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

Introduction

Wyoming provides long-term care resources to seniors through the Division of Healthcare Financing (DHCF) under the Wyoming Department of Health, which administer the Medicaid Programs. Medicaid provides a variety of services in two areas: 1)State Plan Services: Wyoming offers a variety of State Plan services as approved by the Federal Government. Services are offered based on specific eligibility requirements Each state may differ in income and resource limit guidelines, as well as specific services available and amounts included in their State Plan, and 2)Waiver Services: Services under an approved waiver authority are an exception to the State Plan. Each state may apply for a waiver authority and must be approved by the Federal Government in order to provide these services. Services are offered based on specific eligibility requirements.

Medicaid Waiver Programs for Assisted Living and In Home Care

Wyoming Assisted Living Facility Home and Community Based Services Medicaid Waiver (HCBS ALF Waiver)

The Assisted Living Facility (ALF/HCBS) Waiver serves people who are 19 years and older who meet the functional and financial criteria for Medicaid nursing home services. Services include Case Management and Assisted Living services. There are three tiers of Assisted Living services are available. The tier for each applicant is determined through medical necessity evaluation completed for their Medicaid eligibility determination.

The goal of the waiver is to provide access to safe and appropriate services in an Assisted Living Facility to Medicaid eligible, functionally impaired elderly and physically disabled citizens of the State of Wyoming. The objectives are: 1) To minimize admissions to long term care institutions for people in this population who can be safely served in an Assisted Living Facility; 2) to provide a transition option for eligible nursing facility residents to move from a Nursing Facility to an Assisted Living Facility; 3) to provide for the most efficient and effective use of public funds in the provision of needed services which promote and maintain the health and welfare of waiver participants; 4) to allow communities flexibility in developing those services; and, 5) to assure service quality is maintained for participants receiving services through this waiver.

Services

Services include: Case Management and Daily Care provided in an Assisted Living Facility; in addition, an applicant receives traditional Medicaid benefits.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An individual must meet certainincome and asset limits to be eligible for Medicaid for long-term care. For 2017, an individual cannot make more than $2,205 per month and cannot have assets (resources) that exceed $2,000. However, if an applicant’s income is too high, then a Miller Trust, also known as a Qualified Income Trust, may be used to funnel income into for purposes of paying for care in order to access the benefit. For 2017, the non-applicant spouse (if married), is allowed to keep assets up to $120,900 and receive a maximum monthly maintenance needs allowance (MMMNA) of $3,022.50 without affecting the applicant’s financial eligibility.

Practical Considerations

A recipient of the Assisted Living Facility (ALF) Waiver is responsible for paying room and board costs under the ALF waiver. Further, there is a very low enrollment cap so the wait list is likely very long. Finally, both waiver programs are being consolidated in 2017 into the “Community Choices” waiver and will no longer be referred to as different programs.

Wyoming Long Term Care Medicaid Waiver (HCBS Long Term Care Waiver)

The Long Term Care Waiver offers an option for individuals who need nursing home level of care but wish to remain in their home and receive specialized services that could delay or prevent admission to a nursing home.

Services

Services include: Case management; Personal Care; Respite Care; Home Delivered Meals; Personal Emergency Response System; Non-medical Transportation; Adult Day Care; Skilled Nursing; Self Directed Care Option: 1) Qualified waiver participants may direct their own care, 2) Participants may hire and fire their own self help assistant, and 3)Fiscal management services, such as payroll and tax reporting for the self help assistant are provided

Eligibility

  1. Health: Applicants must require a Nursing Home Level of Care.
  2. Financial: An individual must meet certainincome and asset limits to be eligible for Medicaid for long-term care. For 2017, an individual cannot make more than $2,205 per month and cannot have assets (resources) that exceed $2,000. However, if an applicant’s income is too high, then a Miller Trust, also known as a Qualified Income Trust, may be used to funnel income into for purposes of paying for care in order to access the benefit. For 2017, the non-applicant spouse (if married), is allowed to keep assets up to $120,900 and receive a maximum monthly maintenance needs allowance (MMMNA) of $3,022.50 without affecting the applicant’s financial eligibility.

Practical Considerations

A recipient of the Long Term Care (LTC) Waiver is not responsible for paying toward the cost of services provided under the LTC Waiver. Co-payments may apply for services.

Conclusion

In July of 2017, the state of Wyoming is transitioning the Assisted Living Facility waiver and the Long Term Care waive into a new program called Community Choices. To apply for either the Long Term Care of Assisted Living Facility waivers, you can contact the Medicaid Eligibility Long Term Care Unit toll free at 1-855-203-2936 for an application or apply onlinehere.