Overview of Nevada’s Frail Elderly Waiver
Nevada’s Waiver for the Frail Elderly (FE), also called the Home and Community Based Services Waiver for the Frail Elderly (HCBS FE Waiver), is a statewide Medicaid program for seniors who are at risk of nursing home admission. Intended to delay and prevent the need for institutionalization, long-term services and supports are provided to promote independent living. The exact services and supports one receives is based on their specific needs and circumstances, but potential benefits include adult day care, in-home respite care, homemaker services, and personal emergency response systems.
Program participants can reside in their own home, the home of a loved one, a group residential facility, or an assisted living residence. It is thought that they cannot live in an adult foster care home.
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 Frail Elderly Waiver.
Nevada’s FE Waiver 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 waitlist for program participation forms.
Nevada’s Waiver for the Frail Elderly, formally called the Home and Community Based Services Waiver for the Frail Elderly (HCBS FE Waiver), is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. Nevada previously had an Assisted Living Waiver, which was combined with the Waiver for the Frail Elderly in 2014.
Benefits of the Frail Elderly Waiver
In addition to case management, the following long-term home and community based services (HCBS) may be available. An individual care plan determines the exact benefits a program participant receives.
– Augmented Personal Care – personal care assistance / homemaker services in residential group homes for seniors or assisted living residences
– Adult Companion Services – in-home supervision, socialization, and non-medical care
– Adult Day Care
– Chore Services – i.e., trash removal from yard, washing walls, shampooing carpets
– Homemaker Services – light housecleaning, laundry, preparing meals, essential shopping
– Home Delivered Meals
– Personal Emergency Response Systems
– Respite Care – in-home care to relieve a primary caregiver
While program participants can receive care assistance in a residential group home or an assisted living residence, the FE Waiver does not pay for room and board.
Eligibility Requirements for Nevada’s Frail Elderly Waiver
Nevada’s FE Waiver is for elderly Nevada residents aged 65 and older. Additional criteria follow.
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, 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
In 2024, the asset limit is $2,000 for a single applicant. 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 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 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. NV 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, 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 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 has a spouse living in the home.
– The applicant has a dependent child under 21 years old living in the home.
– The applicant has a blind or disabled child of any age 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), and without services through the FE Waiver, would require nursing home admission within 30 days. The assessment tool used to determine if this criteria is met is the Nevada Medicaid Level of Care (LOC). This assessment contains five categories: the ability to self-administer medicine, treatments and special needs (i.e., oxygen dependent, glucose monitoring, wound care), Activities of Daily Living (i.e., continence, bathing, dressing, grooming, transferring, mobility, eating, ambulation), Instrumental Activities of Daily Living (i.e., preparing meals and homemaker services), and the need for supervision. Based on these categories, an applicant is given a numerical score based on functional deficits (limitations). The highest score is 13, which indicates an applicant has 13 functional deficits. To require a NFLOC, an applicant must have a minimum score of 3, or put another way, 3 functional deficits.
It is common for persons with Alzheimer’s Disease or a related dementia to meet the NFLOC need. However, 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.
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, Irrevocable Funeral Trusts (IFTs) can be utilized. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts can provide a good option for persons with a significant amount of “excess” assets. While this strategy should be utilized with advanced planning, once established, the Medicaid applicant is no longer considered the owner of the assets. There are many other 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 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 the Frail Elderly Waiver
Before You Apply
Prior to applying for Nevada’s Waiver for the Frail Elderly, 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 must 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 Nevada’s Frail Elderly Waiver is not an entitlement program and is limed to approximately 3,138 beneficiaries per year, there may be a waitlist for program participation. If a waitlist exists, applicants are placed on it by priority, which means applicants who submitted an application at a later date than other applicants may be awarded a participant slot first based on priority. Priority is first given to applicants currently residing in a nursing facility or acute care facility, followed by those who require maximum assistance, or are fully dependent on assistance, with bathing, toileting, and eating.
Application Process
To apply for Nevada’s Frail Elderly Waiver, persons should complete the Community Based Care (CBC) Program Application and submit it to an Aging and Disability Services Division (ADSD) office. See contact information by office.
Persons can also contact their local ADSD office. for additional information. More on the Frail Elderly Waiver.
The Frail Elderly Waiver is administered by the Nevada Department of Health and Human Services Division of Health Care Financing and Policy (DHCFP) and it is operated by the Aging and Disability Services Division (ADSD). The Division of Welfare and Supportive Services (DWSS) determines financial eligibility.
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. 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 waitlist may exist, approved applicants may spend many months, or longer, waiting to receive benefits.
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.