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

Introduction

Minnesota provides long-term care resources for seniors through the Department of Human Services. The DHS provides state-run Economic Assistance (such as food and nutrition, health counseling and income assistance) and Health Care (including mental health and substance abuse services, and preventive care and disease management to keep people healthy) resources for seniors. DHS also provides a number of other services to help the senior population, including Home and Community Services, to help enable seniors to live at home or in their community longer and healthier.

One of the Home and Community Services available to seniors who do not require nursing home care and are not receiving medical assistance is the Essential Community Supports Program. To qualify you must be 65 years or older and meet other essential criteria. If you are eligible, then you may receive services such as: Adult day service; Caregiver training and education; Chore services; Community living assistance; Home-delivered meals; Homemaker services; Personal emergency response system; and Service coordination / case management. If you want to apply for the Essential Community Supports Program, contact the Senior LinkAge Line® at 800-333-2433 or Disability Linkage Line® at 866-333-2466 for more information.

In addition to the above programs, the Alternative Care program might be another option. A person age 65 and older who is assessed through the Long-Term Care Consultation process is eligible for Alternative Care funding when the following criteria are met:

1) The person has been determined to require the level of care provided to individuals in a nursing facility as determined by the Long-Term Care Consultation process

2) The person’s income and assets would be inadequate to fund a nursing facility stay for more than 135 days 3) The monthly cost of the person’s Alternative Care services must be less than 75 percent of the average Elderly Waiver Medicaid payment limit

3) The person chooses to receive home and community-based services instead of nursing facility services

4) The person pays the assessed monthly fee and

5) No other funding source is available for the community services.

Finally, Minnesota provides a home-and-community based Medicaid waiver program known as the “Elderly Waiver,” for seniors who would otherwise require a nursing home level of care but want to remain in their own community or home.

Medicaid Waiver Program for Assisted Living and In Home Care

Minnesota Elderly Waiver (HCBS Medicaid Elderly Waiver, or EW)

The Elderly Waiver program funds home and community-based services for people age 65 and older who are eligible for Medical Assistance and require the level of care provided in a nursing home but choose to live in the community. The Minnesota Department of Human Services operates the program under a federal waiver to Minnesota’s Medicaid state plan. Counties, tribal entities and health plan partners administer the program.

In 2016, the Elderly Waiver program served 29,822 peopleat a total cost of $401,853,154. The average monthly participant population for fiscal year 2016 was 23,303 and average cost of $1,340 per participant per month under managed care. Ninety-two percent of participants receive their services through a managed care organization. Managed care program options include either: 1) Minnesota Senior Health Options, an integrated Medicaid/Medicare health and long-term care program or 2) Minnesota Senior Care Plus, a Medicaid health and long-term care option.

Services

Services included: Adult day services; Case management; Chore services; Companion services; Consumer-directed community supports; Family caregiver support services, including respite; Home health aides; Home-delivered meals; Homemaker services; Home and vehicle modifications; Non-medical transportation; Personal emergency response systems; Personal care assistance; Residential services, such as customized living services, foster care or other type of residential care; Skilled nursing visits; Specialized equipment and supplies; and Transitional services.

Eligibility

  1. Health: An applicant for the Elderly Waiver must require a Nursing Home Level of Care, as determined by the Long-Term Care Consultation Process.
  2. Financial: An applicant must qualify for Minnesota’s Medical Assistance program, which is the state’s name for Medicaid, which has certain income and asset limits for seniors over age 65. For 2017, an individual theElderly Waiver income limit is $2,205 or 300% of the Federal Benefit Rate (FBR). In addition, the asset limit for an individual is $3,000 and $6,000 for a married couple. If you choose to qualify using the “medically-needy” provision, the income limit for 2017 is $804 per month for an individual if using spenddown. If you want to qualify without the spend down provision, then the income limit for an individual is $1,005 per month. The asset limit for an individual and couple remains the same whether you qualify under the Special Income Limit or through the “medically-needy” provision.

Practical Considerations

The strict Special Income Limit without the ability to use a Miller Trust makes it difficult to qualify for the Elderly Waiver if you have a significant amount of income you receive each month. Additionally, because the “medically-needy” provision does allow you to deduct medical expenses and remedial care costs from your income limit, the state’s level set at $804 a month is very low.

Conclusion

Minnesota’s strict Special Income Limit state without the ability to use a Miller Trust makes it a more unattractive state for Medicaid-funded long-term care in assisted living or in home care. However, with the right assistance a Medicaid Planning specialist may help you save money through the state’s “medically-needy” spend down option if you are already spending most of your monthly income on medical care.