Alternativas a los asilos de ancianos financiadas por Medicaid

Resumen
All 50 states and D.C., have Medicaid-funded programs that are intended to delay nursing home placement by offering nursing home alternatives, a goal that is usually shared by the Medicaid beneficiaries and their families. These programs can cover long term care services and supports for qualified beneficiaries who live in their own home, the home of a family member, or, in many states, other residential settings, such as assisted living facilities, adult foster care, and memory care units.

Home and Community Based Service Waivers

Descripción

Home and Community Based Service (HCBS) Waivers are designed for seniors who require, or are at risk of requiring, a Nursing Facility Level of Care (NFLOC), but want to remain living ?in the community? as an alternative to moving into a nursing home. The definition of NFLOC and how it is measured varies by state, but in general the evaluations are based on an applicant?s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Most evaluations also take cognitive and behavioral issues into consideration, as well as an applicant?s ability to complete the Instrumental Activities of Daily Living (such as shopping, cooking, housekeeping, and medication management).

The settings where HCBS Waivers will provide long term care services and supports vary by state and Waiver program. Every state and the District of Columbia has an HCBS Waiver that will provide the beneficiary with long term care benefits in their own home or the home of a family member. Some states and Waivers will also provide benefits in the home a friend, adult foster care, assisted living facilities, adult day care, subsidized senior housing, memory care units for people with Alzheimer?s and other dementias, and other specialized nursing facilities.

In these settings, HCBS Waivers offer a wide range of long term care benefits to enable aging in place. The list below includes some of the more common HCBS Waiver services and supports, but specific available benefits vary by program and state, as well as the needs and circumstances of each individual.

? Gestión de casos
? Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
? Personal care assistance with the Instrumental Activities of Daily Living (such as shopping, cooking, housekeeping, and medication management)
? Adult day care
? In-home skilled nursing care
? Home modifications (such as wheelchair ramps, grab bars, and widening doorways)
? Vehicle modifications
? Meal delivery
? Transportation (medical and non-medical)
? Respite care for primary caregiver
? Personal Emergency Response Services (PERS)

A crucial difference between Nursing Home Medicaid and HCBS Waivers is that Nursing Home Medicaid is an entitlement, which means all qualified applicants are guaranteed by law to receive benefits without wait. They also receive all their long term care benefits at once. This isn?t the care with HCBS Waivers, which deliver their benefits individually based on specific needs, and are not an entitlement. Instead, Waiver programs have a limited number of enrollment spots, which can range from a few hundred to tens of thousands, depending on the state and program. Once these spots are full, additional eligible applicants are placed on waitlists. Priority on waitlists also varies by waiver. It can be based on medical need, order of wait time, and other factors.

Eligibility

In most states, the financial eligibility criteria for HCBS Waivers and Nursing Home Medicaid are the same. For an individual in 2023, the asset limit is $2,000 and the income limit is $2,742 / month in most states, and for married couples the asset limit is $4,000 and the income limit is $5,484 / month in most states. The major difference here is that Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover the cost of the nursing home, while HCBS Waiver beneficiaries are allowed to keep all of their income in most cases (if they live in government-funded assisted living facilities they will likely be asked to contribute some or all of their income to the state to cover the cost of living in the facility).

Some people assume owning a home would make them ineligible for Medicaid, so receiving long term care benefits through Medicaid in their own home would be impossible. However, if the Medicaid beneficiary lives in their home, and it is below the state?s home equity interest limit (the portion of the home?s equity value the beneficiary owns minus and outstanding mortgage/debt, $688,000 or $1,033,000 in most states in 2023), the home will not be counted against the asset limit.

The functional, or medical, criteria for HCBS Waivers and Nursing Home Medicaid is also the same in most states ? requiring a Nursing Facility Level of Care, as discussed above. There are some states, however, that only require HCBS Waiver applicants to only be at risk of needing a NFLOC. This may mean, for example, they need help with three Activities of Daily Living (mobility, bathing, dressing, eating, toileting) instead of four.

Seniors who meet the eligibility requirements for one of these two programs, HCBS Waivers and Nursing Home Medicaid, are very likely to meet the requirements for both.

Aged, Blind and Disabled Medicaid

Descripción

Qualifying seniors enrolled in Aged, Blind and Disabled (ABD) Medicaid can receive long term care benefits ?in the community? that can delay or prevent the need for a nursing home. ABD Medicaid can also be called Regular State Plan Medicaid for seniors, but it shouldn?t be confused with the Regular Medicaid that is available to low-income people of all ages.

ABD Medicaid long term care benefits that can delay nursing home placement will vary by state, but in general they are similar to the long term care benefits listed above under HCBS Waivers ? case management, adult day care, home/vehicle modifications, transportation, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, housekeeping, and medication management).

Seniors who meet the eligibility criteria for Nursing Home Medicaid won?t necessarily meet the criteria for ABD Medicaid, specifically the financial criteria. But if they don?t meet that financial criteria they will probably be close, and a Medicaid planning professional might be able to help them bridge the gap. Like Nursing Home Medicaid, ABD Medicaid is an entitlement, which means eligible applicants are guaranteed by law to receive benefits without wait. Unlike Nursing Home Medicaid, which delivers its benefits all at once, ABD long term care benefits are delivered individually based on needs and circumstances.

Eligibility

There is not medical or functional criteria to qualify for ABD Medicaid, applicants only need to be over age 65 (or blind or disabled, but this article is focused on seniors). However, to qualify for long term care services and supports through ABD Medicaid, beneficiaries must have medical or functional needs that will be helped by the services and supports. These needs, which can include requiring a Nursing Facility Level of Care, will be evaluated by the state and long term care benefits will be made available accordingly.

The financial eligibility criteria for ABD Medicaid in most states is stricter than the financial eligibility criteria for Nursing Home Medicaid. For an individual in most states in 2023, the asset limit is $2,000 and the income limit typically ranges from $914 – $1,215 / month (compared to the $2,742 / month typical for Nursing Home Medicaid in most states). And for married couples in most states, the ABD Medicaid asset limit is $3,000 and the income limit typically ranges from $1,371 ? $1,643 / month (compared to the $5,484 / month for typical for Nursing Home Medicaid in most states). While Nursing Home Medicaid beneficiaries are required to give almost all of their income to the state to help cover the cost of the nursing home, ABD Medicaid beneficiaries are allowed to keep all of their income in most cases (if they live in government-funded assisted living facilities they will likely be asked to contribute some or all of their income to the state to cover the cost of living in the facility).

Program for All-Inclusive Care of the Elderly

Descripción

Seniors age 55 and over who have a state-certified need for a Nursing Facility Level of Care can coordinate their medical, social service and non-medical personal needs into one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). The National PACE Association estimates that, ?despite a high level of care needs, more than 90 percent of PACE participants are able to continue to live in their community.?

PACE offers multiple benefits that can help seniors age in place and avoid nursing homes. First, PACE can be used by people who are ?dual eligible? for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care. And PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants.

PACE is also known as LIFE (Living Independence for the Elderly) in some states.

PACE/LIFE is available in 32 states and the District of Columbia. This National PACE Association locator tool can help seniors find a PACE program near them.

Eligibility

PACE/LIFE beneficiaries must be dually eligible for both Medicare and Medicaid. While Medicare simply requires a beneficiary to be 65 years of age, Medicaid has financial requirements (discussed above). In addition, the beneficiary must live in or be willing to move to an area served by a PACE/LIFE program.

Money Follows the Person Programs

Descripción

Seniors who are currently living in nursing homes but want to return to the community can receive assistance with that transition through Medicaid?s Money Follows the Person (MFP). This program will help cover moving expenses like security deposits, utility set-up fees, purchasing essential furniture, and paying for movers. MFP programs may also provide benefits after the senior has returned to the community, such as adult day care, home modifications, meal delivery, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

Currently, 36 states and Washington, D.C., offer MFP programs. Some states use different names for their MFP programs. It?s called Gateway to Community Living in Alabama, Homeward Bound in Maine, and Take Me Home in West Virginia. This federal Medicaid webpage has a list of all the states with MFP programs, as well as the contact name, phone number and email address for every state program. These contacts can provide information about the specific benefits available through their MFP program, as well as any potential waitlists.

Eligibility

In addition to meeting the financial and medical requirements outlined above, there are several eligibility requirements specific to MFP program:
? The senior must have been residing in a Medicaid-funded nursing home or another Medicaid-funded institution (such as an intermediate care facility) for a minimum of 60 consecutive days.
? The senior must have been enrolled in Medicaid for at least one day prior to leaving the Medicaid-funded institution.
? The senior must require a Nursing Facility Level of Care, but will be able to live in the community with the help of services provided by the MFP program.
? The senior must express a desire to return to the community.
? The senior must be moving into their own home, the home of a loved one, or a small group home with a maximum of four unrelated residents.