Medicaid Waiver for Older Adults

Will Medical Assistance Pay for Assisted Living and Other Services in the Community?

Medicaid Waiver for Older Adults

The Medicaid Waiver for Older Adults is administered by the Maryland Department of Aging. Under the Medicaid Waiver, the federal government "waives" the requirement that services be provided in a nursing facility. The waiver pays for home and community based services for those who otherwise would be institutionalized in a nursing home. There were 3,150 slots in Maryland that werre filled on a first come first served basis in fiscal year 2007.

Eligibility Criteria

The applicant needs to be at least 50 years of age. The income level is 300% of the SSI Level. The assets allowable are $2,000 for most ($2,500 for some). The applicant must qualify for nursing home care. As of September 1, 2006 people applying for medicaid benefits, including medicaid waiver, will have to prove their citizenship and identity. See http://www.dhmh.state.md.us/html/hotissues_citizen.htm.

Eligibility Process

If you are in the community:

The waiver is full. However, each July 1^st some slots become available. Interested applicants need to add their names to a Registry in order to be considered for a slot. Call toll-free, 1-866-417-3480. Applicants should ask the Registry staff what their number is in line, and call the local Department of Aging to find out what other services may be available.

When slots are available applicants will be contacted (according to their number on the Registry) to complete the eligibility process. You will receive a free medical evaluation from Adult Evaluation and Review Services (AERS). A form used to determine the need for nursing home care (Form 3871) is then sent to the Delmarva Foundation for a determination of medical eligibility. A plan of care will be developed. State law requires that a decision be made on your application within 30 days.

If you are in a nursing home:

Individuals who have been living in a nursing home for at least 30 days and who are on Medical Assistance may apply for the waiver at any time and do not have to wait on the Registry. Applicants should contact their local Department of Aging.

Appeal Rights

Applicants have a right to a written denial and to appeal and have a hearing. If an eligibility decision is not made within 30 days the delay can be appealed.

If you meet all eligibility requirements including the need for nursing home care then you may be eligible for the following services

Assisted Living is a program in which people who need assistance in performing activities of daily living, such as eating, toileting and dressing, can live in a residential environment rather than in a nursing home. Assisted living facilities provide care at three levels. Level 1 care will not be paid for by Medical Assistance. A resident who needs Level 2 care, for example, needs substantial support with some of the activities of daily living (eating, grooming, mobility, toileting and dressing), monitoring to manage frequent behavioral difficulties, and assistance with taking medications. Level 3 residents need a high level of care including intensive supervision to manage chronic behavioral difficulties and medication administration. For Level 2 of Assisting Living, the provider can receive a maximum of $2,054; and $2,482 for Level 3. However, providers can collect only their customary charges. The resident can keep $60 for personal needs and all other income must be paid to the provider. The provider must be licensed and also approved by the Medicaid Administration. The resident must need nursing home care but prefer services in the community.

Assistive Technology includes devices to facilitate a participant’s independence, such as extenders to assist with reaching and special eating instruments.

Behavior Consultation Services include home visits by an individual qualified to render services to evaluate a participant’s acute behavior change, assess the situation, determine the contributing factors, and recommend interventions and treatment.

Case Management Services are services that assist waiver participants in gaining access to needed waiver services and other needed medical, social, housing, and other supportive services.

Environmental Accessibility Adaptations are physical adaptations to a participant’s home or residence which are necessary to ensure the health, welfare and safety of the individual or enable the individual to function with greater independence and without which the individual would require admission to or continued stay in a nursing facility.

Home Delivered Meals

Home Health Services are nursing services provided on a part time or intermittent basis by a home health agency. The services can include physical therapy, occupational therapy and speech therapy.

Personal Care Services include a range of assistance provided to persons with disabilities and chronic conditions, which enable them to accomplish tasks that they cannot do for themselves because of disability. Assistance maybe in the form of hands-on assistance or cueing so that the individuals can perform the tasks by themselves. Such assistance most often relates to performance of activities of daily living.

Personal Emergency Response System is a device that will alert someone or some agency if the client is in an emergency situation.

Respite Care Services are services provided to individuals unable to care for themselves, furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care.

Senior Center Plus Service includes a program of structured group recreational activities, supervised care, assistance with activities of daily living and enhanced socialization provided in an out-of-home, outpatient setting. One nutritional meal is also included.

Waiver recipients may also be entitled to recieve the following service under the State Plan Medicaid:

Medicaid Acute, Primary, & Preventive Services

Limited Pharmacy Services

Medical Day Care

Durable Medical Equipment

Disposable Medical Supplies

For further information, including questions regarding appeals:
Legal Aid Bureau, Inc.
Assisted Living Project
(410) 951-7750 (Baltimore Metropolitan Area)
(800) 896-4213 (Maryland)

Source: Legal Aid Bureau, updated by the Maryland State Law Library (MSLL).

Date last reviewed: 11/3/08 (PLL/M.A.J.)