Washington, D.C. Assisted Living and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

The District of Columbia provides long-term care resources to seniors through its Department of Health Care Finance, Division of Long Term Care (DLTC). The DLTC administers the home-and-community based HCBS waiver along with the Department on Disability Services.

Medicaid Waiver Programs for Assisted Living

Washington, D.C. Elderly & Persons with Disabilities Waiver(HCBS EPD Waiver)

The Elderly and Individuals with Physical Disabilities (EPD) Waiver serves individuals who are age sixty-five (65) and over, and individuals with physical disabilities ages eighteen through sixty four (18 – 64) in home and community-based settings, including assisted living facilities in lieu of nursing facilities. The goal of the EPD waiver is to ensure the target populations (elders and individuals with physical disabilities) have access to in-home supports, adult day health services to maintain people at home including those that are participant-directed that will be enable them to reside in their homes while receiving assistance with their activities of daily living

Services

Services includedin the Washington, D.C. EPD Waiver: Assistive Supports, Day Supports, and Professional Services and Residential Supports.

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care
  2. Financial: Applicants must meet certain income and asset limits to be eligible for the EPD Waiver program. For 2017, the standard was 300$ of the SSI benefit, which is $2,205 for an individual. Washington, D.C. has decided to go above the federal standard for asset limits however, and allows up to $4,000 for an individual and $6,000 for a married couple. In addition, thestate allows for spendown for the “medically-needy,” Individuals who are ineligible for coverage of their long-term care services under the Special Income Standard (SIS) because their income is too high and who have high medical expenses. This provision allows individuals with too much income to spend it own medical and remedial expenses and have it be deducted from the income limit calculation. In D.C., once the individual meets the spend-down obligation for the six month period, he or she will automatically be enrolled in Medicaid from the first day of the month in which the individual meets the spend-down obligation through the rest of the six month period. At the end of the six month period, the individual must file a new application for Medicaid to re-determine their eligibility and/or spend down obligation for the next six month period. For the spouse of an applicant D.C. applies the federal standard regarding the amount of income and other allowances the “community spouse” is allowed to have. For 2017, the community spouse resource allowance or (CRSA) is $120,900. In addition, the spouse is allowed a maximum monthly maintenance allowance (MMMNA) for covering additional costs.

Practical Considerations

The program does not allow Miller Trusts to spend down income to meet the strict financial criteria, however, the asset limit is higher than in most states, which can work to the applicant’s favor.