Overview of the Living Choices Assisted Living Waiver
The Arkansas Living Choices Assisted Living Waiver, often shortened to the Living Choices Program, or simply, Living Choices, is for seniors (aged 65 and older) and adults who are physically disabled who are at risk of nursing home admission. Intended to serve as a nursing home diversion program, program participants live in apartment-style living units within approved assisted living facilities and receive services to help them live independently. This includes around-the-clock response staff, personal care assistance, limited nursing services, housekeeping, and assistance with getting transportation.
Many long-term care Medicaid programs allow program participants the option of self-directing their own care, specifically hiring the caregiver of their choosing. This is not an option through Living Choices.
The Arkansas Living Choices Assisted Living Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when they are full, a waiting list for program participation forms.
Benefits of the Living Choices Assisted Living Waiver
Follows is a list of the benefits available in assisted living residences via the Living Choices Program. An individual care plan determines the exact services and supports a program participant receives.
– 24/7 Care and Supervision
– Activities – therapeutic, social, recreational
– Attendant Care – assistance with bathing, dressing, eating, mobility, toiletry, essential shopping, housekeeping
– Extended Medicaid State Plan Prescription Drugs
– Medication Management
– Nursing Evaluations
– Nursing Services – medication administration, health monitoring, physician referrals
– Transportation Assistance (non-medical)
While room and board (housing and meals) is provided in assisted living residences, the cost of this is not covered by the Living Choices Waiver.
Eligibility Requirements for Living Choices Assisted Living Waiver
Living Choices is for Arkansas residents who are physically disabled and between the ages of 21 and 64, or who are elderly (aged 65+). Persons who enroll in the program under the disabled or blind category can continue to receive waiver services upon turning 65 years old. Program participants must reside in a licensed Level II assisted living facility that is enrolled as an AR Medicaid Living Choices provider. (Level I assisted living facilities do not provide nursing services, while level II facilities do). Additional eligibility criteria are below.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR). This figure increases each January, and in 2024, is $2,829 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $2,829 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance, from their applicant spouse.
Arkansas has set a minimum Spousal Income Allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. The state also sets a maximum income allowance, which in 2024, is $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs. A Spousal Income Allowance, however, can never push a non-applicant’s total monthly income over $3,853.50.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $2,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA).
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If the non-applicant spouse’s portion of the assets is under $30,828, they can keep all of the assets, up to $30,828.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Medicaid in AR considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home after subtracting any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (under 21 years old) living in the home.
– The applicant has a permanently disabled or blind child (of any age) living in the home.
While one’s home is generally safe from Medicaid’s asset limit, it is not necessarily safe from Medicaid’s Estate Recovery Program.
Medical Criteria: Functional Need
An applicant must require an intermediate Nursing Facility Level of Care (NFLOC); an applicant cannot require a skilled nursing facility level of care. For an applicant to meet the functional need for an intermediate level of care, one of the following statements must be true:
– The applicant cannot complete at least one of the following Activities of Daily Living (ADLs) without a substantial amount of assistance or complete dependence on someone else: eating, toileting, or transferring (moving from one position to another) / locomotion (moving from one location to another by walking / wheelchair).
– The applicant cannot complete at least two of the following Activities of Daily Living (ADLs) with limited assistance from someone else: eating, toileting, or transferring (moving from one position to another) / locomotion (moving from one location to another by walking / wheelchair).
– The applicant has Alzheimer’s disease or a related dementia, and due to cognitive impairment, requires extensive supervision because of inappropriate behaviors that create a serious safety or health hazard. To be clear, a diagnosis of dementia in and of itself does not mean one will meet an intermediate NFLOC.
– The applicant requires daily monitoring or assessment by a medical professional because of a life-threatening medical condition if not treated.
Functional need is assessed in-person by a registered nurse employed by an Independent Assessment Contractor. The Arkansas Independent Assessment (ARIA), which consists of more than 300 questions, is the tool that is used. One area of consideration is an applicant’s abilities and limitations to complete their Activities of Daily Living, such as bathing, dressing, mobility, and toileting. As part of the assessment process, a tier level between 0 and 3 is assigned. Tiers 0 and 1 indicate one’s functional needs are not great enough for Living Choices services, tier 2 indicates that one’s functional needs qualify for Living Choices services, and tier 3 indicates that one’s needs are too great for Living Choices services. ARIA results are reviewed by a nurse from the DHS’ Office of Long Term Care who makes the final level of care determination.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for AR Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
When persons have income over the limits, Miller Trusts, also called Income Trusts in Arkansas, can help. “Excess” income is deposited into the trust, no longer counting as income.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts, which protect assets from being counted, can also be utilized, but must be created well in advance of the need for long-term care. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Arkansas to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial criteria, but can also protect assets from Medicaid’s Estate Recovery Program. These strategies often violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for Arkansas’ Living Choices Assisted Living Waiver
Before You Apply
Prior to submitting an application for the Living Choices Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.
Since Living Choices is not an entitlement program, there may be a waiting list for program participation. This waiver is approved for a maximum of 1,725 beneficiaries per year. In the case of a waiting list, priority is given to persons residing in a nursing home with a minimum 90 day stay and persons living in an approved Level II assisted living facility with a minimum 6 month stay. This means applicants who submitted an application at a later date than other applicants may be awarded a participant slot first based on priority.
Application Process
Persons can apply for the Living Choices Assisted Living Waiver online at Access Arkansas, by contacting their local Department of Human Services (DHS) office, or downloading, completing, and submitting the Arkansas Department of Human Services Long-Term Services and Supports Application.
Learn more about the Living Choices Assisted Living Waiver. Persons can also contact the Division of Medical Services at 501-682-8292 or the Choices in Living Resource Center, Arkansas’ Aging and Disability Resource Center, at 866-801-3435.
The Living Choices Assisted Living Waiver is administered by the Division of Medical Services (DMS), the Division of Aging, Adult, and Behavioral Health Services (DAABHS), and the Division of Provider Services and Quality Assurance (DPSQA). The Division of County Operations (DCO) determines financial eligibility and the Office of Long Term Care (OLTC) determines functional eligibility. All divisions are within the Arkansas Department of Human Services (DHS).
Approval Process & Timing
The Arkansas Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months, or even years, waiting to receive benefits.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.