The Elderly Waiver (EW) provides home and community-based services not normally covered under MA to MA enrollees who are at risk of nursing facility placement. In addition, EW recipients are eligible for all standard MA covered services.
In order to receive EW services, an enrollee must:
- be age 65 or older;
- need nursing facility level care as determined by the long-term care consultation process, and choose community care; and
- meet the EW income standard.
In addition, the cost of EW services cannot exceed the estimated cost of nursing facility services.
The EW uses an income standard that is higher than the income standard used by the regular MA program. Individuals with incomes that do not exceed a special income standard of 300 percent of the Supplemental Security Income (SSI) level ($2,199/month)1 are able to qualify for EW and regular MA services. These individuals must contribute any income above a maintenance needs allowance ($988/month)2 towards the cost of EW services. This is referred to as the individual’s waiver obligation. If the amount of income above the maintenance needs allowance is greater than the cost of EW services, individuals can retain any excess income that remains after the waiver obligation is met. No contribution is required towards the cost of regular MA services.
Individuals with incomes that do not exceed the maintenance needs allowance are eligible for EW and MA services without meeting a waiver obligation. Individuals with incomes that exceed the special income standard must spend down to the regular MA spenddown standard for the elderly of 80 percent of FPG ($792/month) to qualify for EW and MA services.
Services available through the EW include the following:
- Adult day service
- Assisted living
- Training for informal caregivers
- Case management
- Chore, companion, and homemaker services
- Licensed community residential services
- Extended home care services
- Home-delivered meals
- Home and vehicle modifications
- Nonmedical transportation
- Respite care
- Specialized supplies and equipment
- Transitional supports
Consumer Directed Community Supports (CDCS) is an option available under the EW (and other home and community-based waivers and the Alternative Care program) that gives enrollees greater flexibility and control in developing a service plan, managing a budget, paying for services, and hiring and managing direct care staff.
EW program statistics for fee-for-service enrollees for fiscal year 2016:
- Total MA expenditures: $45.4 million
- Monthly average recipients: 2,370
- Average monthly cost per recipient: $1,609
EW program statistics for managed care enrollees for fiscal year 2016:
- Total MA expenditures: $356.4 million
- Monthly average recipients: 20,935
- Average monthly cost per recipient: $1,340
- The special income standard is adjusted each January 1. The dollar amount specified is effective for calendar year 2016.
- The maintenance needs allowance is adjusted each July 1. The dollar amount specified is effective for the period July 1, 2016, through June 30, 2017.
The content of this and any related posts has been copied or adopted from the Minnesota House of Representatives Research Department’s Information Brief, Long-Term Care Services for the Elderly, written by legislative analyst Danyell Punelli.