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

Introduction

Maine provides resources to seniors through The Office of Aging & Disability Services (OADS), within the Department of Health and Human Services (DHHS), is responsible for planning, developing, managing, and providing community based services which promote choice and independence for adults choosing to remain in their community. Programs include both federally funded waiver programs as well as state funded home based care.

OADS operates seven state-funded, affordable Assisted Living Facilities (ALF). They were developed on the premise that the consumer would have their own apartment with the option of having services provided. These facilities allow an individual to live independently in their own apartment and receive such services as meals, homemaking, personal care, and/or medication administration. The consumer’s rent is paid directly to the property owner; and services (meals, personal care, medication administration, homemaker services, plus an emergency response system) are provided by the service provider.

OADS currently operatesfive Independent Housing with Services (IHSP) programs throughout the State. The purpose of this program is to address both the housing and service needs for older adults who have long term care needs but do not require a nursing facility level of care.

These facilities offer similar services to the Assisted Living Facilities; however they do not provide medication management. The IHSP provides both affordable housing, as well as supportive services which in turn increased opportunity for independence and freedom of choice. It continues to provide supportive services such as personal care, homemaking, service coordination, and meals.

Additionally, Maine has five Aging & Disability Resource Centers (or, Area Agencies on Aging), which serve as “one-stop-shops” to answer questions from older adults, or from any individuals with disabilities, about a wide range of in-home, community-based, and institutional services. AAAs provide information and assistance to individuals needing either public or private long-term care resources, serve professionals seeking assistance on behalf of their clients’ long-term care needs, serve individuals planning for their future long-term care needs, and serve as the entry point to publicly administered long-term supports including those funded under Medicaid, the Older Americans Act and state revenue programs.

Medicaid Waiver Programs for Assisted Living and In Home Care

Maine Medicaid Waiver for Elderly and Adults with Physical Disabilities (HCB Waiver)

Home and Community Benefits for the Elderly and for Adults with Disabilities (HCB) are in-home care and other services, designed as a package, to assist eligible Members to remain in their homes, or other residential community settings, and thereby avoid or delay institutional nursing facility care. Medical eligibility for these HCB services is established by a medical eligibility determination (MED) assessment, which is conducted by the Department of Health and Human Services, Aging and Disability Services.

Services

Services Include: Care Coordination, Adult Day Health, Assistive Technology, Attendant Services, Home Health Services, Financial Management Services, Personal Care Services, Personal Emergency Response Systems, Respite Care, Transportation services, and Environmental Modifications.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant is subject to certain income and asset limits. Single people can have no more than $2,000 in resources. Couples can have no more than $3,000 in resources (when both spouses receive long-term care). Married couples can have up to $120,900 in resources, as long as one spouse at home DOES NOT receive long-term care services. The income limits are $2,205 for an individual and $4,410 for a couple (when both spouses need long-term care). However, there is a “Waiver Spend-down” option which allows your eligibility to be considered even if your income is over the limit. Waiver Spend-down has a standard $20 income deduction. All individuals are allowed to retain a basic needs allowance from his/her income which is equal to $2,205 (300% of the Federal Benefit Rate, or FBR). Any remainder will be the individual’s liability for the cost of care in Waiver Spend-down.

Practical Considerations

  • The State of Maine requires both a financial and functional assessment to determine an individual’s eligibility for the HCB waiver for the Elderly and Adults with Physical Disabilities. Assessments help individuals and families understand what services are available to them and to plan for service needs. Financial assessments are completed by the Office of Family Independence. Functional assessments are completed by Goold Health Services. The Medical Eligibility Determination Form (MED) is the tool approved by DHHS to determine functional program eligibility for this service.

Below are the steps necessary to apply for services:

  1. Apply for MaineCare Services. You can access the Long Term Care application at: http://www.maine.gov/dhhs/ofi/forms.shtml - Submit completed applications to your local District DHHS office
  2. If you have not already had a functional assessment by Goold Health Services at 1-800-609-7893, call to arrange an appointment.

Members will be accepted into the program on a first-come, first-served basis, based upon the availability of funding. The wait list will be maintained by the Office of Aging and Disability Services.

Conclusion

Maine is a state that does has a strict financial limit for the amount of income and assets an applicant must have. Furthermore, pursuant to federal law, the HCBS Waiver program in Maine has a “medically-needy” provision which allows an applicant to lower their income to come below the limits required for eligibility. Due to the complexity of these rules, and the value of the waiver program, it is essential to have a Medicaid Planning specialist review your finances and application before deciding whether to apply for Maine’s Medicaid waiver for the elderly.