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To best understand how Medicaid can help with the cost of home modifications, it is helpful to begin with some definitions. Medicaid is a federal health insurance program for many different groups of Americans; this article focuses on Medicaid programs that assist the elderly, specifically. While Medicaid is a federal program, each state administers their own Medicaid programs separately. By home modifications we are referring to changes made to a home to accommodate for aging or disability challenges. Typical modifications include bathroom & kitchen designs, wheelchair ramps and stair-lifts, but there are many other modifications for which Medicaid provides help. Medicaid tends to draw the line at modifications that increase the value or the square footage of the home.
Most states offer Medicaid programs that cover home modifications to enable elderly and / or disabled individuals to remain living in at home. To best understand the benefits and limitations of these programs, it helps to provide a historic perspective. Initially, Medicaid assistance for the elderly was provided only in nursing homes. In time, lawmakers recognized that it was both less expense to provide services at home and preferable for care recipients to remain at home rather than go into a nursing home. Thus, the concept of Home and Community Based Services (HCBS) was born. These programs are commonly referred to as Medicaid Waivers (or HCBS Waivers, 1915 Waivers and 1115 Waivers). Waivers offer a variety of in-home support programs, and financial support for home modifications that enable “aging in place” is very often an included benefit.
Some waivers pay for assistive technologies such as special equipment for a washroom and adaptive lighting. Other waivers pay for physical modifications to the home such as the addition of wheelchair ramps, stair-lifts, walk-in or wheelchair accessible bathtubs and showers. These modifications are more formally referred to as Environmental Accessibility Adaptations. Further examples include widening of internal spaces such as landings or doorways to accommodate for wheelchair access. Some waivers include resources for both technologies and modifications. In other words, both the hardware and the services to install the hardware.
Nursing home Medicaid is an entitlement, anyone eligible will receive care. Waivers, on the other hand, are not entitlements. Typically, these programs have limited enrollments and sometimes waiting lists exist for services.
Medicaid Managed Care Programs
Over time some states have replaced their waivers with Medicaid Managed Care programs. These managed care programs were usually required to continue offering the same benefits as the waivers they replaced. Therefore, home modifications continue to be a covered benefit even when a state switches to a managed Medicaid program.
Money Follows the Person Programs
These are Medicaid programs specifically intended for persons that are currently living in a nursing home but who wish to return to living in a private home (their own home or the home of family members or friends). These programs include support for home modifications that help the newly reintroduced individual to safely access the home. As of April 2018, 44 states and Washington DC have Money Follows the Person (MFP) Programs. It should be noted that very often these programs are given different names in each state. For example, the MFP program in West Virginia is called “Take Me Home, West Virginia”.
States with Money Follows the Person Programs in 2018 - AL, AR, CA, CO, CT, DE, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, VA, VT, WA, WI, WV and the District of Columbia.
List of State Medicaid Programs that Cover Home Modifications
Medicaid programs are state specific; they can also be condition-specific and / or age-specific. In each state, they have different names. Our organization has researched and found the following states to have Medicaid programs that include some level of assistance for home modifications / environmental adaptations. To be clear, this list is not comprehensive of all Medicaid programs that pay for home modifications but rather a comprehensive list of those programs that are relevant to the elderly. As an example, those waivers which strictly serve developmentally disabled individuals have been excluded from this list. Finally, some of the programs listed below are “consumer directed” meaning the beneficiary has the freedom to choose how they spend the financial assistance they receive and therefore can be used for home modifications even if the language of the waiver does not specific state that it includes home modifications.
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 out of the nursing homes. Medicaid’s standard benefit for seniors who need long term care is to pay for nursing home residential care. However, when available, Medicaid Waivers help to provide more options for individuals. The cost of the care outside of a nursing home needs to be less than the cost of care in a nursing home.
The Missouri Independent Living Waiver (ILW) provides home and community based services for adults who are physically disabled. With assistance via this program, individuals can continue to live independently in their homes, rather than require placement in nursing homes. Benefits include home modifications, personal care services, such as assistance with bathing, grooming, mobility, toiletry, and eating, and specialized medical equipment and supplies.
Under this program, personal care assistance is consumer-directed. This means an individual can hire the person of their choosing, including family members with the exception of spouses and legal guardians, to provide personal care, given they are qualified to do so. Financial Management Services provide assistance in carrying out the financial aspects of having an employee, such as processing timesheets and payments, and withholding taxes. Employees are paid the Medicaid approved rate for home care, which in 2018, is estimated to be approximately $14 an hour.
Though this program is not specifically for seniors, individuals who enroll in the ILW prior to the age of 64 may continue enrollment in this waiver, given they are still willing and able to self-direct their personal care services.
ILW is administered by the Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services (DSDS) via MO HealthNet Division.
In order to be eligible for the Independent Living Waiver, applicants must be Missouri residents who are between the ages of 18 and 64 and be physically disabled. If the individual also has a cognitive impairment, it must have manifested when the individual was 22 years old or older. In other words, this waiver is not intended for those persons with developmental disabilities. In addition, individuals must require a nursing home level of care, yet still be able to self-direct their own personal care.
Applicants must be Medicaid eligible and actively enrolled in the Missouri state plan. This means there are income requirements that must be met. As of 2018, a single individual is allowed income up to 85% of the Federal Poverty Level, which mean an applicant cannot have a monthly income more than $860.20. For married couples, with both spouses as applicants, the monthly income cannot exceed $1,166.20. However, Missouri does allow applicants that have an income greater than the allowable amount to “spend-down” in order to become eligible. For example, if an individual has $300 each month in recurring medical / care expenses, they are permitted to deduct that amount from their income, so their countable income is $300 less than their actual income.
There are also asset limitations, which are set at $2,000 for single applicants and $4,000 for married applicants, as of 2018. Some assets are considered exempt (non-countable), such as an individual’s primary home, given the applicant lives in it and it is valued under $572,000. A single vehicle and personal items, such as home furnishings, are also exempt. Married applicants whose spouses are not also applying for services can set aside more financial resources for their non-applicant spouses. As of 2018, non-applicant spouses can keep up to $123,600 in joint assets. Please make note, if applicants still have assets greater than the limits, one cannot simply give assets away or sell them for less than they are worth in order to meet Medicaid’s asset requirement. Doing so may violate Medicaid’s 5-year Look-Back Period and may result in a period of ineligibility.
Persons exceeding the income and / or asset limits and still cannot afford their cost of care, should consult with a Medicaid planner.
Unfortunately, individuals who receive Home and Community Based Services via another waiver cannot receive services under ILW.
Benefits and Services
- Self-Directed Personal Care Services
- Financial Management Services
- Case Management
- Home Modifications – ramps, grab bars, specialized electric systems
- Specialized Medical Equipment / Supplies – lift chairs, wheelchairs, shower benches, commode chairs, adult diapers
There is no hard cap on the amount of assistance persons can receive under this waiver. However, the total amount of assistance must be “cost neutral” when compared to the cost of maintaining the individual in a nursing home. Therefore, effectively, persons cannot receive more than approximately $4,000 per month in assistance.
How to Apply / Learn More
To learn more about the Missouri Independent Living Waiver, call the Missouri Department of Health and Senior Services at 573-751-6400. One can also click here for limited information about the waiver.
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