What is a Medicaid Waiver and how does it work?

In order to qualify for in home care under Medicaid, the patient must be qualified for receiving nursing home care, that is the criteria for selection. that mean if the patient is non-ambulatory for the most part, needs help with activities of daily living, personal care, grooming, bathing, etc. then they wiil qualify.

You really need to employ anyone to help you qualify. You just contact the dept. of Social services, apply for Medicaid, and tell tehm you want o apply for the Medicaid Waiver for in home long term care. If you qualify for Medicaid, they will then send out a Nurse and Social worker to do a preliminary assessment of needs, and they will determine if the patient qualifies for the Medicaid waiver. If they do then they will explain teh next steps for your state. Either their will ask you to pick a facilitator who will then be the go between patient and bodies that handle the approval of number of hours patient is qualified to obtain, etc.

You never have to pay anyone to help you through this process. So please double check why these people wna to charge you for something that is avaiable for no cost to you.

http://medicaid.ohio.gov/FOROHIOANS/Programs/OhioHomeCareWaiver.aspx

It looks like you might need to apply for the Home Care Waiver. It sounds a lot like Colorado's Elderly, Blind, and Disabled Waiver that my Mom received. In our case, and it looks like yours too, we had to apply for Medicaid and concurrently we applied for the waiver. The waiver is run by a gatekeeping company in Colorado, so we have to go through them for anything related to the waiver. We went through the department of human services in our county for Medicaid. For medicaid, we had to have less than $2000 in assets to be eligible. Since my husband and I had been paying for my mom's care for several months, ie, taking no rent or money for food, etc., she had over $7000 accumulated in her checking account. Luckily we had saved receipts, so we just submitted those receipts and had a check cut to us, and that along with receipts from my brother who had been taking care of her prior to us, brought her account down to the required less than $2000. So with a current bank statement that said her account was below the max, and info on all her other assets, like life insurance, burial insurance, pension plans, social security, etc. She ended up qualifying.

While all that was going on, (getting the info to the county rep) we had someone from the gatekeeping company stop by the house and interview my mother and myself to determine "need". From that interview she could see that my mom needed the waiver.

Basically from start to finish was 45 days or so. Maybe closer to 2 months. Now the waiver pays for aids to come in the house 11 hours a day, at no charge to my mom. It was paying for her to go to adult day care, but she stopped being able to do that because she became a 2 person transfer for a while.

The thing now is we HAVE to charge her rent and a fee for her groceries, etc, or her account will go up over $2000, since she gets $1800 a month in social security and pension. Basically she has to spend all her money each month or she will not be eligible for medicaid anymore and then no waiver.

So that's sort of good news, in that she can get now anything that tickles her fancy or that we think will help in her care.

The waiver is supposed to take care of home modifications too, but it is a huge hassle because they will only do it as a last resort, so we have to prove that we asked the city to do the stair lift and that they refused and THEN the gatekeeping company will send out contractors to bid on the job and THEN they will award the job to a company and THEN we have to wait for them to schedule to get it done. SIGH.

Anyway, hope this helps a little with the steps, from someone who has done the medicaid thing with help from my sister and husband.

Contact your local Area Agency on Aging. They can send a Care Manager out to assess the needs and may be able to help with some of the programs they have to offer. They are also a great referral source.

Hugemom & RayLin, and everyone who needs help and think you don't qualify for Medicaid:
I BEG you to get with an Elder Law attorney. An Elder Law specialist. Not your street-front lawyer or personal injury lawyer.
An Elder Law specialist can help you qualify for Medicaid by setting up trusts, re-titling assets, etc. Even if you have assets and/or income over the Medicaid limit. They know the legal ways to do this.
Our experience was that my in-laws assets have been saved; my FIL' s expenses are being paid taking just most of his Social Security. His nursing home expense, which may go on for years, would have left his wife with nothing and then on to Medicaid. Now, she has their savings and real estate and his expenses are being paid.
The cost was not cheap. The initial consultation was free, and we were informed of the process and the costs. The attorney's fee and trust expenses were a little more $ than a month in the nursing home. Well worth it, since his NH expenses may go on for a long time.
I expect that the free advice you get from social workers and community aging centers only tells you that you have to be destitute to qualify for Medicaid. A knowlegable attorney can make your loved one destitute without taking the family down, too.
God bless you in your work! Please get the help you need.

Thanks, Ray. No, hubby is not a veteran. I think I’ll call our local family services agency and see if there’s any help we can get. We just added lift financing to our expenses. You’re right, anything helps. And, your feces comment is not tmi! I deal with it on a daily basis too!

Yeah, we don't qualify because of our assets.

However, is your DH a Veteran? The VA does help with supplies but you must ask. Nothing is automatically given.

By carrying DH's supplies and taking the time to explain what-all he uses monthly, we are eligible for Ensure, No-Rinse Soap (Perineal), Adult Wipes, and Pre-Surgical Scrub (Hibiclens). Yes, they are in limited amounts monthly but the Ensure alone saves us better than $30 month, he is allowed 1 case of 24 per month. We get 1 bottle of the Aloe Vesta Perineal Soap, 2 sm bottles Hibiclens, 2 boxes of the adult wipes every month. They will also supply depends but I don't know how many because my DH isn't using them yet. What a God-send. I am very good at saying, "Thank You."

I mix some Perineal, Hibiclens & foam soap and I use this to wash my hands all the time due to handling a lot of things with feces in them. (sorry if TMI)

Any help is still a lot of help!

Thank you, Commutergirl. I have considered applying for SSI, but my past experience, like with Medicaid, is that we just don’t qualify. It’s frustrsting and worrisome, but not everyone who needs help is living below the poverty level. Our income is too high to qualify for much aid, but too low to afford the help we need. Grrrrr!

In our case, mom is on SSI and Medicaid. If neither applies to you, you do not qualify. Medicaid will cover incontinence supplies. You find out what company Medicaid uses, contact them and they fax app to your doctor. Once that happens, they contacted me to go over our monthly supplies. The Waiver is different. Not all states have the waiver. You can check with a community action center in your area to see if your state has the waiver. The waiver is paying someone, or a member of your family, to stay with your loved one in lieu of them being in a nursing home. A lengthy process ensues but it is so worth it. It allows my mom to stay home and allows me to afford to stay with her. Hope this helps.

A Medicaid "waiver" programs pays for services not normally provided by Medicaid. The programs available vary from state to state. However, the person first has to be on community based Medicaid in order to even qualify for a Medicaid program. If you and your husband have significant assets you should consult with an elder care attorney. Be careful that you work with an actual expert, you can call your local bar association. Don't just work with anyone that calls themselves a "Medicaid planner". If it is more a matter of just being a bit over the income cap your state might have a "spend down" program where you can pay the extra into Medicaid monthly and then your husband will qualify for all Medicaid coverage. If your husband already has Medicare, Medicare should be paying for DME rentals and purchases but it will not cover incontinence products. (I am a social worker in NYS who has a lot of experience with these issues)

Hugemom, it sounds like you found a lawyer that is working with you re Medicaid. Some people go that route, like my father-in-law. It can fast track an application, because they are very familiar with the law in your state and the requirements for paperwork, etc. You can apply on your own, be assigned a case worker if approved like TraceyG said. You don't have to pay for a planner, but you can choose to hire a legal person to apply for you. Remember that every state administers its Medicaid plan in a different way. Ohio will be different from Mississippi and Texas. TraceyG, you are very fortunate. In Texas, Medicaid would not pay for anything near 24/7 care in your home. Depending on the county, I've known people on waiver lists for certain services for years.

Sounds like you are on the right path with contacting Passport in your state of Ohio. In New York, once someone is on Medicaid, the incontinence supplies are covered with a prescription from the doctor and utilizing a medical supply company or online provider. I contacted ActivStyle. You can look them up online. They only work within certain states so it's worth checking. I didn't get that information through and Medicaid planner or private pay care manager. I got that through talking to people and researching online. They cover the pull-ups, adult diapers, chucks, and some cover Ensure type products. They do not pay for adult wipes. But just having the cost of the pull-ups or adult diapers covered is a huge help. The prescription side of it is once on Medicaid most prescriptions are covered in full, which is a huge help. But I know all states are different. I guess the bottom line is, you have to do your own research online, ask questions of others going thru the same thing, ask your pharmacist questions, ask the doctor questions, ask, ask, ask. Good Luck and take care of yourself:)

You should not pay anything at all to have anyone negotiate for you. All you have to do is call your state's division of Medicaid services and ask for a Waiver Social worker. I am sure that services are offered differently in each state. Our goal was to bring my sister home on from the nursing home with assisted help at home. We needed round the clock care for her and could not provide that ourselves. In Mississippi a resident had to be in a facility for 3 months to qualify for this program and then would be placed on a waiting list. After about 6 months, we were able to bring her home with almost 24 hour care paid for by the waiver program. They provide you with a social worker who coordinates everything and I believe there was up to $1000 provided to purchase supplies they would need to get her moved. They even decorated her bedroom at home with bedding, curtains, dresser, etc., paid for all medications, and paid for aides to come into take care of her. It was a great program, but there is no need for you to pay for help in getting these services.

Hugemom, while some of these things vary by state I'm not sure the prescription drug plans do. My mom has an AARP supplemental and drug plan attached to her Medicare and we have been told now that we should shop that because she might save a bit per month with another plan and I'm still a bit unclear about what comes from where but several months aga I discovered that her Medicare drug plan offered not deductible on her prescriptions if we ordered 3 months worth at a time and through their on-line pharmacy. It's a bit of a pain to get started and takes some upkeep but I'm able to do that from home (about 4.5hrs from Mom) and it's been so much easier now on both my brother who lives closer and ends up being the one going to the pharmacy as well as her bank account. You might look into it, I imagine all prescription benefits for Medicare have this option or will.

Thank you, everyone! I researched Passport, and through that site, I was told I’d be contacted by a Medicaid “Planner”. The initial consultation is free, but the disclaimer says the fee could be anywhere from $0 to $5,000. The article also said these people have the knowledge to negotiate Medicaid acceptance.

We are not asking for the world. Help with his DME rental, help with incontinence supplies, maybe a way to get meds cheaper. I don’t hold out much hope for help, but if help is available, I’d like to know. Thanks again!

We just qualified for a medicaid waiver in the state of Indiana. The waiver helps pay for assisted living. The organization that helped us with the waiver process is applying for medicaid FOR us. It seems to move the process along a little bit faster. Medicaid then helps pay for the nursing services as well as supplies and prescriptions that we need for my elderly aunt. Unfortunately, we had to move my aunt from the state of Arizona to Indiana as the state of Arizona is not as capable of funding assistance for the elderly as the state of Indiana is. There is a medical component in order to qualify for the waiver. We had a very nice lady come to our home and ask our aunt questions about what she can and cannot do. Of course, she said she could do everything and did not need help, so it is extremely important to be on site when this interview occurs and let the individual screening her know what the real story is. We know we will qualify for medicaid as we have sold my aunt's home, all her personal property such as jewelry etc., and her car in order to pay for all her assisted living up to this point. Now she is really under the $2000 asset limit and brings in less than 2250 a month for income. I will remind you that ALL states are different. It was heartbreaking to move her from her friends, but great to have her near us again!!!! My advice to the 50 something crowd is to purchase nursing home insurance.....you never know what is going to happen to you.

Here's the simple answer. It's a program for those on Medicaid that helps with assisted living. You have to less than $2000. in assets to qualify. The patient pays most of their ssi and get an allowance each month for their own disgressionary spending.

Regarding what waivers are........ Waivers are diversions of federal funding by a state & are required to be limited in funding & period of time. Usually they are done on a 3 or 5 year planning cycle if renewing to stay about the same, or 7 year if it likely to morph into a permanent program.

Waivers are why you hear that a just few states Medicaid readily pay for AL, but most states don’t pay AL at all. Skilled nursing care (aka a NH) is dedicated funding from the feds to the states as there is public law requiring those funds to be there to provide NH care, BUT AL is paid via a waiver with $ coming from a limited % of dedicated funds taken for the waiver. The states have to pony up the $ to fill in whatever the federal waiver $ doesn’t pay. States can very narrowly define eligibility for waivers.

The trend right now is to move from any waiver that is 1-on-1 like AL or at-home services to a PACE type of community based care where they go 2 -4 times a week 6-7 hrs for health care oversight, medication management, meals, activities. The one by us also provides transportation, gives out all sorts of tie-in’s, from energy efficient light bulbs to incontinent supplies and weekend ready meals to go. You do need to be a “dual” aka your on both Medicare & Medicaid as funding needs both payment streams to work. I’d try to find out if PaCE exists for you & hubs. The local Area on Aging should have info on what programs are out there. Good luck.

From a planning perspective waivers are hard to deal with as so much uncertainty for smaller providers, vendors, for families.

Is he on Medicaid? Go to Medicaid.ohio.gov and search for Passport Waiver. Depending on the level of care needed, and meeting certain conditions, you can get some services that would be covered by Medicaid in a facility to be provided at home. However, it’s administered by county and many counties have a long waiting list.