Medicaid HCBS Waiver Waitlists: How They Work & How to Navigate Them

Your parents are hopeful they can keep living at home with the help of a Medicaid long-term care program in their county that has gotten great reviews. They do some research, gather paperwork and submit their application, only to be put on a waitlist. They’re not sure how long they’ll be on the waitlist, how it will be prioritized or if they’ll be approved for the Medicaid long-term care program once they reach the top of the list. What seemed like a good idea now feels like a bunch of unknowns.

Waitlists can be frustrating, but they’re a reality for many seniors when it comes to Medicaid long-term care coverage. To learn more about Medicaid waitlists and how to handle them, keep reading, or contact us.


Understanding Medicaid HCBS Waiver Waitlists

Some Medicaid programs that provide long-term care benefits to people living at home or other places in the community have a limited number of enrollment spots or funds. Once those spots are full or the funds are used up, additional applicants will be placed on a waitlist. This article is about these kind of waitlists, how they are prioritized, how they vary and how planning for them can help you or your loved one receive the best care possible.

The Medicaid programs that have these waitlists are generally known as Home and Community Based Services (HCBS) Waivers, but they all have unique names that may or may not include the word Waiver. Every state that offers HCBS Waivers has at least one that covers long-term care services and supports for seniors who live in their own home or the home of a family member. In some states, there may also be an HCBS Waiver that covers long-term care benefits for seniors who live in other places in the community such as the home of a friend, assisted living residences, adult foster care, group homes or memory care unity for people with Alzheimer’s disease and other dementias.

Some Medicaid programs are entitlements, which means eligible applicants are guaranteed by law to receive the benefits without wait. HCBS Waivers are not one of these programs. Instead, Waivers have a limited number of enrollment spots, as we mentioned above. This means that every Waiver program has the potential to have a waitlist, and many of them do, but not all. In regions with smaller populations, or larger numbers of Waiver programs, there may not be a wait for Medicaid long-term care benefits.


Nursing Home Waitlists for Medicaid Beneficiaries

Medicaid recipients who have qualified for nursing home coverage my also encounter waitlists at nursing homes, but this article will not cover those types of waitlists. They are managed by the individual nursing home and can vary accordingly.

In fact, receiving nursing home coverage through Medicaid is an entitlement, which means eligible applicants are guaranteed by law to receive the benefits without wait. So, there’s never a waitlist for the nursing home coverage, but there may be waitlists at the nursing homes where you or your loved one is hoping to go. Not all nursing homes accept Medicaid, and those that do may not have any open spaces when you or your loved is looking.

You or your loved one could put your name on a waitlist in these circumstances, but you could also look for another nursing home in the state that accepts Medicaid and has an opening. This is not usually an option for seniors receiving long-term care at home via Medicaid. In-home caregivers will only travel so far, and Medicaid won’t pay for a senior to move to another part of the state where there’s a Medicaid Waiver program that has open enrollment spots.


How Medicaid Waitlists are Organized and Prioritized

In most states, Medicaid applicants are screened for eligibility before they are placed on a waitlist. That means the state will process their application and make sure they meet the financial criteria and medical requirements. However, some states, including Texas, Pennsylvania and Ohio, place Medicaid applicants on waitlists without screening them for eligibility. This means a senior could be waiting for long-term care only to find out they’re not eligible when they get to the top of the list. On the other hand, if the applicant was aware of how the waitlist operated, they could use that time on the list to gain eligibility. This is a complicated strategy and should only be attempted by a professional, like one our Certified Medicaid Planners.

In most states and for most of Medicaid’s HCBS Waiver programs, length of time on the waitlist is one of the top factors for priority. In some cases, it’s the only factor and waitlists are operated on a strictly first-come, first-served bases. But in other cases there are factors when it comes to waitlist priority. Some states use the level of emergency or crisis as a priority factor. Other states prioritize seniors who will be using the program to help them leave an institution (like a nursing home) and return to the community. Some states also flip that around and use risk of institutionalization as a priority factor.

Medicaid waitlists can be state-wide, but they can also be separated into smaller regions, like counties or cities. Some waitlists may be organized by caregiver or by the agency that supplies the caregivers.


How a Medicaid Planner Can Help You Navigate Waitlists

When it comes to navigating Medicaid Waitlists, having in-depth knowledge that comes from years of experience is crucial, and the best place to get that knowledge is from a Certified Medicaid Planners.

The state website might tell you the waitlist time can last anywhere from 3-12 months, but a Certified Medicaid Planner will be able to tell you that their last five clients were only on the list for an average of two weeks, so it’s the wait is not that bad. Or maybe it’s the other way around and our Planner knows the wait will be on the long end. They can help you apply for a different program, budget for long-term care in the interim or find other options that will meet your long-term care needs.

Certified Medicaid Planners will also be familiar with the process and priority when it comes to waitlists. If you’re in a state that doesn’t screen for eligibility, our team of professionals can make sure you are eligible by the time you get to the top of the list. They can also make sure you don’t miss any communication from the state about your status on the list. They will know the waitlist priority factors and will make sure you use all of them to your advantage. For example, if your medical condition changes while you’re on the list, they’ll know if that might impact your priority status and how to communicate that to the state.

No one likes to wait in line. But if that’s what you have to do for your Medicaid long-term care benefits, our team at Eldercare Resource Planning will make sure your wait is worth it.

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