Overview of the Multipurpose Senior Services Program
The Multipurpose Senior Services Program (MSSP) Waiver provides home and community based services for elderly California residents who require a nursing home level of care, but prefer to remain at home. Intended to prevent and / or delay the need for nursing home care, MSSP provides in-home personal care assistance, home delivered meals, and personal emergency response systems to promote safe independent living. Adult day care and respite care are also available program benefits and often supplement care one’s family is already providing. In addition to being a nursing home diversion program, MSSP also assists current nursing home residents in transitioning back home.
While many waiver programs offer a self-directed option, allowing program beneficiaries to select their own caregivers, MSSP does not. Instead of the ability to hire friends and family members, care services are provided by licensed agency providers.
MSSP is not an entitlement program. This means applicants who meet eligibility requirements are not guaranteed immediate receipt of program benefits. There are a limited number of participant enrollment slots, and when these slots are full, a waitlist forms.
The Multipurpose Senior Services Program is a 1915(c) Medicaid waiver. In California, the Medicaid program is called Medi-Cal.
Benefits of the Multipurpose Senior Services Program
In addition to care management, follows is a list of the benefits available via the Multipurpose Senior Services Program Medi-Cal Waiver. An individualized service plan determines which services a program participant will receive, and the frequency with which they are received.
– Adult Day Care – non-medical daytime care in a community-based center
– Assistive Technology – to maintain or improve one’s ability to function
– Communication / Translation Services
– Consultive Clinical Services – nutritional, social services, legal, pharmacy, and monitoring of vital signs
– Counseling and Therapeutic Services – group or individual counseling, money management, and social support
– Homemaker Services – housekeeping, laundry, shopping, and meal preparation
– Home Modifications – addition of wheelchair ramps & grab bars and modifying a bathroom for wheelchair access
– Meal Services– home delivered or congregate
– Non-Medical Home Equipment – items necessary for safety and independence due to a functional limitation
– Personal Care – non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating
– Personal Emergency Response Systems – 24/7 emergency communication
– Respite Services – in-home & out-of-home care to give an unpaid primary caregiver, often a family member, a break
– Supplemental Protective Supervision – in-home non-medical supervision to prevent immediate nursing home placement
– Transitional Services – payment of security deposits, utility set-up fees, and moving services for persons moving from a nursing home back home
– Transportation – non-medical and medical
MSSP services are available in one’s home or the home of a family member or friend. Program beneficiaries cannot reside in Residential Care Facilities for the Elderly (RCFE). RCFE’s can be thought of as assisted living facilities or adult foster care homes.
Eligibility Requirements for Multipurpose Senior Services Program
MSSP is for California residents who are 65 years of age or older. Applicants must reside in a geographic area in which the program is offered. At the time of this writing, MSSP services are available in the following California counties:
|California Counties in which the Multipurpose Senior Services Program is available (Updated Mar. 2022)|
|Alameda||Amador||Butte||Calaveras||Contra Costa||El Dorado||Fresno||Glenn||Humboldt|
|San Bernardino||San Diego||San Francisco||San Joaquin||Santa Barbara||Santa Clara||Santa Cruz||Shasta||Siskiyou|
MSSP services are anticipated to become available in Sutter County. This change is currently awaiting approval by CMS. As program rules and availability can change, it is best to contact one’s local county Area Agencies on Aging (AAA) office to confirm or deny this program is available in one’s geographic region. Contact information can be found here.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL), which increases annually in January. However, for CA Medicaid, the income limits increase each April. Effective April 2022 – March 2023, the monthly income limit for MSSP for a single applicant is $1,564. When both spouses are applicants, the income limit is $2,106 / month for the couple. 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 $1,564 / month. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance. The maximum amount that can be transferred is $3,435 / month (effective January 2022 – December 2022) and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a spousal income allowance.
Effective July 2022, the asset limit is $130,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit will be $195,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse will be able to retain up to $130,000 in assets and the non-applicant spouse can keep up to $137,400. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.
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 30-months of long-term care Medi-Cal application. This is because Medi-Cal has a look back rule and violating it results in a penalty period of Medicaid ineligibility.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for Medi-Cal eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has “intent” to return to the home and indicates it in writing. California is unique from other states in that there is no home equity interest limit. Home equity interest is the current value of the home minus any outstanding mortgage.
– A non-applicant spouse lives in the home.
– The applicant has a dependent relative, such as a disabled child, living in the home.
– The applicant has a child under 21 years of age living in the home.
While the home is likely exempt while one is receiving Medi-Cal benefits, it may not be safe from Medicaid’s estate recovery program. To learn more about when Medicaid can and cannot take one’s home, click here.
Medical Criteria: Functional Need
An applicant must require a nursing facility level of care (NFLOC). For the Multipurpose Senior Services Program, an in-person assessment called the MSSP Level of Care Certification Form is completed by a registered nurse to determine if this level of care need is met. An applicant’s ability to independently complete activities of daily living (ADLs) and instrumental activities of daily living (IADLs) is one area of consideration. Examples of ADLs and IADLs include personal hygiene, mobility, dressing, meal preparation, and housework. Relevant to persons with Alzheimer’s disease or a related dementia, cognitive deficits, such as memory, decision making, and judgment, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for the Multipurpose Senior Services Program. 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.
Medi-Cal has a share of cost program, which may also be referred to as a medically needy program. With this program, an applicant with income over Medi-Cal’s income limit has to pay towards the cost of their care services / medical expenses, which is their “share of cost”. This can be thought of as a deductible and is based on one’s monthly income. Once one has paid their share of cost for the month, MSSP will pay for services and supports.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are annuities that turns countable assets into a stream of income. 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 the state of California 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 for family as inheritance. These strategies often violate Medi-Cal’s 30-month look back rule, and therefore, should be implemented well in advance of the need for long-term care. 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 the Multipurpose Senior Services Program
Before You Apply
Prior to submitting an application for MSSP, 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 a 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 30-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 held up is required documentation is missing or not submitted in a timely manner.
Since the Multipurpose Senior Services Program is not an entitlement program, there may be a waitlist for program participation. The MSSP is approved for a maximum of 11,370 beneficiaries each year. In the case of a waitlist, an applicant’s access to a participant slot might be based on the immediate need for program services.
To apply for MSSP, one must complete an application, and be determined eligible, for Medi-Cal. An application can be downloaded here. It should be indicated on the application that long term home and community based care is needed. Persons who require assistance with completing the application can call Covered California’s Customer Service Center at 1-800-300-1506. Persons can also apply online at CoveredCA.com or over the phone / in person at one’s Department of Health Care Services county office. As part of the application process for MSSP, an in-person functional assessment is completed by a registered nurse at one’s local MSSP site.
For additional information about the Multipurpose Senior Services Program Waiver, click here and here. Alternatively, persons can contact their local DHCS county office. Another option is to contact the Area Agencies on Aging (AAA) at 1-800-510-2020 or contact one’s local AAA. The MSSP Waiver is administered by the California Department of Health Care Services (DHCS) and the California Department of Aging (CDA). MSSP services are provided by approximately 40 local agencies that contract with the CDA.
Approval Process & Timing
The 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 even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). However, despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists 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.