How To Get a Caregiver Through a Medicaid Waiver (Home and Community Based Services)

 

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Artwork: Elizabeth D’Angelo

Whatโ€™s a waiver?

Waiver programs are designed to help people with disabilities stay in their homes instead of moving to nursing homes.

This program provides free home aides or care attendants to people who are not able to care for themselves. It is designed for people who have a high level of need for care.

Waiver programs are called different things in different states. It may not be called “Waiver” in your state. It may be called “medicaid long-term care” or “home and community based services” something else.

Do I need to be on Medicaid?

No. This program is funded through Medicaid, but in most states, you can apply for this program even if you are not currently on Medicaid. You will need to be screened for Medicaid, but the financial criteria for Medicaid waivers is VERY different than for Medicaid health insurance in some states. For example, in many states they will not consider your spouse’s income at all. They may have completely different income regs and criteria and there may be special trusts you can set up so your income or assets do not count.

There are MANY different ways to qualify for Medicaid. Many people think they are not eligible when actually they are. Please see below for what to do if you do not meet the financial criteria.

Do I need to be on Disability?

No. In most states, you can apply even if you were turned down or you are still applying for disability. If you are applying for disability, make sure to request and collect your entire file from the waiver program. Then send everything in your file to Social Security. It will help with your disability application.

What if I got turned down for Medicaid? What if I have too much money for Medicaid?ย ย 

You can still apply for this program. In many states, the financial criteria is completely different than for Medicaid health insurance. See below for what to do if you are turned down or told you have too much money.

What services can a caregiver provide?

The programs are different in every state. In most states, a caregiver can provide help with bathing, eating, dressing, toilet, as well as help in your home with cooking, cleaning, shopping, doctorโ€™s appointments and errands.

Can they provide childcare or help for my family?

No. They cannot care for your kids. They cannot shop, cook or clean for anyone else in your home. The services are only for you.

What is the cost?

Free for most people. If your income is high, you may be required to pay a portion, but there are regulations that may be able to keep you from being charged this way. See below.

Who will be my caregiver?

You have a choice:

๐Ÿ’  Agency directed – They will send someone from an agency

๐Ÿ’  Self-directed – You can hire anyone you want. Can be a friend, neighbor, brother, sister, parent, child, etc. In most states, it can not be a spouse. If you chose this option, you or someone in your household must be able to manage hiring, supervision, timesheets, admin, and paperwork. The person you chose must pass a background check.

๐Ÿ’  Combo – Some people select an agency and then arrange for a friend or family member to apply for a job at that agency and be assigned to their case. This way, the agency handles the paperwork.

What’s better? Self-Directed or Agency Directed?

๐Ÿ’  Great question, for which there is no simple answer. There are pros and cons both ways. Learn more: How to Decide: Agency Care or Self-Directed Care

How does this program work? What else do I need to know?ย 

๐Ÿ’  Comprehensive guide with a lot more information about waiver programs.

๐Ÿ’ ย Names and descriptions of waiver programs – Includes a state-by-state list on many different waiver programs. Not all waiver programs are included here, but many are. This site is for seniors, and most of the pages just say for seniors. However, most of these waivers are available to younger people with disabilities as well.

๐Ÿ’ ย List of Medicaid waiver programs. This is a list of the names of many different waiver programs. If you see one that looks interesting you can research it further.

๐Ÿ’ ย Kids & Adults Waivers – This page has a excellent list of waivers available to children. Many of the programs listed on this page also accept adults.

How to qualify

๐Ÿ’ ย If you need assistance with personal care (bathing, feeding, dressing, etc) plus assistance with household needs (shopping, cooking, laundry, etc) you will qualify.

๐Ÿ’ ย If you need assistance with partial or occasional assistance with personal care (bathing, feeding, dressing, etc) plus assistance with household needs (shopping, cooking, laundry, etc) you may or may not qualify.

๐Ÿ’ ย If you need assistance just household needs (shopping, cooking, laundry, etc) and do not need any kind of personal care, you will not qualify.

Many people get turned down for waiver programs, or have to apply more than once because they answer the questions about personal care questions too quickly, or because they feel shy or embarrassed, or because they do not meet with their doctor first to talk about all their personal care needs.

It’s very important to let them know anyย kind of assistance you need in the areas listed above. Learn more:ย How to Apply for Personal Care

What if I don’t need any help with personal care? I just want shopping and cleaning.

You will not be eligible for a waiver program. In some areas there may be a simpler program you can apply for. However, in many areas this kind of simpler program is not available. The simpler programs are often a few hours per week of care, using a home aide sent from a health care agency. Try calling your local Adult Services Department or social services agency. Also, try calling your area agency on aging (even if you are young, still call here).

Application Process

๐Ÿ’  You have an interview with Medicaid (can be in your home or over the phone).

๐Ÿ’  Your doctor fills out a form. (Please talk to your doctor. Tell her you are applying. Tell her she will be getting this form. Tell her ALL of your needs with bathing, eating, dressing, mobility and bathroom. Don’t be shy. If she doesn’t know your needs and fills out the form the wrong way, you will be automatically denied.)

๐Ÿ’  You fill out financial forms (if you are already on Medicaid, this step is skipped)

Where to apply

๐Ÿ’  Contact your local social services department

๐Ÿ’  Contact your local area agency on aging (do this even if you are young)

๐Ÿ’  Read this article on questions asked during a Medicaid waiver interview.

What else do I need to know?

๐Ÿ’  A bunch of helpful tips onย How to Get Extra Help if You Are in a Medicaid Waiver Program

๐Ÿ’  Plus How to Get Extra Help if You Have a Live-In Caregiver

“I have too much money”

If you are told you have too much money to qualify try this:

๐Ÿ’  You can consult with a medicaid planner. Medicaid planners can be free services at nonprofit agencies, or they can be paid services through an estate planning lawyer who specializes in medicaid.

๐Ÿ’  Ignore what you are told. The people who work at Medicaid often tell people the wrong thing. How to Respond When You Are Told You Canโ€™t Get Medicaid

๐Ÿ’  Very important: Make sure you are getting information about waivers and long term care. Do not look at the information for Medicaid health insurance. The financial limits are totally different in some states.

๐Ÿ’  Research everything yourself. Find the policies yourself online. Request a written copy of the financial policies for long term care.

๐Ÿ’  Never ever ever get scared off by what someone says on the phone. Research the policies. If you think you are eligible, apply on paper and get a decision in writing.

๐Ÿ’  If you discover that you really are not eligible, look into opening a miller trust a special needs trust or a pooled income trust for people with disabilities.

๐Ÿ’ ย Some states will tell you that you have a Medicaid spend-down or cost-share and charge you a portion of the bill. Before accepting a spend down, look into other options below. This page is for California, but includes a lot of information and ideas that would be helpful in any state:ย How to Avoid Share of Cost

๐Ÿ’  Learn more about Medicaid. Most states have multiple Medicaid programs and each have different rules:ย How To Get On Medicaid Even if You Canโ€™t Get On Medicaid

๐Ÿ’ ย If you can qualify for a different form of medicaid, that will automatically make you eligible for a waiver program. For example, some medicaid programs do not count your assets or do not count your spouse’s income or allow you to make $75,000 per year. Make sure to check all Medicaid programs.

๐Ÿ’  Also, look into Medicaid buy in programs for working adults with disabilities. In some states you can qualify even if only working a few hours per month at home (tutoring, babysitting, pet sitting, making jewelry, etc).

๐Ÿ’  If you have an inheritance or wealth, consult with a Medicaid planning specialist, or with a lawyer who specializes in Medicaid estate planning.

๐Ÿ’  If you have gotten turned down, and you believe you are eligible, always appeal. Appeal in writing. Once again, never ever let them turn you down over the phone or in a meeting. Get it in writing.

๐Ÿ’  You do not need a lawyer to appeal. You can do it yourself. Do not bother contacting disability lawyers, as they will not know anything in this area. In some cases, you may be able to get assistance through your state’s disability rights legal organization and/or through your local nonprofit poverty legal programs. Contact nonprofit disability rights legal organizations in your state. Also contact your local Center for Independent Living and ask if they have an advocate or lawyer who can help you. Once again, you can also appeal on your own without a lawyer.

What’s ADAPT?

ADAPTย is a national grassroots community group that organizes disability rights activists. They also have several Facebook groups. Many ADAPT members are in medicaid waiver and caregiver programs and they work to protect and expand these programs.

 

 

 

 

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