he Aged & Disabled Medicaid Waiver Program is an alternative to nursing home care. It provides services in your own home to help take care of you and assist you with activities of daily living. This program is also called home and community-based care.
Under this waiver program you can receive services that enable you to remain living independently in the community rather than having to move to a nursing home. However, one significant difference between in-home care on the waiver and nursing home care is that the care received on the waiver is not around-the-clock. This arrangement can be ideal for you if you do not need constant medical care or if you have a relative or spouse or informal support who can care for you when the home care provider is absent.
Eligibility for this Medicaid waiver program is similar in many ways to nursing home Medicaid eligibility. In order to qualify for the Medicaid waiver program you must be both medically and financially eligible. Your medical eligibility is assessed by a company called West Virginia Medical Institute (WVMI) using the same assessment tool (the PAS 2000) and standard required for nursing home medical eligibility.
The Medicaid waiver program requirements are different in some ways from nursing home Medicaid. The Medicaid waiver program may be better for you financially. For one thing, the Medicaid waiver program does not count the income or assets of your spouse in determining your eligibility. Since you are not penalized for transferring assets to your spouse, you could put everything into your spouse’s name and those assets would not be counted for the Medicaid waiver program. The asset limit for the Medicaid waiver program is the same as the asset limit for nursing home Medicaid. Under the Medicaid waiver program, the covered individual may have up to $2,000 in assets.
The income requirement for the Medicaid waiver program is the same as the income requirement for nursing home Medicaid. Your monthly income must be equal to or below 300% of the monthly SSI payment. For nursing home Medicaid a single individual often must spend all but $50 per month on care. However, under the Medicaid waiver program, you do not have to contribute any of your income if you meet the income requirement.
Before you decide to move to a nursing home you may consider participating in the Medicaid waiver program. However, funding for the Medicaid waiver program is limited, and even if you are found medically eligible you still may have a waiting period before you can receive any benefits.
If you are considering applying for the Medicaid waiver program, contact your local West Virginia Department of Health and Human Resources (DHHR) office. In addition, you can contact:
WV Bureau of Senior Services Phone: 1 (877) 987-3646 or
Medicaid Waiver Staff 1 (304) 558-3317
Mailing Address: 1900 Kanawha Boulevard, East Fax: 1-304-558-5609
Charleston, WV 25305 http://www.wvseniorservices.gov
Physical Address: Town Center Mall, 3rd Level, Charleston WV
Table Comparing Aged and Disabled Medicaid Waiver Program to Nursing Home Medicaid
|Aged & Disabled Medicaid Waiver Program||Nursing Home Medicaid|
|Location of services||C provides services in your own home to assist you with daily living||C provides services in a nursing home|
|Amount of care||C care is available for a set number of hours per week||C care is available 24/7|
|Eligibility requirements||requires that you meet eligibility standards to become eligible for this program||requires that you meet eligibility standards to become eligible for this program|
|Impact of spouse’s income on eligibility||does not count the income or assets of your spouse in determining eligibility for the program||counts the income and assets of your spouse in determining your eligibility for the program|
|Contribution of income to care||you do not have to contribute any of your income to your care||you must make some contribution to your care based on your income|
|Program funding and receipt of benefits||funding is limited, and so even those who are eligible for the program may have to wait before receiving benefits||C this program is well funded, and there is generally no wait time to receive benefits|
For more information, see: 42 U.S.C. §§ 1396u, 1396d (2015); 42 C.F.R. §§ 440.180, 441.300-.365 (2014); West Virginia Department of Health and Human Resources, Income Maintenance Manual, §§ 17.9-.11, 17.17-.31, Chapter 2, Appendix B, http://www.wvdhhr.org/bcf/family_assistance/policy.asp (last visited May 26, 2015); Joan M. Krauskopf et al., Elderlaw: Advocacy for the Aging § 11.86 (2nd ed. 1993).