Long-term senior care can be a significant financial burden but medicaid waivers can substantially ease this liability for many.
Navigating Medicaid and understanding the waiver programs and all they have to offer can be tough, but we’re here to clear things up.
Many people confuse Medicare and Medicaid but it’s vital to understand that these are two discrete programs. They are both government-run but intended to help different people. The programs are separately funded.
Medicare is a program operated by the federal government with the intention of providing healthcare to all people over the age of 65 as well as disabled people under 65. On the other side of the fence, Medicaid is a program run by both federal and state governments and its core purpose is to assist people with little by the way of money or resources.
Because Medicaid is operated by individual states, eligibility requirements vary slightly. Also, the programs available will differ from state to state. Recent laws also give states the ability to opt-out of requirements that make them eligible for Medicaid funding.
While both Medicare and Medicaid offer health insurance benefits, they don’t often cover the same services. As an example, Medicare does not offer assistance paying for personal care but Medicaid does help with this.
As you can see, if you’re eligible for both programs, this can be highly beneficial to you.
What Are Medicaid Waivers?
As previously explained, Medicaid is funded and governed by both federal and state governments. There are many federal laws pertaining to Medicare and how it must be used. In certain circumstances, the federal government will waive some rules that typically apply to the Medicaid program.
When the federal government grants these waivers, they allow states to operate their Medicaid programs more flexibly. These waivers help to reduce costs and expand coverage as well as improve care for targeted groups such as pregnant women and the elderly.
With the aid of these waivers, states have the ability to provide their citizens with certain services that can’t be provided by federal programs.
Different Types Of Medicaid Waivers
All Medicaid waivers must comply with the rules laid out in Sections 1115 and 1915 of the Social Security Act.
- Section 1115: These waivers are known as research and demonstration waivers and they allow states to test new ways of financing Medicaid and delivering care to those who qualify. The federal government only grants these waivers if the proposition doesn’t cause any change in its budget. The federal government has recently given states additional funding for Medicaid programs and many states are harnessing this waiver to more efficiently use those funds.
- Section 1915: Under this section, there are both (b) and (c) subsections for waivers. The 1915(b) waivers give states the ability to operate their Medicaid programs much like managed care programs. They provide for health care services, but they give beneficiaries very few choices in the care they receive. The 1915(c) waiver is known as the Home and Community-Based Services waiver and it’s used to give states the ability to provide long-term care to people in need. These waivers allow elderly people to stay in their own home or community instead of needing to head into a nursing home.
Our core focus today is on the 1915(c) HCBS waiver and how this waiver can be used to allow elderly people to benefit from long-term care while remaining at home.
Home And Community-Based Services Waivers
As outlined above, this type of Medicaid waiver is used to help certain demographics in communities receive optimal care. This waiver can be used for people under 65 with disabilities as well, but our emphasis today is on senior assisted living.
As people age, they tend to need more help carrying out the tasks associated with daily living. Often, elderly people find themselves in institutional nursing facilities instead of being allowed to continue living at home and in their communities.
The 1915(c) Medicaid waiver allows for a different outcome.
When taking advantage of the HCBS waiver, beneficiaries are able to continue living as normally as possible. Sometimes, they are able to remain in their own homes. On other occasions, it might make the best fit to move into a relative’s home or even into a senior-focused community (that is not a nursing home).
Every state has different guidelines for acceptance into these waiver programs and they will also vary slightly in terms of what’s offered in their program.
Generally, people can receive both medical and non-medical care including elements like:
- Case management and support services
- Housekeeping services for laundry, cleaning, and shopping
- Meal delivery services
- Personal care and supervision
- Senior daycare
- Safety modifications to the home and vehicle
- Transportation to medical appointments
Again, not all these services will be offered everywhere or to every person who is eligible. You need to check with your specific state to find out what the requirements are as well as what services you might be eligible for.
To be eligible for an HCBS waiver, certain requirements must generally be met no matter where you reside.
Normally, the person must have health needs that require care in an institution like a nursing home. The goal of the HCBS waivers is to allow these people to remain in their homes and communities. If a person is elderly but not medically fragile, then they likely won’t be eligible for the waiver. A doctor must verify that this need is genuine.
On top of these basic medical criteria, there are also financial requirements in place. Medicaid is geared toward people who have little money and few resources so it’s highly unlikely that a person of financial means would be eligible for this waiver.
If you believe you need an HCBS waiver to assist in paying for care, you should apply for medicaid.
Your state Medicaid agency will take your information and determine your eligibility. They can help guide you through the process and determine your eligibility for Medicaid waivers as well.
If you or your loved one is looking for an assisted living facility, Landmark Senior Living can help. Please visit our website and reach out to schedule a free tour of one of our assisted living facilities in Hobbs New Mexico.