Overview of Nevada Medicaid Structured Family Caregiving Waiver
The Nevada Structured Family Caregiving Waiver, or Family Caregiving Waiver, is intended for persons with Alzheimer’s Disease or a related dementia who are at risk of nursing home admission, but can live at home with long-term care services. Via Structured Family Caregiving, which can loosely be thought of as adult foster care, an informal (unpaid) relative or non-relative caregiver lives with the care recipient and provides them with supervision, personal care assistance, and homemaker services. In exchange, the caregiver is paid and receives training specifically focused on the care recipient’s needs.
The Family Caregiving Waiver will allow for self-direction, allowing the care recipient to choose their own caregiver, as well as the home in which they live (their own or the caregiver’s). Even a spouse or legally responsible person can be selected as the caregiver. The caregiver will then be employed by a home care agency or an intermediary service organization and paid a daily stipend. The amount is unknown, but the “employer” will be required to pay the caregiver a minimum of 65% of the per diem rate received from Medicaid.
The Structured Family Caregiving Waiver will not be an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the number of participant enrollment slots will be limited to 100. When these slots are full, a waitlist for program participation will form.
The Nevada Structured Family Caregiving Waiver is a new 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver program that will begin 1/1/25.
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. The goal of HCBS (home and community based services) 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 program participant slots.
Benefits of the Structured Family Caregiving Waiver
In addition to case management, the following benefits will be available via the Structured Family Caregiving Waiver.
– Personal Care Services – i.e., assistance with bathing, dressing, grooming, personal hygiene, toileting, transitioning, mobility, eating
– Health-Related Services / Home Health Aide Services
– Homemaker Services – i.e., assistance with housecleaning, laundry, preparation of meals, shopping for essentials
In addition to a daily stipend for the caregiver, the caregiver will receive training to assist them in caring for the care recipient.
Eligibility Requirements for the Structured Family Caregiving Waiver
The Structured Family Caregiving Waiver will be for Nevada residents of any age with a diagnosis of Alzheimer’s Disease or a related dementia. They will be required to live in the same home as the care recipient full time. Additional eligibility criteria are as follows and is relevant for seniors 65+ years of age:
Financial Criteria: Income, Assets & Home Ownership
Income
It is anticipated that the applicant income limit will be equivalent to 300% of the Federal Benefit Rate (FBR). This figure changes each January, and in 2024, is $2,829 / month.
If the Family Caregiving Waiver were currently active, this would mean an individual applicant would be allowed income up to $2,829 / month. If both spouses were applicants, they would be treated individually, with each spouse allowed income up to $2,829 / month. If only one spouse were an applicant, the income of the non-applicant spouse would not be counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse could be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA).
In 2024, Nevada has a MMNA of $3,853.50 / 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 $3,853.50 is not entitled to a Spousal Income Allowance.
Assets
It is anticipated that the asset limit for a single applicant will be $2,000. For married couples, with both spouses as applicants, it is anticipated to be $3,000. If only one spouse were an applicant, the assets of both the applicant and non-applicant spouse would still be limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse would be able to retain up to $2,000 in assets and the non-applicant spouse would be able to keep up to $154,140.
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.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that NV Medicaid will take it. 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 and 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 has a spouse living in the home.
– The applicant has a minor child (under 21 years old) living in the home.
– The applicant has an adult child (21+) who is blind or disabled (permanently and totally) living in the home.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant will need to require a Nursing Facility Level of Care (NFLOC). It is currently unclear how this will be determined, but generally a need for assistance with the Activities of Daily Living (ADLs), which are essential for day-to-day functioning, and include mobility, eating, toileting, bathing, and dressing / grooming, are indicative of this level of care need. Relevant to many persons with Alzheimer’s disease or a related dementia, cognition, such as decision making ability, memory, and comprehension, are also likely 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 Nevada 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 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 are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid Asset Protection Trusts in which assets are placed and no longer considered owned by the Medicaid applicant. While assets are not counted towards Medicaid’s asset limit and are also protected for family as inheritance, this option violates Medicaid’s 60-month Look-Back Rule. Therefore, it should be implemented well in advance of the need for long-term care. 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 Nevada 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 the Medicaid Estate Recovery Program. While these strategies commonly violate the Look-Back Rule, there are some workarounds, such as the Modern Half a Loaf, 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).
How to Apply for Nevada Medicaid Structured Family Caregiving Waiver
Before You Apply
Prior to submitting an application for the Family Caregiving 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 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.
The Structured Family Caregiving Waiver will limit the number of participant enrollment slots to 100. Therefore, there could be a waitlist for program participation in the future.
Application Process
Since the Structured Family Caregiving Medicaid Waiver is not currently active, persons cannot currently apply for this program.
The Nevada Department of Health and Human Services will administer the Structured Family Caregiving Waiver.
Approval Process & Timing
The 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, if a waitlist were to exist, approved applicants could spend many months, or longer, waiting to receive benefits.