Page Reviewed / Updated – Nov. 3, 2022

Program Description

The Community Choices Home and Community Based Services Waiver, abbreviated as CCW, is also called the Assisted Living Facility and Long Term Care Waiver. This Medicaid program provides long-term care services for individuals who require a nursing home level of care, but choose to remain living in the community (their home, the home of a family member, or an assisted living residence) rather than in a nursing home. Services include personal care assistance, meal delivery, adult day care, respite care, and more.

One particularly attractive benefit of the CWW is the In-Home Participant Directed Option (more commonly called self-directed or consumer directed care). This benefit allows eligible participants to serve as the employer of their care provider, also referred to as a direct service worker. This means they can choose who will be their paid caregiver. Individuals using the In-Home Participant Directed Option must have the ability to, and must want to, direct their own care. This role includes all aspects of being an employer, including the hiring, training, and firing of their direct service worker. For those unable to manage these activities, a family member with power of attorney for health care may be able to do so on their behalf.

Another attractive component of the In-Home Participant Directed Option is that family members, such as an adult child, can be hired as the direct service worker. Make note, spouses, legal guardians, power of attorneys for health care, power of attorneys, and health care directive designees cannot be hired to provide care. Direct service workers earn an hourly wage and cannot work in excess of 40 hours / week.

The Community Choices Waiver is not an entitlement program, which means there are limited slots available for enrollment. Said another way, just because one is eligible for the program does not guarantee that they will be accepted into the program. CCW is administered by the Wyoming Department of Health’s Division of Healthcare Financing (DHCF).

Eligibility Guidelines

Community Choices Home and Community Based Services Waiver is a Medicaid program, and as such, the participant must be eligible for Wyoming Medicaid. The following eligibility criteria are specifically for seniors applying for this waiver.

Residency – Applicants must be residents of the state of Wyoming.

Age – Applicants must be 65 years of age or older or between 19 and 64 years old and be declared blind or disabled.

Functional Ability – Applicants must require a level of care that is equivalent to that of nursing home care.

Income – As of 2022, a single applicant cannot have income in excess of $2,523 / month, or no more than $30,276 / year. This figure is 300% of the Federal Benefit Rate (FBR).

However, having income greater than this amount does not automatically disqualify an applicant. A married applicant who has a spouse who is not also a Medicaid applicant, is able to transfer up to $3,435 / month in income to their non-applicant (community) spouse. This spousal allowance not only helps to lower the applicant’s income, but also is intended to prevent the community spouse from becoming impoverished. Another possible way to still qualify is by establishing a qualified income trust. Learn more about income trusts here.

Assets – In 2022, a single applicant can have resources (assets) up to $2,000. That being said, certain resources are considered exempt items, such as one vehicle and an individual’s primary home, given the applicant’s equity value interest in the home is not more than $636,000, and the applicant, or their spouse, lives in the home. In the case of a married applicant whose spouse is not also applying for Medicaid services, there are spousal impoverishment rules in place to prevent the non-applicant (community) spouse from having too little in which to live. As of 2022, the community spouse is able to retain a resource allowance up to $137,400 of the couple’s assets. This is in addition to the $2,000 the applicant spouse is able to retain.

Those who have assets over the abovementioned limits must not gift money or valuables to family or friends in an effort to meet Medicaid’s asset limit. Rather than meet the asset requirement and become eligible for Medicaid, persons may be penalized with a period of ineligibility. This is because Medicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized.

Wyoming residents who exceed these limits (income and assets) but still cannot afford their care costs might also qualify for this program by working with a Medicaid planning professional. Learn more.

Benefits and Services

A variety of services are available via this waiver, including both in-home services and services provided in assisted living. (This waiver does not cover room and board for assisted living, strictly services to help delay nursing home placement.) Make note, not all services may be available in all areas.

  • Adult Day Care
  • Assisted Living Services – homemaker, personal care, medication management, and supervision
  • Case Management
  • Fiscal Management Services – for the participant directed option 
  • Home Delivered Meals – up to two meals / day
  • In-Home Participate Directed Option / Direct Service Worker
  • Non-Medical Transportation
  • Personal Care Attendant – assistance with bathing, grooming, oral hygiene, toiletry, grocery shopping, meal preparation, etc. 
  • Personal Emergency Response System – installation and monthly service
  • Respite Care – 30 day limit per year
  • Skilled Nursing – must be prescribed by a physician

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How to Apply / Learn More

For additional information about the Community Choices Waiver, click here. To apply, contact the Division of Healthcare Financing Long Term Care Unit at 855-203-2936, or for questions, call 855-203-2823. Applicants should expect to have a medical assessment done to determine the level of care needed. In most cases, one’s application is either approved or denied within 45 days.

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