Idaho Assisted Living and In-Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Idaho provides long-term care resources to seniors through the Idaho Department of Health and Welfare. For dual-eligible Medicare and Medicaid seniors, Idaho offers a unique coordinated health plan. This program, the Medicare-Medicaid Coordinated Plan (MMCP), offers one set of comprehensive benefits, one accountable entity to coordinate the navigation and delivery of services, and one care management team to develop care plans and coordinate benefits. The MMCP is administered by Blue Cross of Idaho. The name of this plan is True Blue Special Needs Plan.

In addition to the MMCP program, Idaho offers alternatives to seniors who need a nursing home level of care through a Medicaid home-and-community based (HCBS) waiver program. Idaho’s HCBS waiver gives adults who are elderly or physically disabled more choices for long-term care. Eligible adults will be able to choose services that allow them to stay in their own homes or communities. You can talk to staff at your nearest Medicaid office to find out if you qualify.

Medicaid Waiver Program for Assisted Living and In-Home Care

Idaho Aged & Disabled Medicaid Waiver (HCBS A&D Waiver)

The goal of theAged & Disabled Waiver (A&D Waiver) is to allow Idaho's elderly and disabled citizens who meet nursing facility level of care to choose to live in a home or community setting rather than in an institution. Individuals seeking A&D waiver services will complete an application for Medicaid with Self-Reliance staff in the Division of Welfare, a division within the Idaho Department of Health and Welfare. The Division of Welfare determines financial eligibility for the waiver. The waiver is administered by the Division of Medicaid's Bureau of Long Term Care (BLTC).

When possible, A&D waiver services should be available in the consumer's own home and/or community regardless of their age, income, or ability, and should encourage the involvement of natural supports, such as family, friends, neighbors, volunteers. The Aged & Disabled Waiver, offers services in settings such as the home or apartment of the participant, or in homes or apartments where the participant lives with a family member.

Services

Services included in the A&D Waiver include: Certified Family Homes, and Residential Assisted Living Facilities, Chore Services, Environmental Accessibility Adaptations, Home Delivered Meals, Personal Emergency Response System, Skilled Nursing, Specialized Medical Equipment and Supplies, Non-Medical Transportation, Homemaker, Attendant Care, Companion Services, Consultation, Respite

Eligibility

  1. Health: Applicants for the A&D waiver mustmeet the Nursing Home Level of Care.
  2. Financial: Applicants for the A&D waiver must meet certainincome and asset limits to be eligible for the waiver program. For 2017, the Special Income Limit (SIL) for an individual is $2,205.00 per month (calculated at 300% of the SSI Federal Benefit Rate). The asset, or resource limit, is $2,000 for an individual and $3,000 for a married couple. If your income is too high to qualify under the criteria, the A&D waiver allows for a Miller Trust (or Qualified Income Trust) to funnel your income into and pay for care while becoming eligible for Medicaid. There are also additional requirements regarding the treatment of assets if the applicant is married and the spouse is not applying for the A&D waiver, commonly referred to as the “community spouse.” The A&D waiver sets certain Spousal Impoverishment Standards, which outline the rules for treatment of assets and other financial requirements on the community spouse. For 2017, the community spouse is allowed to keep $120,900 in assets (known as the Community Spouse Resource Allowance, or CSRA).

Practical Considerations

The enrollment limit for 2017 is 10,460 and will increase over the next five years to slightly over 12,000. The A&D waiver program will only cover up to 100% of the costs of what nursing home care would be if the applicant required treatment in a facility when determining the eligibility of an applicant.. There are currently the following certified locations under the HCBS program:

  • Adult Day Health Centers – 53 service sites
  • Developmental Disability Agencies – 75 service sites
  • Certified Family Homes – 2,212 service sites
  • Residential Assisted Living Facilities – 352 service sites

Conclusion

Idaho’s Aged and Disabled Waiver is a good option for seniors who would rather reside in their homes or in a community setting instead of a nursing home, but require a nursing home level of care. The high enrollment limit and good number of A&D waiver qualified locations make this program very accessible. In addition, the ability to use a Miller Trust to help lower your income to meet the income and asset limits for Medicaid’s financial eligibility means that Medicaid planning for these services may help you access the care benefit under Medicaid if your income and assets are above the limit.