Overview of the MN Medicaid Elderly Waiver
Minnesota’s Elderly Waiver (EW) provides home and community-based services (HCBS) for state residents aged 65+ who are at risk of being institutionalized (being placed in a nursing home). Program benefits are intended to assist beneficiaries in living independently or to supplement care already being provided by an informal caregiver, with the end goal of preventing and / or delaying nursing home admissions. Available long-term services and supports include adult day care, homemaker services, in-home personal care assistance, skilled nursing visits, and home modifications. Transitional services, to assist in relocation from a nursing home to community living, is also available.
Via EW, there is a service delivery option (meaning a way for beneficiaries to receive services) called Consumer Directed Community Supports (CDCS). This participant directed option allows program beneficiaries to choose the services and supports to meet their needs and their providers. This includes the ability to hire the caregiver of their choosing to provide personal care assistance and help with other daily living activities, such as mobility, laundry, light housecleaning, and preparation / cleanup of meals. Relatives, including adult children and spouses, can be hired to provide care. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.
Program beneficiaries can reside in their own home, the home of a loved one, an adult foster care home, or an assisted living residence.
EW is not an entitlement program, which means 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 these slots are full, a waitlist for program participation forms.
The Minnesota Elderly Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid waiver. Medicaid in Minnesota is called Medical Assistance (MA).
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.
Benefits of the MN Medicaid Elderly Waiver
In addition to case management, follows is a list of benefits available via the Elderly Waiver. An individual care plan will determine which services and supports a program participant will receive.
– Adult Day Care – daytime care and supervision in a community group setting. In some cases, baths can be provided.
– Adult Foster Care Services
– Assisted Living Services – memory care (specialized dementia care) is also available
– Chore Services – i.e., washing windows and pest control
– Companion Services – supervision, care (non-medical), and socialization
– Consumer Directed Community Supports – participant-directed option
– Family Caregiver Support Services – training (includes dementia-specific training), education, counseling
– Home Delivered Meals
– Home Health Aides
– Homemaker Services – i.e., light housecleaning, laundry, preparation of meals, essential shopping
– Home Modifications
– Individual Community Living Supports
– Non-Medical Transportation
– Personal Care Assistance
– Personal Emergency Response Systems
– Skilled Nursing Visits
– Specialized Equipment / Supplies
– Transitional Services – for persons returning to the community from a nursing facility. Includes coverage of rental deposit, utility set-up fees, and necessary home furnishings.
– Vehicle Modifications
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
Eligibility Requirements for MN Medicaid Elderly Waiver
EW is for Minnesota residents who are 65+ years of age who are at risk of nursing home care. The cost of long-term care services must be less than would be the cost of nursing home care. Additional eligibility criteria are as follows below.
Financial Criteria: Income, Assets & Home Ownership
The 2021 applicant income limit, which increases on an annual basis in January, is set at $2,382 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. 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. There is a minimum income allowance, set at $2,177.50 / month (effective July 2021 – June 2022), which is intended to bring a non-applicant spouse’s monthly income up to this amount. There is also a maximum income allowance, which is $3,259.50 / month (effective January 2021 – December 2021), and is dependent on the non-applicant spouse’s shelter and utility costs. This monthly maintenance needs allowance is intended to ensure the non-applicant spouse does not become impoverished.
In 2021, the asset limit is $3,000 for a single applicant. For married couples, with both spouses as applicants, each spouse can have up to $3,000 in assets. 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 can retain up to $3,000 in assets and the non-applicant spouse can keep up to $130,380. 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 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.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that MN Medicaid will take their home. Fortunately, for 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 his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child (under 21) living in the home.
– The applicant has a blind or disabled child 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 Waiver, an applicant’s ability / inability to independently complete their activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are considered. These activities include mobility, eating, toileting, bathing, dressing, preparing meals, medication management, laundry, and housecleaning. Persons with Alzheimer’s disease or a related dementia may be eligible for program services if NFLOC is met. However, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
More information about long-term care Medicaid in Minnesota.
Qualifying When Over the Limits
Having income and / or assets over MN Medical Assistance’s / Medicaid’s limit(s) does not mean an applicant cannot still qualify for 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.
Minnesota has a Medically Needy Spend-Down Program for applicants who have high medical expenses relative to their income. Via this 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 income limit.
When persons have assets over the limits, Irrevocable Funeral Trusts are an option. These are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons can also “spend down” countable assets in other ways in which they are not counted towards Medicaid’s asset limit. This includes making home accessibility modifications, updating the heating and plumbing systems in one’s home, and purchasing personal items, such as clothing. Another option, although no longer a popular option and limited to couple’s with a significant amount of excess assets, is a Medicaid divorce. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid / Medical Assistance 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 Minnesota to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. While there are a variety of planning strategies, some do violate Medicaid’s 60-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 all of 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 MN Medicaid Elderly Waiver
Before You Apply
Prior to submitting an application for EW, 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 held up is required documentation is missing or not submitted in a timely manner.
Since the Elderly Waiver is not an entitlement program, there may be a waitlist for program participation. The waiver is approved for a maximum of approximately 36,777 beneficiaries each year. In the case of a waitlist, an applicant’s access to a participant slot is based on the date in which one was determined program eligible.
To apply for the Elderly Waiver, applicants should call the Long-Term Care Consultation contact / Department of Human Services (DHS) office in one’s county to schedule a long-term care needs assessment. Contact information can be found here. Applicants must also complete the Application for Medical Assistance for Long-Term-Care Services (MA-LTC), which can be found here.
Seniors who are already enrolled in MN Medicaid / Medical Assistance should contact their care coordinator to request a long-term care needs assessment.
For more information about the Elderly Waiver, click here. Alternatively, applicants can call 800-333-2433 to reach the Senior LinkAge Line or contact their county DHS agency. To see contact information by county, click here. The Minnesota Department of Human Services (DHS) administers the Elderly Waiver.
Approval Process & Timing
The Minnesota Medicaid / Medical Assistance 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 waiting to receive benefits.