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

Introduction

Missouri provides long-term care resources to seniors through local Area Agencies on Aging. Missouri has ten (10) AAAs, each responsible for providing services within specifically defined geographic boundaries. In order to receive funding from the Department of Health and Senior Services (DHSS), each AAA is required to submit an area plan for review and approval. Additional resources for state-funded long-term care assisted living and in home care options for Missouri residents can be found here. Missouri HealthNet for the Aged, Blind and Disabled is the state’s Medicaid program and can provide regular Medicaid services if the applicant meets thecriteria, which has an income and asset limit. For individuals, the income limit is 85% of the Federal Benefit Rate

Medicaid Waiver Programs for Assisted Living and In Home Care

Missouri Aged & Disabled Waiver (HCBS Medicaid Waiver)

TheAged and Disabled Waiver offers in-home services to individuals aged 63 or over who have been assessed with certain impairments and unmet needs to the extent that they would require nursing home care in the absence of these services. The Department of Health and Senior Services, Division of Senior and Disability Services administers this program through an interagency agreement with the MO HealthNet Division.

Services

Services include: homemaker, chore, respite, home delivered meals and adult day care.

Eligibility

  1. Health: An applicant must Nursing Home Level of Care, however the determination process for the A&D waiver is different than for Medicaid nursing home long-term benefits.
  2. Financial: An applicant must meet certain income and asset limits to be eligible Medicaid long-term care services. Unlike most states which follow the asset and income limits established annually by the federal government’s Medicaid guidelines and cannot require an income limit to be lower than 300% of the Federal Benefit Rate (FBR) if they choose to provide the waiver with a special income limit. Missouri is a 209(b) state, however, meaning they are able to set income and asset limits that can be more restrictive if there is a special income limit. For 2017, Missouri’s income limit is more restrictive, and is set at $1,285 for an individual (adjusted annually at 85% of the Federal Benefit Rate set by the Social Security Administration). The asset limitis $1,000 for an individual and $2,000 for a couple. Asset rules for a married couple follow the same rules as for nursing home Medicaid eligibility and the non-applicant, or “community spouse” is able to keep $120,900 in assets, which, in some circumstances can be increased through an administrative hearing or court decision.

Practical Considerations

The Aged & Disabled waiver is available to seniors 63 and older, which is unusual for Medicaid waiver programs which usually have an age limit of 65. Further, the unique individual asset limit because of the status as a 209(b) state makes it harder for people to qualify because the income limit is lower than usual. Also, while the allowances and asset limits for the spouse are the same as Medicaid for nursing homes, the asset limit can be increased through the legal system, which is a unique feature to Missouri’s A&D Waiver.

Missouri Independent Living Waiver (HCBS Medicaid Waiver)

The Independent Living Waiver was developed to provide community-based alternatives to physically disabled individuals 18 years of age and above who otherwise would be institutionalized in a nursing facility. The goal is to establish and maintain a community-based system of care of individuals 18 years of age and over who have physical disabilities that live and wish to continue living independently in their homes and/or communities.

Objectives of the Independent Living Waiver include: 1) providing physically disabled individuals choice between nursing facility institutional care and services that allow them to remain in their home and community in a cost effective manner, and 2) maintaining and improving a community based system of care that diverts individuals from institutional care and residential care.

Services

Services included: environmental accessibility adaptations, specialized medical equipment and supplies, financial management services, case management

Eligibility

  1. Health: An applicant must Nursing Home Level of Care - which follows the same determination process as for other long-term Medicaid benefits.
  2. Financial: : An applicant must meet certain income and asset limits to be eligible Medicaid long-term care services. Unlike most states which follow the asset and income limits established annually by the federal government’s Medicaid guidelines and cannot require an income limit to be lower than 300% of the Federal Benefit Rate (FBR) if they choose to provide the waiver with a special income limit. Missouri is a 209(b) state, however, meaning they are able to set income and asset limits that can be more restrictive if there is a special income limit. For 2017, Missouri’s income limit is more restrictive, and is set at $1,285 for an individual (adjusted annually at 85% of the Federal Benefit Rate set by the Social Security Administration). The asset limitis $1,000 for an individual and $2,000 for a couple. Asset rules for a married couple follow the same rules as for nursing home Medicaid eligibility and the non-applicant, or “community spouse” is able to keep $120,900 in assets, which, in some circumstances can be increased through an administrative hearing or court decision.

Practical Considerations

This program is initially only available to persons between 18 and 64 years of age; however, if someone who is in the ILF waiver turns 65, the may continue to receive waiver services through. However, unless the applicant has already applied before they are 65, then the waiver service is not available. The program is not a viable option for long-term care planning.

Conclusion

In Missouri, the Aged & Disabled waiver is really the only option for seniors looking for assisted living or in-home care through Medicaid. If you are disabled and under 65 years old the ILF waiver program might be a good option, because you can continue receiving the resources after turning 65 without having to apply for any other waiver applications.