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larth9 Asked June 2020

What is a Medicaid waiver?

EXPERT John L. Roberts Jun 2020
Home Care paid by Medicaid is called a "Waiver" program, because the federal government waives the requirement that Medicaid pay only for care inside a nursing home.

The Corona Virus Crisis made it especially important to know about home care options for your loved ones.

If you live in a state that has a “Money Follows the Person Demonstration Program” the money that would have been spent on a nursing home follows you home, if you are able to move out and get elder care in your home. To apply for MFP, the person must 1) be living in a Skilled Nursing Facility now, 2) Need a clinical level of care, and 3) be safely cared for in their home in the community.

The application would be screened by the MFP Waiver Unit in your state. Since MFP is for people who have been in a nursing home for 90 consecutive days or longer, you’re not eligible for MFP if you are at home now, and want to continue living at home.

So, other waiver programs pay for care for frail elders who can put together a plan to stay safely in their homes. Call your Aging Services Access Point (ASAP) for a list of waiver programs. An Elder Law Attorney in your state can explain how you can qualify for waiver program, under the income and asset regulations in your state.

JoAnn29 Jun 2020
"Medicaid Waiver programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community."

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igloo572 Jun 2020
Waivers are a transfer of state and federal $ required under federal law that would be paid for LTC SNF care to go instead to a waiver program. LTC in a skilled nursing care facility aka a NH is required program coverage for Medicaid if states want federal $. But a state can - if it so chooses- can ask for a % of that LTC NH $ to instead go into another program & done via waivers. Like $ goes into PACE centers or for AL.

It is totally up to your state to decide what waivers are done and for what population and for how long.
Waivers are not permanent, like they have to be reviewed & renewed Or reapplied for. Most done on a 3 or 5 year cycle. Some 7 years, Some are just 2-3 yr demonstration pilot projects. So it’s kinda temporary funding & because of this some vendors - like AL or home health agencies - just won’t apply for them as too much risk that they will staff up or build out and then $ stops. Plus the daily reimbursement rate paid by Medicaid may be too low to be profitable. Or profitable for a teeny tiny # of participants.

Most states do not do LTC facility waivers for AL at all.
Maybe 1/3 have some kind of inhome health caregiver program; paid by the state (so reported taxable income) to family member not working another job and living in the home & paid at slightly above state minimum wage or paid to a home-health agency with a state contract. Home health has to have a needs assessment done to determine # hours. Seems to be around 20-25 hrs a week average based on what folks have posted on this site. It will not replace the income you get from a full time job ever.

MichaelEzekiel Jun 2020
My mom is on a waiver program; so much is provided for her in her own apt! She pays a couple people; hairdresser, morning and night 15 minutes set up person, 7x a week, and food/pharmacy delivery. All the rest is paid with the waiver. We added up today and realized she has 15 people/services that keep her out of a NH!
ShenaD Jun 2020
15 min???? The minimum requirement is 2 hours. I would check on that. Someone may be getting paid 2 hours and staying 15 minutes.

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