Overview of Nevada Medicaid’s Adult Day Health Care
Nevada’s Adult Day Health Care (ADHC) benefit is intended to prevent seniors and adults with disabilities from premature nursing home admissions. Via ADHC, program participants receive daytime care, supervision, socialization, and meals in a community-based facility. Assistance with daily living activities (i.e., mobility, eating, toileting) and medication administration might also be provided.
Persons can reside in their own home or that of a loved one and attend Adult Day Health Care. One cannot live in a group home, an assisted living facility, an adult foster care home, or any other residential facility in which 24-hour care is paid.
While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver, this is not an option for Adult Day Health Care. Program participants, however, are able to select which Medicaid-enrolled Adult Day Health Care facility they would like to attend from a list of providers.
Adult Day Health Care is part of Nevada’s Regular State Medicaid program. It is a 1915(i) Home and Community Based Services (HCBS) State Plan Option and is an entitlement. This means meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance; there is never a waiting list for program participation.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of Adult Day Health Care
Services and supports in Adult Day Health Care facilities may include the following.
– Activities – Social and Recreational
– Care Coordination
– Meals / Snacks
– Medical Supervision
– Medication Administration
– Nursing Services
– Nutritional Assessments
– Personal Care Services – assistance with daily living activities
– Restorative Therapy / Care
Eligibility Requirements for Nevada Medicaid’s Adult Day Health Care
Nevada’s Adult Day Health Care is for NV state residents who are 18+ years old. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 150% of the Federal Poverty Level (FPL), which increases annually in January. In 2023, the individual applicant income limit is $1,823 / month. For married couples with both spouses as applicants, the income limit is $2,465. 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 counted, which is limited to $1,823 / month. 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.
In 2023, Nevada has a MMNA of $3,715.50 / month. This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. A non-applicant spouse who has their own monthly income equal to or greater than $3,715.50 is not entitled to a Spousal Income Allowance.
In 2023, the asset limit for a single applicant is $2,000. For married couples, with both spouses as applicants, the asset limit is $3,000. 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 NV 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, Nevada Medicaid 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 resides in the home.
– The applicant has a dependent relative living in the home.
Learn more about the potential of Medicaid taking the home here.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant need a Nursing Facility Level of Care (NFLOC), this is not the case for Nevada’s Adult Day Health Care. An applicant, however, must require assistance or prompting with a minimum of two ADLs (Activities of Daily Living). ADLs include bathing, dressing, toileting, grooming, mobility, transferring (i.e., from a bed to a chair), and eating. Furthermore one of the following statements must be true.
– The individual has a medical condition that is chronic and without the supervision of a registered nurse, they are at risk of their condition worsening.
– The individual has a lack of support (family or social) and is at risk of social isolation.
– The individual has a history of behaving aggressively if not under supervision or if medicine is not administered by a registered nurse.
A Health Care Coordinator from the Department of Health and Human Services’ Division of Health Care Financing and Policy completes an assessment to determine if one meets the level of care need. While it is common for persons with Alzheimer’s Disease or a related dementia to meet the level of care need, a diagnosis of dementia in and of itself does not mean one will automatically be 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 NV Medicaid. There are a variety of Medicaid 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.
Utilizing Miller Trusts, often called Qualified Income Trusts, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. Miller Trusts, unfortunately, are not permitted for applicants to become income-eligible for Adult Day Health Care.
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-Compliant Annuities, which turn countable assets into a stream of income, is 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 Nevada 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 Nevada Medicaid’s Adult Day Health Care
Before You Apply
Prior to applying for Nevada’s Adult Day Health Care Program, 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.
To apply for Nevada Adult Day Health Care, persons must first be a Nevada Medicaid recipient, or in other words, a recipient of Medical Assistance to the Aged, Blind and Disabled (MAABD). Persons can apply online at Access Nevada, or alternatively, complete and submit an “Application for Assistance” to one’s district Division of Welfare and Supportive Services (DWSS) office. Contact information for northern DWSS offices can be found here, and southern DWSS offices, here. DWSS offices can also provide application assistance and / or answer Medicaid eligibility questions.
Once enrolled in Medicaid, a referral form for Adult Day Health Care needs to be completed and submitted. Persons can choose from a list of providers which Adult Day Health Care facility they would like to attend. The facility can assist in completing the referral form with required documents. To receive a list of providers, email [email protected]. Following referral submission, one will be contacted by a Health Care Coordinator to schedule an assessment.
Learn more about Adult Day Health Care here.
Adult Day Health Care is administered by the Nevada Department of Health and Human Services’ Division of Health Care Financing and Policy (DHCFP). Adult Day Health Care Facilities are licensed by the Division of Public and Behavioral Health (DPBH), Bureau of Health Care Quality and Compliance.
Approval Process & Timing
The Medicaid application process in Nevada 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. 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.