Overview of the Aged and Disabled Waiver
Missouri’s Aged & Disabled Waiver (ADW) provides home and community-based services (HCBS) for persons aged 63+ 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 unpaid caregiver, with the end goal of preventing and / or delaying nursing home admissions. Services and supports may include adult day care, homemaker and chore services, home delivered meals, and respite care.
Many Medicaid waiver programs offer a participant-directed option, allowing program beneficiaries to select their own caregivers, including friends and relatives. Unfortunately, the MO Aged & Disabled Waiver does not. Waiver services are provided by provider agencies.
Program beneficiaries must live in their own private home or the home of a close friend or relative. It is thought that program participants cannot reside in an assisted living residence or adult foster care home.
ADW 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 Missouri Aged and Disabled Waiver is a 1915(c) Medicaid waiver. Medicaid in Missouri is Called MO HealthNet.
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 Aged and Disabled Waiver
In addition to case management, follows is a list of the benefits available via the Aged and Disabled Medicaid Waiver. An individual care plan will determine which services and supports a program participant will receive.
– Adult Day Health Care – supervised care in a community group setting up to 10 hours per day / 5 days per week. Transportation between home and the facility may be provided.
– Chore Services – tasks that are required on an irregular basis to maintain the safety and health of program participants in their homes (i.e., rodent control, shampooing rugs, washing walls)
– Home Delivered Meals – up to 2 meals per day
– Homemaker Services – assistance with housecleaning, laundry, preparation of meals, shopping for essentials, etc.
– Respite Care – in-home care to relieve a primary caregiver. In addition to basic respite care, advanced respite care for persons with special needs is available. This includes persons who are mostly confined to bed or have behavioral issues related to dementia.
Eligibility Requirements for Missouri’s Aged and Disabled Waiver
ADW is for Missouri residents who are elderly (65+) or between the ages of 63 and 64 and physically disabled. Persons who enroll between the ages of 63 and 64 will continue to receive waiver services upon turning 65. Additional eligibility criteria are as follows:
Financial Criteria: Income, Assets & Home Ownership
The 2021 applicant income limit, which increases on an annual basis in January, is set at $1,388 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $1,388 / 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 $5,035 for a single applicant. For married couples, with both spouses as applicants, each spouse can have up to $5,035 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 $5,035 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 MO 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 years old) who lives in the home.
– The applicant has an adult child (21+) who is blind or disabled (permanently and totally) who lives 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 Aged and Disabled Waiver, the tool used to make this determination is the InterRAI HC (Home Care). This assessment contains twelve categories relative to daily living. Points are assigned based on the amount and level of assistance required. The higher the score, the greater the level of care need. Several categories are activities of daily living (ADLs), which are essential for day-to-day functioning, and include mobility, eating, toileting, bathing, and dressing / grooming. Relevant to many persons with Alzheimer’s disease or a related dementia, cognition, such as decision making ability, memory, and comprehension, 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 MO HealthNet’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.
When persons have income over the limits, Miller Trusts, also called a qualified income trust 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 are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid Asset Protection Trusts, which not only protects assets from Medicaid’s asset limit, but also preserves them as inheritance by protecting them from Medicaid’s estate recovery program. 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 Missouri 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 Missouri’s Aged and Disabled Waiver
Before You Apply
Prior to submitting an application for ADW, 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 Aged and Disabled Waiver is not an entitlement program, there may be a waitlist for program participation. The waiver is approved for a maximum of 26,932 beneficiaries each year. In the case of a waitlist, an applicant’s access to a participant slot is based on level of care needs. This means persons who submitted an application at a later date than other applicants may be awarded a participant slot first if their needs are greater.
To apply for the Aged and Disabled Medicaid Waiver, applicants must be eligible for MO HealthNet. Persons can apply online at myDSS, over the phone by calling the Family Support Division (FSD) at 1-855-373-4636, or at one’s local family support office / resource center. Contact information for local offices can be found here.
Persons already enrolled in MO HealthNet should contact their local family support office or call FSD at 1-855-373-4636 to ask for a referral for ADW.
As part of the ADW application process, an in-person functional needs assessment will be completed by the Division of Senior and Disability Services. The Division of Senior and Disability Services (DSDS) within the Missouri Department of Health and Senior Services (DHSS) administers the MO Aged and Disabled Medicaid Waiver.
For additional information about ADW, click here. Persons can also call FSD at 1-855-373-4636 for information and / or assistance.
Approval Process & Timing
The Medicaid / MO HealthNet 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.