Medicaid waiver programs

Today on our Medicaid road trip, we are going to take a side road and explore Medicaid waiver programs that help cover the cost of long-term care.  These programs offer an excellent alternative to institutional care in a nursing home by keeping people at home. As you have seen so far along our journey, Medicaid isn’t a straight road. It has many side roads with twists and turns.

Who is eligible for services?

Persons who are elderly or disabled with physical and cognitive impairment which make it difficult to live independently and perform the activities of daily living may be eligible. Their care needs must be approved by a physician for an intermediate level of nursing home care, and they must meet Medicaid’s asset and income requirements. For a thorough discussion on Georgia Medicaid’s asset and income requirements click here

What type of services are provided?

Medicaid waiver programs provide home and community-based services to eligible enrollees as an alternative to placement in a nursing home. This can be especially helpful for families wanting to keep their loved ones at home. Options available include in-home care, adult day care, and alternative living arrangements like small personal care homes. 70% of recipients elect in-home care services

How do I enroll in the program?

If you meet both the care needs and financial requirements of the program, requesting services begins with an assessment performed by your local Area Agency on Aging.  If the screening confirms initial eligibility, your name will be placed on a waiting list.

When will my services begin?

In order to receive services, you must clear the waitlist.  It is ranked based upon your unmet need for care. You will receive a Determination of Need (DON) score after your initial screening.  When your name moves to the top of the list you will be contacted for an in-home assessment.  The waiting list is difficult and frustrating as your care partners and trusted advisors cannot provide you with the specifics of WHEN your care services will begin. Due to the many steps of this process, waiver programs are not often a solution for families needing quick care and relief.

Is there a cost for these services?

Yes, every participant in a Medicaid waiver program has a “cost share”. Your cost share is based upon your monthly income.  Individuals who are married and receive benefits may be eligible to “divert” a portion of their income to their caregiver spouse under program rules.

Putting together a plan for care can involve services paid through the Medicaid program.  Whether your needs are immediate, or you are planning for future care, understanding if Medicaid can be part of the solution is a smart strategy for families. Contact Hurley Elder Care Law at 404-843-0121 for more information on Medicaid waiver programs.