Medical Assistance for Long-Term Care Services

2.4.2.3.2 Home and Community-Based Services Waiver for People Age 65 or Older

Home and Community-Based Services (HCBS) waiver for people age 65 or older is the Elderly Waiver (EW).

This section discusses rules for determining a person’s household composition and family size. It also refers to the income limits and cost-sharing calculations used to determine income eligibility for EW.

Household Composition and Family Size

Household composition means the people included in a person’s household. Household composition determines the family size. Household composition and family size are factors used to determine financial eligibility.

Household composition and family size are determined for each person separately and may be different for each person on an application or in a household.

The EW program allows special rules to be applied to people age 65 or older who are not eligible for Medical Assistance (MA) using the MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD) household composition and family size and deeming rules. These people are treated as a household of one, and only their income counts.

If a person enrolled in MA for Employed Persons with Disabilities (MA-EPD) requests EW, the MA-EPD family size rules are used.

Income Limits and Cost-Sharing

This section covers the income limits and refers to the cost-sharing calculations used to determine eligibility for MA for Long-Term Care Services (MA-LTC) through EW.

Income Limits

The income limit for EW is 300% of the federal benefit rate (FBR) known as the special income standard (SIS). People who are eligible for EW due to income at or below the SIS are referred to as being eligible for SIS-EW.

If the gross income of the person requesting MA-LTC through EW is greater than the SIS, the person may still be eligible for EW. This group is referred to as being eligible for EW. Two income methodologies may be used to determine eligibility for MA-LTC for people who are eligible for EW with income above the SIS.

Cost-Sharing

Cost-sharing refers to the amount of income the person is required to contribute to their cost of care. People eligible for SIS-EW, with or without a community spouse, use an LTC income calculation to determine eligibility for MA-LTC.

People eligible for EW because they have income greater than the SIS use one of the following cost-sharing calculations, based on whether or not there is a community spouse, to determine eligibility for MA-LTC:

Community Income Calculation is used for people who do not have a community spouse.
LTC Income Calculation is used for people who have a community spouse.

Legal Citations

Minnesota Statutes, section 256B.058

Minnesota Statutes, section 256B.0915