooking, meal planning and preparation, shopping for groceries and other essentials, and assistance with transportation. ADL assistance can be received either in one’s home or in an adult day health facility.
Goods and Supplies – Items that increase the elder’s independence. Examples include home delivered meals, assistive technology, durable medical equipment, personal emergency response services, remote monitoring equipment and adaptive lighting.
Home and Vehicle Modifications – Alterations to one’s home or car to accommodate for a disability, such as the addition of wheelchair ramps and lifts or grab bars.
Health Maintenance Support – Medical, dental, audiology, vision care, physical therapy, massage, and alternative therapies, such as acupuncture.
Educational Supports – Skill development training for the participant, as well as caregiving training, such as diabetes self-management.
How to Apply / Learn More
Residents of King and Pierce Counties who believe they meet the eligibility rules should call the Home and Community Services eligibility line for their county.
King: 800-346-9257 / 206-341-7750
Pierce: 800-442-5129 / 253-476-7200
One can learn more about the New Freedom Medicaid Waiver program here. Families can also contact their local Area Agency on Aging for further direction on the application process and to address questions about the program.
Waiting lists may exist for services. The application process can take between 30 and 60 days.
