Medicaid HCBS Waivers: Eligibility, Benefits, Settings and Wait Lists

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Last Updated: Mar 15, 2024
EligibilityWaitlistsBenefitsLocationsHow a Medicaid Planner Can Help

The arthritis in your mother’s hands is so bad she’s struggling with the simplest daily tasks – getting dressed, cooking and even holding a fork. Her doctor says she needs a Nursing Facility Level of Care, but she doesn’t want to live in a nursing home, and you don’t want her to, either. The closest one that accepts Medicaid is two hours away.

There are alternatives to Medicaid nursing home care and one option is a Home and Community Based Services (HCBS) Waiver. HCBS Waivers largely have the same eligibility criteria as Medicaid nursing home, but services are provided to beneficiaries in their homes or “communities”. In this case, “communities” can be adult day care in specialized centers or in many states in assisted living residences.

To learn about which Waivers exist in your state, the eligibility requirements for HCBS Waivers and the long-term care benefits they will cover, keep reading. Or you can ask our team. 

Eligibility Requirements for Home and Community Based Services Waivers

There are two financial eligibility requirements for Home and Community Based Services (HCBS) Waivers – an asset limit and an income limit. In most states in 2024, the individual asset limit for HCBS Waivers is $2,000 and the individual income limit is $2,829/month. Most assets (like bank accounts, retirement accounts, cash, etc.) and most income (like Social Security benefits, pension, wages, etc.) are counted toward these limits. However, the home will not be counted as an asset if the Medicaid recipient is living in it, which presumably they will be if they are applying for an HCBS Waiver, as long as the home is below the state’s home equity limit. In most states in 2024, the home equity limit is either $713,000 or $1,071,000 (in states with higher property values). Essential home furniture and appliances are also exempt from the asset limit.

If you are over these financial limits there are strategies to reduce your resources and become eligible, but these strategies should not be used without the help of a Certified Medicaid Planner.

The medical requirement for most HCBS Waivers is needing a Nursing Facility Level of Care (NFLOC). This means the type of constant care and supervision usually associated with a nursing home. However, how each state defines and measures NFLOC can be different. In some states, for example, a NFLOC might mean needing help with two or more of the Activities of Daily Living – mobility, bathing, dressing, eating and toileting. In other states, it might mean needing help with three or more of them. The evaluations for determining if someone needs a NFLOC or not will most likely include an in-person evaluation and some type of communication with the applicant’s primary care provider, but these evaluations can also change by state. Some may put more weight on the doctor’s opinion than the in-person evaluation, some may do the opposite. Some states may place more emphasis on cognitive or behavioral issues than other states.

Some HCBS Waivers only require applicants to be at risk of needing a NFLOC, but the same variations in definition and evaluation method applies to this level of care requirement as it does to needing a full NFLOC.

 

Waitlists for HCBS Waivers

Even if an applicant meets the financial and medical requirements, they are not guaranteed to receive coverage from an HCBS Waiver. That’s because these programs have a limited amount of funds, which means a limited amount of enrollment spots. When all of those spots are full, additional applicants will be placed on a waitlist.

How these HCBS Waiver waitlists are organized and prioritized vary by state and program. Some states pre-screen applicants so only eligible applicants are placed on a waitlist, while other states place everyone on the list and only review their application once they reach the top of the list. How long it takes to reach that top and what it takes to get there can also vary. Some waitlists are prioritized strictly on a first-come, first-served basis. Others give priority to people with the greatest health needs, others to individuals who are in an emergency situation. Having a Certified Medicaid Planner on your side can prove especially helpful, and comforting, if you wind up on a waitlist.

 

Home and Community Based Services Waivers Benefits

The long-term services and supports covered by HCBS Waivers can vary depending on the Waiver. They can also vary by the individual. For example, two seniors may be covered by the same Waiver, but their coverage from that Waiver might be different in terms of which benefits are covered and how often they are covered. That being said, HCBS Waiver benefits can, and often do, include the following:

• Adult Day Care
• Home modifications for safety and accessibility
• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Assistive technology and devices
• Case management
• Homemaker services
• Durable and home medical equipment
• Financial management services
• Meal delivery
• Transportation
• In-home nursing services
• Personal Emergency Response Systems (PERS)
• Respite care for unpaid caregivers
• Transportation
• Vehicle modifications

 

Locations Where HCBS Waivers Can Provide Long-Term Care

States that offer HCBS Waivers all have at least one Waiver that will cover long-term care services and supports in the beneficiary’s home or in the home of a family member, such as an adult child or grandchild, if that’s where the beneficiary lives. The home in these cases can be a single-family house, a multi-unit house, a condominium, an apartment, a houseboat or a mobile home, with or without the land.

Some Waivers in certain states will also cover long-term care benefits in other settings in the community. These can include assisted living residences, adult foster care, group homes, the home of a friend or memory care units for patients with Alzheimer’s disease and other related dementias.

 While HCBS Waivers will cover long-term care services and supports in multiple locations, it will not cover room and board expenses in any of them. This includes mortgage payments, rent, utility bills and food expenses.

 

How a Medicaid Planner Can Help with HCBS Waivers

Since the benefits and availability of HCBS Waivers can vary so much from state to state, having a Certified Medicaid Planner help you with the research and application process can be invaluable. Our team of professionals at Eldercare Resource Planning will know if there is an HCBS Waiver in your state that can work in your situation. They’ll know what kind of coverage the Waiver offers, what kind of benefits you can expect and where you can expect them.

If the Waiver works for you, one of our Certified Medicaid Planners can figure out of you’re eligible or not. They will know the financial eligibility limits for HCBS Waivers in your state and what assets and income will count toward those limits. They can also provide you with options to become eligible if you don’t meet those financial limits.

If you end up on a waitlist, our team will know what it takes to reach the top of the list and how long it might take to get there. They’ll know if being on the waitlist means you will be automatically accepted when you get to the top of the list, or if you should use your time on the list to become eligible.

Most seniors would rather stay at home than move to a nursing home. An HCBS Waiver can help them do that, and our team of professionals can help with HCBS Waivers, so connect with us now.

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