Idaho Medicaid Aged and Disabled (A&D) Waiver Provides Home and Community Based Services

Last updated: February 28, 2024

 

Overview of Idaho’s Aged and Disabled Waiver

The Idaho Aged and Disabled Waiver (A&D Waiver) is a statewide Medicaid program for Idahoans who are elderly or disabled and are at risk of institutionalization (nursing home admission). Intended as a nursing home diversion program, various long-term services and supports (LTSS) are available to assist persons in continuing to live at home and in the community. These include adult day health care, skilled nursing, specialized medical equipment, personal emergency response systems, personal care assistance, and respite care. Transitional assistance for persons currently residing in nursing home facilities who wish to move back home are also available.

Program participants can reside in their home, a loved one’s home, a certified family home (adult foster care home), or a residential assisted living facility.

The services offered under the A&D Waiver may be provided by licensed agency providers or program participants have the option to self-direct some of their benefits. This includes the ability to hire a friend or relative, such as an adult child, to provide care. A spouse, however, is prohibited from being hired. A financial management services agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.

Idaho’s Aged and Disabled 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. The number of participant enrollment slots are limited, and when these slots are full, a waiting list for program participation forms.

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Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to the Aged and Disabled Waiver? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
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Benefits of Idaho’s Aged and Disabled Waiver

Follows is a list of long-term services and supports available via the A&D Waiver. An individualized service plan indicates the exact benefits a program participant receives. The benefits that can be self-directed are marked with an asterisk.

– Adult Day Health
– Adult Residential Care Services
– Attendant Care* – personal care assistance and medical tasks
– Chore Services* – yard and sidewalk maintenance, heavy housework, minor home repairs
– Companion Services* – supervision, assistance with daily living activities
– Consultation*
– Habilitation – day and residential
– Homemaker Services* – laundry, preparing meals, essential errands
– Home Meal Delivery
– Home Modifications – installation of ramps, grab bars, widening of doorways, etc.
– Non-Medical Transportation
– Personal Emergency Response Systems
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Skilled Nursing*
– Specialized Medical Equipment / Supplies
– Supported Employment
– Transition Services* – to assist institutionalized persons in moving home or to another community based setting

While program participants can reside in certified family homes and assisted living residences and receive A&D Waiver services, the cost of room and board is not paid for by this program.

 Dual eligible (eligible for both Medicaid and Medicare) Idaho residents in certain counties can receive their Aged and Disabled Waiver benefits through one of two managed care programs: Idaho Medicaid Plus (IMPlus) or Medicare Medicaid Coordinated Plan (MMCP).

 

Eligibility Requirements for Idaho’s Aged and Disabled Waiver

The A&D Waiver is for Idaho residents who are seniors (65+ years old) or between the ages of 18 and 64 and disabled. Persons who are disabled can continue to receive Waiver services as an aged individual upon turning 65. Additional eligibility criteria as follows below.

 The American Council on Aging now offers a quick and easy Medicaid Eligibility Test for Idaho seniors. Begin here

 

Financial Criteria: Income, Assets & Home Ownership

Income
The individual applicant income limit is $2,849 / month. This figure is equivalent to 300% of the Federal Benefit Rate (FPR) for 2024 ($2,829) + a $20 income disregard. When both spouses of a married couple are applicants, there is a couple income limit of $5,678 / month. This amount is equivalent to $2,829 / month for each spouse plus a $20 income disregard. When only one spouse is an applicant, the individual income limit of $2,849 / month applies and the income of the non-applicant spouse is disregarded. However, in some cases, income can be allocated to the non-applicant spouse from the applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).

In Idaho, there is a minimum income allowance, which is set at $2,465 / month (eff. July 2023 – June 2024). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. In 2024, there is also a maximum income allowance, which is $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, the exact amount one can receive is dependent on their shelter and utility costs. However, a Spousal Income Allowance 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 limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can have $2,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.

In 2024, the CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.

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.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator for Idaho Medicaid.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Medicaid in ID 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 $750,000. Home equity is the current value of the home minus 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 child under 21 living in the home.
– The applicant has a disabled or blind child of any age living in the home.

While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home here.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the A&D Waiver, functional need is assessed through an in-person or telephone interview utilizing the Uniform Assessment Instrument (UAI). Limitations in the ability to independently complete Activities of Daily Living (i.e., bathing, dressing, mobility, eating, toileting) and Instrumental Activities of Daily Living (i.e., preparing meals, laundry, and housecleaning) are considered. Problematic behaviors, such as wandering, and cognitive impairments commonly seen in persons with Alzheimer’s disease or related dementias are also considered. While persons with dementia might meet the functional need for care, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC. A scoring system, based on the completed assessment, determines if one meets the NFLOC.

 Learn more about long-term care Medicaid in Idaho.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for ID 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 Qualified Income Trusts, can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are trusts that protect assets from Medicaid and Medicaid’s Estate Recovery Program. Another option are Medicaid-Compliant Annuities, which take a lump sum of cash and convert it to a monthly income stream. There are additional Medicaid planning strategies available 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 Idaho to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of the strategies 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.

 Idaho Medicaid also has a Personal Care Services Program that provides seniors with in-home assistance with daily living activities. This program has slightly different eligibility requirements.

 

How to Apply for Idaho’s Aged and Disabled Waiver

Before You Apply

Prior to submitting an application for the A&D 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 free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.

Since Idaho’s Aged and Disabled Waiver is not an entitlement program, there may be a waiting list for program participation. This Waiver is approved for a maximum of approximately 14,704 beneficiaries per year. In the case of a waiting list, as best as can be determined, access to a participant slot is based on date of application.

 

Application Process

Persons can apply for the Aged and Disabled Waiver online at idalink, over the phone at 877-456-1233, or in-person at one’s local Department of Health and Welfare office. Furthermore, an Application for Health Coverage Assistance can be downloaded here and submitted per instructions on the application.

A “Level of Care Determination” will be completed as part of the application process.

Although not intended for a consumer audience, additional information about the A&D Waiver can be found here.

The Bureau of Long Term Care (BLTC) within the Idaho Department of Health and Welfare (IDHW) administers the Aged and Disabled Waiver. IDHW’s Division of Welfare determines financial eligibility.

 

Approval Process & Timing

The Idaho 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 waiting to receive benefits.

 What are 1915(c) HCBS Medicaid Waivers?
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.

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