Overview of Mississippi’s Elderly and Disabled Waiver
Mississippi’s Elderly and Disabled Waiver, abbreviated as the E&D Waiver, is a statewide Medicaid program for seniors and persons who are disabled and at risk of institutionalization (nursing home admission). Intended to help promote independent living, a variety of long-term home and community based services are available. The exact benefits a program participant receives is dependent on the individual’s unique needs and existing supports. Examples of potential benefits include adult day care, meal delivery, respite care, personal care assistance, and community transition services to help persons living in a nursing home to transition back home.
Program participants can reside in their own home or that of a loved one. Persons cannot live in assisted living residences nor adult foster care homes. Persons who are interested in residing in an assisted living facility should consider Mississippi’s Assisted Living Waiver.
Many long-term care Medicaid programs allow program participants the option of self-directing their own care, specifically hiring the caregiver of their choosing. This is not an option through the E&D Waiver.
Mississippi’s Elderly 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. Instead, the number of participant enrollment slots are limited, and when they are full, a waiting list for program participation forms.
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 the Elderly and Disabled Waiver
Follows is a list of long-term services and supports available via the E&D Waiver. While all program participants receive case management, an individual assessment determines which other services and supports one receives.
– Adult Day Care – includes transportation to / from the facility
– Community Transition Services – i.e., payment of essential household furnishings, moving expenses, and security deposits to help persons relocate to the community from a nursing home
– Extended Home Health Visits – skilled nursing / home health aide services
– Environmental Safety Services – minor home maintenance / repair, pest control, heavy household cleaning, etc.
– Home Delivered Meals
– Medication Management
– Personal Care Services – i.e., assistance with bathing, dressing, eating, meal preparation, housekeeping
– Respite Care – in-home and institutional
– Therapy Services – physical and speech
Eligibility Requirements for Mississippi’s Elderly and Disabled Waiver
The E&D Waiver is for Mississippi residents who are seniors (65+ years old) or aged 21 – 64 and physically disabled. Persons who are disabled who enroll prior to turning 65 years old can continue to receive waiver services upon turning 65. Additional eligibility criteria follows.
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 2024, is $2,829 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,829 / 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 $2,829 / 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. In 2024, the MMNA is $3,853.50. The MMNA allows a non-applicant spouse to supplement their spouse’s income to bring it up to $3,853.50 / month. 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 2024, 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 $154,140. This larger allocation of assets to the non-applicant spouse is intended to prevent spousal impoverishment and is called a Community Spouse Resource Allowance (CSRA).
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.
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 2024, their home equity interest is no greater than $713,000. 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’s spouse lives 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 E&D Waiver, functional need is assessed in-person by a licensed social worker and registered nurse through utilization of a Long Term Services and Supports 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 is another area of consideration. While persons with dementia commonly meet the NFLOC 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.
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 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 long-term care, are trusts that protect assets from Medicaid and for family as inheritance instead. Medicaid-Compliant Annuities, which turn countable assets into a stream of income, are another option. There are many other 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 Mississippi to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of these 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 Mississippi’s Elderly and Disabled Waiver
Before You Apply
Prior to submitting an application for the E&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 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 delayed is required documentation is missing or not submitted in a timely manner.
Since the Elderly 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 22,200 beneficiaries per year. Of these slots, approximately 50 are reserved for applicants currently living in a nursing home who wish to transition back to community living, approximately 50 are reserved for individuals transferring from another MS 1915(c) HCBS Waiver, and approximately 50 are reserved for priority admission to prevent nursing home admission for specific groups of persons in crisis, such as persons with Alzheimer’s disease or Parkinson’s who require assistance with at least three activities of daily living. In the case of a waiting list, persons are awarded a participant slot based on date of application.
Application Process
To apply for the E&D 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 Division of Medicaid at 800-421-2408.
The Office of Long Term Care within the Mississippi Division of Medicaid (DOM) administers the Elderly and Disabled Waiver. Learn more about the Elderly and Disabled Waiver.
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 a waiting list may exist, approved applicants may spend many months waiting to receive benefits.