Topics on this page:
- Medicaid Waiver for Older Adults
- Eligibility Criteria
- Eligibility Process
- Appeal Rights
- Eligible Services
- Medicaid Services
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. The program received funds for approxiamately 3,000 participants in fiscal year 2011. See fact sheet http://mmcp.dhmh.maryland.gov/docs/Older_Adults_Fact_Sheet_October_2010.pdf
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.
If you are in the community:
Individuals who are interested in the Waiver should add their name to the Waiver Services Registry. As slots become available, the Department of Aging will contact registrants. Each July 1st some slots become available. Call the Registry 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.
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:
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 $71 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
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
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
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
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
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
A device that will alert someone or some agency if the client is in an emergency situation.
Respite Care Services
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 receive 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