Maine Medicaid (MaineCare) Home and Community Benefits (HCB) Waiver for the Elderly and Adults with Disabilities

Last updated: July 12, 2022

 

Overview of Maine’s Elderly and Adults with Disabilities Waiver

Maine’s Elderly and Adults with Disabilities Waiver, also called the Home and Community Benefits (HCB) Waiver for the Elderly and Adults with Disabilities, is a statewide Medicaid (MaineCare) program for seniors and disabled adults who are at risk of institutionalization (nursing home admission). Intended to prevent premature nursing home admissions, a variety of long-term care benefits are available to assist persons in continuing to live at home. Examples include personal care assistance, assistive technology, home delivered meals, personal emergency response systems, home modifications, and home health services.

Program participants can reside in their own home or that of a loved one. They cannot live in an assisted living facility or an adult foster care home.

Personal care assistance offered under the Elderly and Adults with Disabilities Waiver may be provided by licensed agency providers, but participant-directed care is also an option. This allows program participants to hire, manage, and even fire, their own “personal care attendant” (caregiver). While friends and select relatives can be hired, such as an adult child, a spouse is excluded. A financial management services agency handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.

Maine’s Elderly and Adults with Disabilities 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 this 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 the Elderly and Adults with Disabilities Waiver

Follows is a list of home and community based services available via the Elderly and Adults with Disabilities Waiver. An individualized care plan determines which benefits a program participant receives.

– Assistive Technology
– Care Coordination
– Consumer-Directed Attendant Care Services – assistance with bathing, personal hygiene, toiletry, mobility, eating, preparing meals, laundry, light housecleaning
– Chronic Disease Self-Management (Living Well for Better Health)
– Falls Prevention (Matter of Balance)
– Financial Management Services – for persons self-directing their own care
– Home Delivered Meals
– Home Health Services – nursing services, home health aides, therapies (physical, occupational, speech language)
– Home Modifications – wheelchair ramps, stair lifts, roll in showers, grab bars, etc.
– Personal Care Services – assistance with bathing, personal hygiene, toiletry, mobility, eating, preparing meals, laundry, light housecleaning
– Personal Emergency Response Systems
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Skills Training – for persons self-directing their own care
– Transportation Services

 Maine has another Medicaid program through which personal care assistance is provided. It is the Consumer Directed Attendant Services Program. Unlike with the Elderly and Adults with Disabilities Waiver, a nursing facility level of care need is not required.

 

Eligibility Requirements for Maine’s Elderly and Adults with Disabilities Waiver

The Elderly and Adults with Disabilities Waiver is for Maine residents who are seniors (65+ years old) or 18+ years old and physically disabled. Additional eligibility criteria is below.

 The American Council on Aging provides a quick and easy MaineCare eligibility test for seniors.

 

Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases each January. In 2022, an applicant, regardless of marital status, can have a monthly income up to $2,523. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,523 / 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. 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 Maine, there is a minimum income allowance, effective 7/1/22 – 6/30/23, which is set at $2,288.75 / month. This allows the applicant spouse to transfer up to $2,288.75 / month to their non-applicant spouse in order to bring the non-applicant’s total monthly income up to $2,288.75. The state also sets a maximum income allowance of $3,435 / month (effective 1/1/22 – 12/31/22). While this potentially allows a non-applicant spouse a higher income allowance, any additional amount they 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 $3,435.

Assets
In 2022, the asset limit is $10,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $15,000. 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 have up to $10,000 in assets, while the non-applicant spouse is allocated up to $137,400 of the couple’s assets as a community spouse resource allowance (CSRA). This is intended to prevent spousal impoverishment.

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.

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 ME considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has intent to return, and in 2022, their home equity interest is no greater than $955,000. 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.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC). For the Elderly and Adults with Disabilities Waiver, a registered nurse completes an in-person functional needs assessment utilizing the Medical Eligibility Determination (MED) tool. To meet the level of care need, one of the following statements must be true.

– The applicant requires daily skilled nursing or requires significant assistance and physical support with at least three of the following activities of daily living (ADLs): bed mobility, locomotion, transferring, toileting, and eating.
– The applicant’s needs are a combination of behavior, cognition, and skilled nursing, and they require assistance with at least one of the following activities of daily living (ADLs): bed mobility, locomotion, transferring, toileting, and eating.

While persons with Alzheimer’s disease or a related dementia might meet the functional need for care, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

For more information about long-term care Medicaid in Maine, click here.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for ME 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.

Maine has a medically needy pathway to eligibility for Medicaid applicants who have high medical expenses relative to their income. Also known as a Spend-Down Program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s medically needy income limit. The amount that must be “spent down” can be thought of as a deductible. Once one’s “deductible” has been met, the Elderly and Adults with Disabilities Waiver will pay for care services and supports.

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 annuities, which take a lump sum of cash and convert it to a monthly income stream. There are additional 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 the state of Maine 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.

 

How to Apply for Maine’s Elderly and Adults with Disabilities Waiver

Before You Apply

Prior to submitting an application for the Elderly and Adults with Disabilities 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 Maine’s Elderly and Adults with Disabilities Waiver is not an entitlement program, there may be a waiting list for program participation. This waiver is approved for a maximum of approximately 2,119 beneficiaries per year. In the case of a waiting list, an applicant’s access to a participant slot is based on the date of Medicaid application and need for program benefits. In some cases, persons who submitted an application at a later date than other applicants may be awarded a participant slot first if their needs are greater.

 

Application Process

Persons can apply for the Elderly and Adults with Disabilities Waiver online at My Maine Connection, by calling the Office for Family Independence at 855-797-4357, or in-person at one’s district Department of Health and Human Services office. Furthermore, an Application for Long Term Care MaineCare can be found here.

Additional information about the Elderly and Adults with Disabilities Waiver can be found here.

The Elderly and Adults with Disabilities Waiver is administered by Maine’s Department of Health and Human Services (DHHS) and is operated by the Office of Aging and Disability Services (OADS). The Office of Family Independence (OFI) determines financial eligibility, and an Assessing Services Agency determines functional eligibility.

 

Approval Process & Timing

The Maine Medicaid (MaineCare) 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 even further. 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). However, 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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