What is a Medicaid Waiver and how does it work?

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What is a Medicaid Waiver and how does it work?

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While reading all your excellent answers, I keep seeing “Medicaid Waiver” mentioned. I was wondering if someone could explain what it is and how to qualify for one. We spend a small fortune on hubby’s home care supplies, large and small, with no help, including incontinence supplies. A small fortune we don’t have. TIA for your answers.

Medicaid Medical Equipment and Supplies

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Is he on Medicaid? Go to Medicaid.ohio.gov and search for Passport Waiver. Depending on the level of care needed, and meeting certain conditions, you can get some services that would be covered by Medicaid in a facility to be provided at home. However, it’s administered by county and many counties have a long waiting list.

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Regarding what waivers are........ Waivers are diversions of federal funding by a state & are required to be limited in funding & period of time. Usually they are done on a 3 or 5 year planning cycle if renewing to stay about the same, or 7 year if it likely to morph into a permanent program.

Waivers are why you hear that a just few states Medicaid readily pay for AL, but most states don’t pay AL at all. Skilled nursing care (aka a NH) is dedicated funding from the feds to the states as there is public law requiring those funds to be there to provide NH care, BUT AL is paid via a waiver with $ coming from a limited % of dedicated funds taken for the waiver. The states have to pony up the $ to fill in whatever the federal waiver $ doesn’t pay. States can very narrowly define eligibility for waivers.

The trend right now is to move from any waiver that is 1-on-1 like AL or at-home services to a PACE type of community based care where they go 2 -4 times a week 6-7 hrs for health care oversight, medication management, meals, activities. The one by us also provides transportation, gives out all sorts of tie-in’s, from energy efficient light bulbs to incontinent supplies and weekend ready meals to go. You do need to be a “dual” aka your on both Medicare & Medicaid as funding needs both payment streams to work. I’d try to find out if PaCE exists for you & hubs. The local Area on Aging should have info on what programs are out there. Good luck.

From a planning perspective waivers are hard to deal with as so much uncertainty for smaller providers, vendors, for families.

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Here's the simple answer. It's a program for those on Medicaid that helps with assisted living. You have to less than $2000. in assets to qualify. The patient pays most of their ssi and get an allowance each month for their own disgressionary spending.

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We just qualified for a medicaid waiver in the state of Indiana. The waiver helps pay for assisted living. The organization that helped us with the waiver process is applying for medicaid FOR us. It seems to move the process along a little bit faster. Medicaid then helps pay for the nursing services as well as supplies and prescriptions that we need for my elderly aunt. Unfortunately, we had to move my aunt from the state of Arizona to Indiana as the state of Arizona is not as capable of funding assistance for the elderly as the state of Indiana is. There is a medical component in order to qualify for the waiver. We had a very nice lady come to our home and ask our aunt questions about what she can and cannot do. Of course, she said she could do everything and did not need help, so it is extremely important to be on site when this interview occurs and let the individual screening her know what the real story is. We know we will qualify for medicaid as we have sold my aunt's home, all her personal property such as jewelry etc., and her car in order to pay for all her assisted living up to this point. Now she is really under the $2000 asset limit and brings in less than 2250 a month for income. I will remind you that ALL states are different. It was heartbreaking to move her from her friends, but great to have her near us again!!!! My advice to the 50 something crowd is to purchase nursing home insurance.....you never know what is going to happen to you.

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You should not pay anything at all to have anyone negotiate for you. All you have to do is call your state's division of Medicaid services and ask for a Waiver Social worker. I am sure that services are offered differently in each state. Our goal was to bring my sister home on from the nursing home with assisted help at home. We needed round the clock care for her and could not provide that ourselves. In Mississippi a resident had to be in a facility for 3 months to qualify for this program and then would be placed on a waiting list. After about 6 months, we were able to bring her home with almost 24 hour care paid for by the waiver program. They provide you with a social worker who coordinates everything and I believe there was up to $1000 provided to purchase supplies they would need to get her moved. They even decorated her bedroom at home with bedding, curtains, dresser, etc., paid for all medications, and paid for aides to come into take care of her. It was a great program, but there is no need for you to pay for help in getting these services.

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http://medicaid.ohio.gov/FOROHIOANS/Programs/OhioHomeCareWaiver.aspx

It looks like you might need to apply for the Home Care Waiver. It sounds a lot like Colorado's Elderly, Blind, and Disabled Waiver that my Mom received. In our case, and it looks like yours too, we had to apply for Medicaid and concurrently we applied for the waiver. The waiver is run by a gatekeeping company in Colorado, so we have to go through them for anything related to the waiver. We went through the department of human services in our county for Medicaid. For medicaid, we had to have less than $2000 in assets to be eligible. Since my husband and I had been paying for my mom's care for several months, ie, taking no rent or money for food, etc., she had over $7000 accumulated in her checking account. Luckily we had saved receipts, so we just submitted those receipts and had a check cut to us, and that along with receipts from my brother who had been taking care of her prior to us, brought her account down to the required less than $2000. So with a current bank statement that said her account was below the max, and info on all her other assets, like life insurance, burial insurance, pension plans, social security, etc. She ended up qualifying.

While all that was going on, (getting the info to the county rep) we had someone from the gatekeeping company stop by the house and interview my mother and myself to determine "need". From that interview she could see that my mom needed the waiver.

Basically from start to finish was 45 days or so. Maybe closer to 2 months. Now the waiver pays for aids to come in the house 11 hours a day, at no charge to my mom. It was paying for her to go to adult day care, but she stopped being able to do that because she became a 2 person transfer for a while.

The thing now is we HAVE to charge her rent and a fee for her groceries, etc, or her account will go up over $2000, since she gets $1800 a month in social security and pension. Basically she has to spend all her money each month or she will not be eligible for medicaid anymore and then no waiver.

So that's sort of good news, in that she can get now anything that tickles her fancy or that we think will help in her care.

The waiver is supposed to take care of home modifications too, but it is a huge hassle because they will only do it as a last resort, so we have to prove that we asked the city to do the stair lift and that they refused and THEN the gatekeeping company will send out contractors to bid on the job and THEN they will award the job to a company and THEN we have to wait for them to schedule to get it done. SIGH.

Anyway, hope this helps a little with the steps, from someone who has done the medicaid thing with help from my sister and husband.

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Thank you, everyone! I researched Passport, and through that site, I was told I’d be contacted by a Medicaid “Planner”. The initial consultation is free, but the disclaimer says the fee could be anywhere from $0 to $5,000. The article also said these people have the knowledge to negotiate Medicaid acceptance.

We are not asking for the world. Help with his DME rental, help with incontinence supplies, maybe a way to get meds cheaper. I don’t hold out much hope for help, but if help is available, I’d like to know. Thanks again!

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Sounds like you are on the right path with contacting Passport in your state of Ohio. In New York, once someone is on Medicaid, the incontinence supplies are covered with a prescription from the doctor and utilizing a medical supply company or online provider. I contacted ActivStyle. You can look them up online. They only work within certain states so it's worth checking. I didn't get that information through and Medicaid planner or private pay care manager. I got that through talking to people and researching online. They cover the pull-ups, adult diapers, chucks, and some cover Ensure type products. They do not pay for adult wipes. But just having the cost of the pull-ups or adult diapers covered is a huge help. The prescription side of it is once on Medicaid most prescriptions are covered in full, which is a huge help. But I know all states are different. I guess the bottom line is, you have to do your own research online, ask questions of others going thru the same thing, ask your pharmacist questions, ask the doctor questions, ask, ask, ask. Good Luck and take care of yourself:)

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Contact your local Area Agency on Aging. They can send a Care Manager out to assess the needs and may be able to help with some of the programs they have to offer. They are also a great referral source.

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In order to qualify for in home care under Medicaid, the patient must be qualified for receiving nursing home care, that is the criteria for selection. that mean if the patient is non-ambulatory for the most part, needs help with activities of daily living, personal care, grooming, bathing, etc. then they wiil qualify.

You really need to employ anyone to help you qualify. You just contact the dept. of Social services, apply for Medicaid, and tell tehm you want o apply for the Medicaid Waiver for in home long term care. If you qualify for Medicaid, they will then send out a Nurse and Social worker to do a preliminary assessment of needs, and they will determine if the patient qualifies for the Medicaid waiver. If they do then they will explain teh next steps for your state. Either their will ask you to pick a facilitator who will then be the go between patient and bodies that handle the approval of number of hours patient is qualified to obtain, etc.

You never have to pay anyone to help you through this process. So please double check why these people wna to charge you for something that is avaiable for no cost to you.

What is a Medicaid Waiver and how does it work?

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