Washington DC Medicaid Elderly and Persons with Physical Disabilities (EPD) Waiver

Last updated: February 20, 2024

 

Overview of Washington DC’s Elderly and Persons with Physical Disabilities Waiver

The District of Columbia’s Elderly and Persons with Physical Disabilities Waiver, or EPD Waiver, is a district-wide Medicaid program for seniors and adults who are physically disabled and at risk of institutionalization (nursing home admission). Intended to prevent premature nursing home admissions, a variety of long-term services and supports are available to assist persons in living independently. Examples include adult day care, home modifications for safety and accessibility, personal care assistance, and personal emergency response systems. Transitional services, which assist persons who are currently living in a nursing home in moving back into the community, are also available.

In addition to living at home or the home of a loved one, a program participant may live in an assisted living residence or an adult foster care home.

EPD services may be provided by licensed care workers or program participants who live at home have the option to self-direct their care via the Services My Way Program. This participant-directed option allows the hiring of a relative or friend to provide care. While this includes one’s adult child, a spouse or other legally responsible relative is excluded. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.

The District of Columbia’s Elderly and Persons with Physical Disabilities 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.

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Wait List Alternatives: Are you interested in connecting with a Medicaid Planning Professional to discuss alternatives to the Elderly and Persons with Physical Disabilities Waiver? Wait-lists can last from months to years, but there are other Medicaid programs that offer immediate care outside of nursing homes.
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Benefits of the Elderly and Persons with Physical Disabilities Waiver

Follows is a list of home and community based services available via the EPD Waiver. An individualized care plan determines which benefits a program participant receives.

– Adult Day Health Care
– Assisted Living Services
– Case Management
– Chore Services
– Community Transition Services – assists program participants in transitioning from an institution back into the community
– Homemaker Services
– Home Modifications – i.e., wheelchair ramps, grab bars, widening of doorways
– Participant-Directed Goods / Services – through the Services my Way Program
– Personal Care Aide Services
– Personal Emergency Response Services
– Respite Care – residential and in-home care to relieve a primary caregiver

While a program participant can reside in an assisted living residence or an adult foster care home, the EPD Waiver does not cover the cost of room and board.

 

Eligibility Requirements for Elderly and Persons with Physical Disabilities Waiver

The EPD Waiver is for District of Columbia residents who are elderly (65+ years old), or physically disabled and between 18-64 years of age. Persons who enroll as a disabled adult can continue to receive Waiver services under the aged category when turning 65. Additional eligibility criteria as follows below.

 The American Council on Aging provides a quick and easy Medicaid Eligibility Test for District seniors. Start here
Financial Criteria: Income, Assets & Home Ownership

Income
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases each January. In 2024, an applicant, regardless of marital status, can have a monthly income up to $2,829. 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. However, in some cases, income can be allocated to the non-applicant spouse from their applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance (MMNA). Specific to Washington DC, it is called a Community Maintenance Needs Allowance (CMNA).

In 2024, the maximum amount of income that can be transferred to the non-applicant spouse is $3,853.50 / month. This is intended to ensure they have a minimum monthly income of this amount. To be clear, this allowance is intended to bring a non-applicant’s monthly income up to $3,853.50. If a non-applicant’s own income is equal to or greater than this amount, they are not entitled to a Spousal Income Allowance.

Assets

In 2024, 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 have $2,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.

In 2024, the CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828, the non-applicant spouse can keep all of the couple’s assets, up to this amount.

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.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator.

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, Medicaid in the District of Columbia 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 $1,071,000. 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) living in the home.
– The applicant has a disabled or blind 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 here.

 Learn more about long-term care Medicaid in Washington DC.

 

Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC). For the EPD Waiver, an in-person assessment is completed using the interRAI Home Care Assessment System tool. One’s ability / inability to complete Activities of Daily Living (ADLs), such as bathing, dressing, mobility, eating, and toiletry, and a need for skilled care, such as wound care and infusions, is taken into consideration. Cognition and behavior is also considered. This is relevant to many persons with Alzheimer’s disease or a related dementia, as cognitive decline and certain behaviors, such as wandering, is common. To be clear, a diagnosis of dementia in and of itself does not mean one will meet a NFLOC. A total score is determined based on the three areas of assessment and a combination of 9 points or higher indicates a NFLOC is required.

 The District of Columbia’s Medicaid program also provides State Plan Personal Care Aide Services and Adult Day Health Program Services. Unlike with the EPD Waiver, a Nursing Facility Level of Care need is not required.

 

Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid in Washington DC. 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.

Persons who have income over the limit, but have high medical bills, can become income eligible via DC’s Medically Needy Spenddown program. This program permits applicants to spend their “excess” income on medical expenses in order to meet the Medically Needy income limit. The amount that must be paid each month can be thought of as a deductible. Once one’s “deductible” has been met for the month, the EPD Waiver will pay for services and supports. More about the Medically Needy pathway to eligibility.

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 both Medicaid and Medicaid’s Estate Recovery Program. 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 the District of Columbia 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 Washington DC’s EPD Medicaid Waiver

Before You Apply

Prior to submitting an application for the Elderly and Persons with Physical Disabilities 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 Washington DC’s EPD Waiver is not an entitlement program, there may be a waiting list for program participation. This waiver is approved for a maximum of approximately 6,160 beneficiaries per year. Sixty of the participant spots are reserved for persons transitioning into the community from an institution, such as a nursing home facility. In the case of a waiting list, an applicant’s access to a participant slot is usually based on the date of Medicaid application.

 

Application Process

Persons can apply for the EPD Waiver by completing the Long-Term Care Program Medical Assistance Application. Persons can request an application via the Department of Aging and Community Living (DACL) by calling 202-724-5626. Persons can also obtain an application at an Economic Security Administration (ESA) Service Center.

To initiate the functional needs assessment, a Prescription Order Form (POF) must be completed by a doctor or advance practice registered nurse who is enrolled as a DC Medicaid Provider. The POF must be submitted to Liberty Healthcare per instructions on the form.

More information about the EPD Waiver is located here (make sure to click on the attachment). Persons can also call the Department of Aging and Community Living (DACL) at 202-724-5626 or the Department of Health Care Finance Long Term Care Administration at 202-442-5988 to learn more. The EPD Waiver is administered by the Washington DC Department of Health Care Finance (DHCF) Long Term Care Administration (LTCA).

 

Approval Process & Timing

The District of Columbia’s 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 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. Furthermore, as a waiting list may exist, approved applicants may spend many months waiting to receive benefits.

 What are 1915(c) HCBS Medicaid Waivers?
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.

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