Mississippi Medicaid-Funded Assisted Living to Prevent Nursing Home Admissions

Last updated: February 13, 2025

 

Overview of Mississippi’s Assisted Living Waiver

The Mississippi Assisted Living Waiver, abbreviated as the AL Waiver, is intended for seniors and adults who are disabled and at risk of nursing home admission. Intended to serve as a nursing home diversion program, program participants live in assisted living facilities and receive services and supports to help them live independently. This includes supervision, personal care assistance, homemaker tasks, nursing services, and attendant call systems.

“Assisted living” encompasses several types of living settings. Commonly called personal care home-assisted living (PCH-AL) facilities, the following all qualify as “assisted living”: licensed personal care homes, state-approved assisted living residences that accept Medicaid, congregate housing, and community residential care facilities. Furthermore, persons with TBI (traumatic brain injury) can reside in TBI residential care facilities.

Many long-term care Medicaid programs allow program participants the option of self-directing their own care, specifically hiring and managing the caregiver of their choosing. This is not an option through the AL Waiver.

The Mississippi 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, there are a limited number of participant enrollment slots, and when they are full, a waiting list for program participation forms.

 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. Meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of Mississippi’s Assisted Living Waiver

All program participants receive case management. Follows is a list of other benefits available in personal care home-assisted living facilities via the AL Waiver.

– Activities – therapeutic, social, recreational
– Attendant Call System / Emergency Response Systems
– Attendant Care
– Homemaker / Chore Services
– Medication Management / Administration
– Skilled Nursing Services (intermittently)
– Personal Care Assistance
– Transportation

While room and board (housing and meals) is provided in personal care home-assisted living facilities, the cost of this is not covered by the Assisted Living Waiver.

 Another Option: Mississippi seniors who wish to continue living in their homes might consider Mississippi’s Elderly & Disabled Waiver. Intended to assist persons in living independently, a variety of Home and Community Based Services are available. This includes adult day care, personal care assistance, home delivered meals, and home health visits.

 

Eligibility Requirements for Mississippi’s Assisted Living Waiver

The AL Waiver is for Mississippi residents who are 21- 64 years of age and disabled or who are 65 years of age or older. Persons who are disabled who enroll in the program prior to the age of 65 will continue to receive services upon turning 65. Program participants must reside in a personal care home-assisted living facility that is enrolled as a MS Medicaid provider for assisted living services. Additional eligibility criteria are below.

 The American Council on Aging provides a quick and easy Mississippi Medicaid 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). This figure increases each January, and in 2025, is $2,901 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,901 / 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 $2,901 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance (MMNA), from their applicant spouse.

Mississippi has set a MMNA of $3,948 / month in 2025. This is intended to bring a non-applicant spouse’s monthly income up to $3,948. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.

Assets
In 2025, the asset limit is $4,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $6,000. 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 can keep up to $157,920. 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. 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 the Medicaid 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. For eligibility purposes, Medicaid in MS considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has Intent to Return, and in 2025, their home equity interest is no greater than $730,000. Home equity is the current value of the home minus any outstanding debt against it. 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 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.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the Assisted Living Waiver, functional need is assessed in-person by a licensed social worker and registered nurse through utilization of a Long Term Services and Supports (LTSS) assessment tool. Activities of Daily Living (ADLs), such as toileting, bathing, dressing, transferring, mobility, and eating, and one’s limitations in independently completing these activities, is one area of consideration. One’s capability in independently completing Instrumental Activities of Daily Living (IADLs), like preparing meals, laundry, light housecleaning, and shopping for essentials, is also considered. Furthermore, cognitive deficits, which are commonly seen in persons with Alzheimer’s disease or a related dementia are another area of consideration. While persons with dementia commonly meet the Nursing Facility Level of Care need, a diagnosis of dementia in and of itself does not mean one will automatically meet it. As part of the functional assessment process, a numerical score is generated utilizing assessment data, and those above a specified score are considered functionally eligible.

 Learn more about long-term care Medicaid in Mississippi.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for MS 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 Mississippi, 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. Persons might also opt to “spend down” excess assets on items that Medicaid does not count as assets, such as clothing, a comfortable recliner, hearing aids, and home furnishings. 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 MS 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 Certified Medicaid Planner.

 

How to Apply for Mississippi’s Assisted Living Waiver

Before You Apply

Prior to submitting an application for the Assisted Living 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. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Assisted Living Waiver is not an entitlement program, there may be a waiting list for program participation. This waiver is approved for a maximum of approximately 1,200 beneficiaries per year. Some of these participant slots, however, are reserved for certain groups of applicants. Ten slots are for persons residing in nursing home facilities who wish to transition back to community living, 10 slots are for specific groups of persons in crisis (i.e., those with Alzheimer’s disease or Parkinson’s who require assistance with at least three activities of daily living), 10 slots are for persons with acquired traumatic brain injury, and 10 slots are for individuals transferring from another MS 1915(c) HCBS Waiver . In the case of a waiting list, applicants are awarded a participant slot based on date of application.

 

Application Process

To apply for the Assisted Living Waiver, applicants should contact their regional Mississippi Division of Medicaid office. See contact information by region. Alternatively, persons can call the Mississippi Access to Care Center (MAC Center) at 844-822-4622 or the MS Division of Medicaid’s Office of Long Term Care at 800-421-2408. Learn more about the AL Waiver.

The Assisted Living Waiver is administered by the Division of Medicaid (DOM) Office of Long Term Care.

 

Approval Process & Timing

The Mississippi 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 waiting lists may exist, approved applicants may spend many months, or even years, waiting to receive benefits.

 

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