In my case, it is for my mother in law who lives in our home in Maryland but will need either home care or assisted living care in the near future. She has zero assets and montly income of less than 2,000 before taxes. She only has the Medicare part that is free (I can't remember which one it is).
I ask because I know there are waiting lists for assisted living care under Medicaid, but there is no waiting list for the Community First Choice Program for home care. I just wanted to make sure; this seems like a simple case but I know Medicaid is complicated. Thank you
Program Descriptions
Included here is a description of many of the programs and services available with information on how and where to apply for benefits. Information relevant to health care providers is included, as well as information on obtaining data and published reports. Information on committees, activities, and other departmental efforts that are underway regarding health care in Maryland are also available here.
Until recently the Community Options Waiver was called the Waiver for Older Adults. That program and the Living at Home Waiver are now merged under this new title. This waiver is called Home and Community-Based Options Waiver and, in this article it is referred to as simply the CO Waiver.
The new CO waiver allows individuals who need nursing home level care to receive care services in their home or group living community instead. To clarify, group living communities includes assisted living residences provided they are participating in the program and willing to accept the Medicaid payment rates. Also, Maryland Medicaid is sometimes referred to as Medical Assistance.
The CO Waiver is popular both with families and the state of Maryland but for different reasons. Participants generally prefer to remain living at home for as long as possible; this waiver assists them in doing so. The cost of caring for someone at home is also less expensive for the state than it would be to place the individual in a nursing home. This is because home care utilizes caregiving assistance from family members.
Due to the popularity of this program, waiting lists for services exist.
A waiting list, in Medicaid language, is referred to as the Waiver Services Registry. Persons who are currently residing in a Medicaid funded nursing home may be able to bypass the Services Registry or may be placed on a different, shorter Registry. Alternatively a new Medicaid program in 2015, allows for similar services without waiting lists. Read about Maryland's Community First Choice (CFC) Program.
Eligibility Guidelines
The CO Waiver considers age, income, assets and functional ability as qualifying criteria. Participants must be at least 18 years of age to be eligible and they must be assessed and found in need of nursing home level care.
Financially, the monthly income limit for 2016, is $2,199 (300% of SSI). The asset limit for a single applicant is $2,000. Persons whose monetary resources are greater than the limits may still qualify in one of three ways.
1) If they are married and their spouse is not seeking Medicaid, a certain amount of income and financial resources can be allocated to the non-applicant spouse as a living allowance. This can help lower the applicant's income and assets to an acceptable level. In 2016, a non-applicant spouse (sometimes called the 'community spouse') can have countable assets valued at $119,220. Community spouses also often require certain amount of the the couple's joint income to pay living expenses. Up to $2,981 in the couple's monthly can be given to a community spouse.
2) Persons with high medical costs can participate in a Maryland's Medically Needy spend-down. They are conditionally accepted into Medicaid, provided they spend-down their excess income and assets on their care needs until they meet the eligibility limits.
3) They can re-structure their finances to meet the limits. Excess assets can be converted from countable resources into exempt resources. The additional benefit of this approach is that certain resources are then preserved for future generations of the family.
Re-structuring one's finances typically requires professional expertise. There are various types of professionals available to provide assistance, providing a range in level of services offered. Learn more here about advisory services.
Benefits and Services
The Waiver for Older Adults provides a variety of support services in assisted living or at home. In addition to individual case management, waiver participants may be approved for any of the following:
Adult medical day care
Assistive technology
Behavior counseling
Environmental modifications
Family caregiver training
Home-delivered meals
Nutritionist services
Personal care
Personal Emergency Response Services (PERS)
Respite care
Waiver program participants can also receive medical care, home medical equipment, disposable supplies and pharmaceutical assistance, however these benefits are provided as regular Medicaid benefits not under waiver services.
How to Apply / Learn More
The application process is different for individuals currently living at home versus those living in a Medicaid funded nursing home. Those living at home can call 866-417-3480 to add their name to a waiting list (Services Registry). Those living in a nursing home should contact their county's Area Agency on Aging.
One can download a brochure about this program on the Mar
Medicaid, as with most government programs, is very complex and comes with not just waiting lists but strict eligibility rules. Each state has its own set of rules and with Maryland the programs for home and community based services are more difficult to get approved for due to the waiting lists, some are as much as 5 years currently. The Community First Choice Program currently does not have a wait list but there are other eligibility rules in place for it and the financial eligibility [such as assets and income] is different from the standard medicaid program that you would apply for if you were entering a nursing home. These and many more reasons is why it's best to have a specialist on your side guiding you through the process and ensuring that you will be approved and all of your questions are answered properly as apposed to hoping to get the proper answers to complex questions by someone who basically has no idea what they are talking about on a web post [ no offense]. You may invest $2,000 with a Medicaid planner, however, you stated that you wanted to get the most possible in regards to benefits for your Mother-in-law which could be as much as $4-$6,000 per month in benefits. As you should receive the most, my advise is... invest the $2,000 and you will get the results that you need. Good luck
SO VERY TRUE we invested mega dollars and it paid off in getting through the maze
If you have experienced dealing with one state you have dealt with one state
However the $ 2000 you speak of is INCOME not assets, Income comes in regularly and if it is not spent in 30 days it becomes and asset.
Contact your local agency on aging and get some advice and printed material on the waiver program you want to apply for.
Contact your local Veterans Service Office, Not the Fed VA but a local office. Get an application for Aide and Attendance for surviving spouse and see what she is eligible for. If she is eligible for some money from the VA it will help while she is on the wait list for Medicaid Waivers.
Good Luck.
I have been told various things about what happens to the VA benefit if she gets approved for Medicaid. I know it does go down to 90 dollars a month, but I think the benefit is still in force, it just goes directly to the facility and not to the bank account anymore, and somehow Medicaid benefits are coordinated, but that may be an over-simplification.
If we are calculating the Veteran's portion only the Pension portion counts as income.
Best of luck to you, it is always helpful to apply for all the services a person is eligible for .
In MASS I think it is called the SHINE program.
Ask your State Medicaid about their requirements, and do not trust anyone except the official agency for the facts.
Good advice from an elder affairs lawyer can be a must to avoid pitfalls. A person may be a beneficiary, insurance policy, stocks, etc. When the holder dies the person receiving medicaid could find their income jumping higher than allowed and loosing their medicaid.
I am in the process of changing beneficiaries to Payable-on-death and moneys go an estate so if I have another heart attack and croak my ADW will be protected. I just barley survive a recent heart attack and it has change my outlook on which of us will kick off first.