*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: May 1, 2013 |
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03.40.25 - Elderly Waiver (EW) |
Archived: June 1, 2016 (Previous Versions) |
The Elderly Waiver (EW) program funds home and community-based services for people age 65 or older who require the level of medical care provided in a nursing home but choose to reside in the community. To receive EW services, a person must choose community care and be:
l Eligible for Medical Assistance (MA) payment of long-term care (LTC) services.
l Age 65 or older.
l Assessed through a Long-Term Care Consultation (LTCC) and determined to need the level of care provided in a nursing facility (NF-I or NF-II).
l Be in need of supports and services beyond those available through the standard MA benefit set according to the LTCC screening.
l Incurring a cost to MA for community-based services that is less than the cost of institutional care.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow standard MA guidelines.
EW eligibility determinations can be especially complex. Encourage the applicant or authorized representative to attend a face-to-face interview; however, an interview is not required.
Refer all applicants or their authorized representatives to the appropriate area of the county agency to obtain an LTCC screening if they have not already done so at the time they apply for MA.
Eligibility for waiver services cannot begin before an LTCC is completed, a care plan is developed, and eligibility for MA payment of LTC services has been determined.
Renewals (standard guidelines)
Follow standard MA guidelines.
The lead agency case manager will verify the following information on the Lead Agency Case Manager/Worker Communication Form (DHS-5181):
l Waiver program conversion or diversion status.
l LTCC date.
l Anticipated start date of waiver services.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Residency (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
EW enrollees who are not eligible for the Medicare Savings Programs may be eligible for payment of Medicare premiums as cost effective insurance.
Household Composition (standard guidelines)
MA eligibility is determined using a household size of one for all months in which the applicant or enrollee receives EW services.
Use a household size of one for all EW clients and their spouses when determining eligibility for either spouse for MA or the Medicare Savings Programs.
Example:
Beulah lives with her husband Henry. She is eligible for Medicare and is requesting MA payment of EW services.
Action:
Determine Beulah’s eligibility for MA payment of EW services and for the Medicare Savings Programs using a household size of one.
Use Method B for assets and income.
Asset Guidelines (standard guidelines)
l Asset limit:
The asset limit is $3,000 (household size of one).
Exception: People who remain eligible for and enrolled in MA-EPD while on EW are subject to the MA-EPD asset limit, disregards and exclusions.
l Spouse's assets:
n When both spouses request MA payment of LTC services, each has a $3,000 limit.
n When an EW applicant has a community spouse, an asset assessment must be completed to determine how many marital assets are available to the EW applicant. The community spouse of a person receiving EW services is entitled to a community spouse asset allowance. See Asset Assessments for more information.
Exception: People who have a community spouse and who remain eligible for and enrolled in MA-EPD while on EW are subject to the MA-EPD asset limit, disregards and exclusions and do not need to complete an asset assessment.
l Transfers:
EW applicants and enrollees may transfer assets to their spouses without penalty. Asset transfers by applicants, enrollees or their spouses to others may be uncompensated, resulting in a transfer penalty period during which the client is ineligible for MA payment of LTC services, including LTC services received through the EW waiver. See Transfers for more information on transfers.
l Home Equity Limit:
EW applicants and enrollees are subject to a Home Equity Limit.
l Annuities:
EW applicants and enrollees are subject to certain rules regarding annuity interests. See Annuities for more information.
Only count the income of the applicant or enrollee in any month he or she receives EW services. See MA Payment of Long-Term Care (LTC) Services to determine the correct budgeting method to use.
Exception: People who remain eligible for and enrolled in MA-EPD while on EW are subject to MA-EPD budgeting.
Deductions/Disregards (standard guidelines)
Follow standard MA guidelines based on the budgeting method used to determine eligibility. See MA Payment of Long-Term Care (LTC) Services to determine the correct budgeting method to use.
Exception: People who remain eligible for and enrolled in MA-EPD while on EW are subject to MA-EPD budgeting.
l People with income equal to or less than the special income standard (SIS) are eligible for MA without a spenddown, but must contribute any income over the maintenance needs allowance and other applicable deductions to the cost of services received under EW. This is known as the waiver obligation .
l People with income in excess of the SIS have either a medical spenddown or an LTC spenddown. See LTC Spenddowns and Waiver Obligations for more information.
l People who remain eligible for and enrolled in MA-EPD while on EW will continue to have an MA-EPD premium. They will not have a waiver obligation or medical spenddown. See MA-EPD for more information.
Covered Services (Prepaid MHCP Manual)
EW funds the following services in addition to the standard MA services:
l Adult day care.
l Adult day care bath.
l Adult foster care (other than room and board costs).
l Customized living services.
l 24-hour customized living services.
l Caregiver training and education.
l Case management.
l Chore services.
l Consumer directed community supports.
l Corporate foster care (adult).
l Companion services.
l Equipment and supplies not covered by MA, Medicare, or the client. The equipment and supplies must help keep the client out of a nursing facility.
l Extended home health.
l Extended nursing services.
l Extended personal care.
l Transportation.
l Family foster care (adult).
l Home-delivered meals.
l Homemaker services.
l Home modifications and adaptations.
l Respite care (in-home/out-of-home/facility/hospital).
l Residential care.
l Transitional services.
Service Delivery (Prepaid MHCP Manual)
People who are not enrolled in a managed care plan receive services through fee-for-service (FFS).
People age 65 or older, including people who receive services through the Elderly Waiver (EW), who are not subject to a managed care exclusion will be enrolled in Minnesota Senior Care or Minnesota Senior Care Plus, depending on their county of residence. Most seniors may voluntarily enroll in Minnesota Senior Health Options (MSHO) if they so choose.
Not applicable.
Follow standard MA guidelines.
Not applicable.
Alternative Care (AC) is an option for some people who are not eligible for EW. AC provides funding for home and community-based services for people who are at risk of nursing facility placement and supports informal caregivers who care for older adults.
AC is a state-funded program with higher income and asset limits than EW. People eligible for AC have monthly income greater than 120%FPG or assets of more than $3,000.
AC clients pay fees that are applied to the cost of their services. Their fees are based on their income and assets and the cost of their AC services.
Some AC rules reflect MA regulations.
l AC clients cannot improperly transfer assets.
l Spousal impoverishment rules apply for AC clients with a community spouse.
l AC clients may be eligible for Medicare Savings Programs.
People with income less than or equal to 120%FPG and assets under $3,000 are not eligible for AC. However, they can receive AC services for up to 60 days while their application is being processed for MA-EW.