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

Introduction

Mississippi provides long-term care resources to seniors through the Mississippi Department of Human Services(MDHS), Division of Aging and Adult Services (DAAS). DAAS coordinates the delivery of many services available to adults 60 years of age and older through Area Agencies on Aging (AAAs) located across the state. The programs work to assure quality of life and continued independence for the state's older citizens. Additional services provided by DAAS include: Nutrition Support, Transportation, Information Services, Adult Day Care, In-Home Services, and Legal Assistance.

In concert with the State programs administered by DAAS and through the local AAAs, long-term care for seniors who are Medicaid eligible are administered by the Mississippi Division of Medicaid. The State offerstwo different home-and-community based (HCBS) Medicaid waiver programs to assist seniors who would otherwise require a nursing home level of care to stay in their own home or in a community setting while receiving the equivalent level of services.

Medicaid Waiver Programs for Assisted Living and In Home Care

Mississippi Assisted Living Waiver (HCBS Medicaid Assisted Living Waiver)

The Assisted Living Waiver is a home and community-based waiver that provides services to beneficiaries who, but for the provision of such services, would require the level of care provided in a nursing facility. Qualified beneficiaries are allowed to reside in a Personal Care Home-Assisted Living (PCH-AL) facility that is licensed as a PCH-AL Facility by the Mississippi State Department of Health, and is approved as a Medicaid provider for Assisted Living services. Medicaid reimburses for the services received in the facility.

Services

Case management is a required service and you are assigned to a case manager, who is a licensed social worker. The case manager is responsible for assessing your health, welfare, and social needs; developing a plan of services and supports to address your assessed needs; and managing and coordinating services on the plan of services and supports.

Additional services include: personal care; homemaker services; attendant care; medication oversight; medication administration; therapeutic social recreational programming; intermittent skilled nursing services; transportation; and attendant call systems.

Eligibility

  1. Health: An applicant for the Assisted Living waiver must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset limits to be eligible for the program. Waivers in Mississippi follow a Special Income Limit (SIL) rule that means that the income limit for an individual applicant is 300% of the Federal Benefit Rate, as set by the Social Security Administration. For 2017, the income limit for an individual is $2,205 per month. Theasset limit for an individual is $4,000. Thewaiver programs does allow for a Miller Trust, or Qualified Income Trust, to be used to divert income over the limit so that the applicant can qualify if they earn too much income every month. There are additional rules governing the non-applicant spouse, or “community spouse,” that limit the assets and other allowances the community spouse can keep. The community spouse resource allowance (CSRA) is $120,900 and the monthly allowance for living expenses is $3,022.50 (the maximum monthly maintenance needs allowance, or MMMNA).

Practical Considerations

The Assisted Living waiver is a good resource for seniors who wish to remain out of a nursing home and stay in a community setting while receiving Medicaid long-term care services. The ability to use a Miller Trust to help meet the strict income limits helps for eligibility purposes, however, the small number of available slots makes it very likely there is a waitlist.

Mississippi Elderly & Disabled Waiver (HCBS Medicaid E&D Waiver)

The Elderly and Disabled Waiver is a statewide program administered and operated by the Mississippi Division of Medicaid (DOM). It is designed to offer assistance and services in a home or community-based setting if you qualify for Medicaid. The program allows you to remain in a home or community-based setting as an alternative to nursing facility care or other institutional care. Case Management services are provided by the Planning and Development Districts. The case management team is composed of a registered nurse and a licensed social worker who are responsible for identifying, screening and completing an assessment on individuals in need of at-home services.

Services

Services include: adult day health care; home-delivered meals; personal care services; institutional respite services; in-home respite; expanded home health visits

Eligibility

  1. Health: An applicant for the E&D Waiver must require a Nursing Home Level of Care.
  2. Financial: An applicant must meet certain income and asset limits to be eligible for the program. Waivers in Mississippi follow a Special Income Limit (SIL) rule that means that the income limit for an individual applicant is 300% of the Federal Benefit Rate, as set by the Social Security Administration. For 2017, the income limit for an individual is $2,205 per month. The asset limit is $4,000. Thewaiver programs does allow for a Miller Trust, or Qualified Income Trust, to be used to divert income over the limit so that the applicant can qualify if they earn too much income every month. There are additional rules governing the non-applicant spouse, or “community spouse,” that limit the assets and other allowances the community spouse can keep. The community spouse resource allowance (CSRA) is $120,900 and the monthly allowance for living expenses is $3,022.50 (the maximum monthly maintenance needs allowance, or MMMNA).

Practical Considerations

There are many issues to consider for the A&D waiver: 1) If income exceeds the 300 percent limit,you must pay the amount that is over the limit each month to the Division of Medicaid under an income trust (Miller Trust), provided you are otherwise eligible; 2) you must be determined clinically eligible through the use of a comprehensive Long Term Services and Supports (LTSS) assessment tool; 3) you must require nursing facility level of care if assistance is not provided; and, 4) your nursing facility level of care must be certified by a physician and re-certified every 12 months at a minimum.

Conclusion

Mississippi has a robust HCBS Waiver system and offers two pathways for Medicaid-eligible seniors over 65 who wish to remain in a community setting or at their own home and receive long-term care services. The ability to use a Miller Trust to help lower your income to below the strict special income limit is an advantage over some other states. Further, the asset limit of $4,000 is higher in Mississippi than most states. A Medicaid Planning specialist may be able to help ensure you maximize your savings while becoming eligible for one of the HCBS waiver programs for long-term care.