Overview of the Mississippi Independent Living Waiver
The Mississippi Independent Living Waiver is intended for MS residents 16+ years of age who are at risk of nursing home admission due to severe neurological or orthopedic impairments. Particularly relevant to seniors, qualifying conditions may include arthritis, osteoarthritis, and Alzheimer’s disease or a related dementia. Also known as the IL Waiver, this statewide Medicaid program helps persons remain living in their homes by providing a variety of long-term services and supports that promote independent living. Examples include home modifications for safety and accessibility, personal care assistance, and transition services to help persons living in a nursing home to move back home.
Program participants can reside in their own private home or that of a loved one. Persons cannot live in assisted living residences nor adult foster care homes.
Personal assistance services offered under the Independent Living Waiver can be participant directed. This means program participants can hire the person of their choosing to provide care rather than have their care provided by licensed agency workers. Friends, and some relatives, such as adult children, given they do not live with the program participant, can be hired. Spouses, unfortunately, cannot be hired. Program participants who cannot direct their own care may have a representative do so on their behalf. The state handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.
Mississippi’s Independent 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. The number of participant enrollment slots are limited, and when these slots 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. 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 Mississippi Independent Living Waiver
Follows is a list of long-term services and supports available via the IL Waiver. While all program participants receive case management, an individual assessment determines which other services and supports one receives.
– Home Modifications / Environmental Accessibility Adaptations – i.e., widening of doorways for wheelchair access, wheelchair ramps, grab bars
– Personal Care Attendant Services – i.e., assistance with bathing, dressing, eating, meal preparation, laundry
– Specialized Medical Equipment / Supplies
– Transition Assistance – Coverage of initial expenses for persons transitioning from a nursing home to community living (i.e., security deposits, utility set up fees, moving expense, essential household furnishings)
Eligibility Requirements for Mississippi Independent Living Waiver
The IL Waiver is for Mississippi residents who are 16+ years of age. Persons must have severe neurological or orthopedic impairments, be medically stable, and capable of communicating either verbally or non-verbally. Additional eligibility criteria are below.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR). This figure increases each January, and in 2023, is $2,742 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,742 / 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 $2,742 / 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 MS, the MMNA is $3,715.50 / month. This allows an applicant spouse to supplement their non-applicant spouse’s income, bringing it up to $3,715.50 / month. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.
In 2023, 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 $148,620. This larger allocation of assets to the non-applicant spouse is called a Community Spouse Resource Allowance and 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.
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 MS considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2023, their home equity interest is no greater than $688,000. 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 living in the home.
– The applicant has a permanently disabled or blind child living in the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the IL 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 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 care, are trusts that protect assets from Medicaid and for family as inheritance instead. Persons who do not have a significant amount of excess assets might “spend down” their excess assets on ones that are exempt (not counted). Examples include purchasing furniture, household items, and clothing. There are additional 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 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 the Mississippi Independent Living Waiver
Before You Apply
Prior to submitting an application for the IL 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 the Independent 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 5,800 beneficiaries per year. Of these slots, approximately 25 are reserved for applicants currently living in a nursing home who wish to transition back to community living. In the case of a waiting list, persons are awarded a participant slot based on the date of application.
To apply for the Independent Living Waiver, applicants should contact their regional Mississippi Division of Medicaid office. Contact information by region can be found here.
Learn more about the IL Waiver here and here. Alternatively, persons can call the Mississippi Access to Care Center (MAC Center) at 844-822-4622, the Mississippi Division of Medicaid’s Long Term Care Office at 800-421-2408, or the Mississippi Department of Rehabilitation Services at 800-443-1000.
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.