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Medicaid Covered Long Term Care outside the Nursing Home

Max, age 90, had lived in the same home for almost sixty years.  He and his wife raised three children there and the home had been the backdrop for most family gatherings even after the kids had grown and moved away.  Max meticulously maintained the home.  The exterior was always in superb shape and the lawn neatly manicured.  Max was proud of his little piece of real estate.

Janet, Max’s eldest daughter, lives just a few houses down from him.  In the last year or so, she started to notice that Max was not able to maintain the house to his standard.  He also was falling often and a recent trip to the doctor indicated that Max was suffering from dementia.  Janet did not want to take Max away from his home, but she was uncertain how Max could afford the supports he needed.  Fortunately, her friend introduced her to an elder law attorney who was able to give her some encouraging news about long term care services in the home covered by Medicaid under its Aged and Disabled Waiver.

What is the Aged and Disabled Waiver?

The Aged and Disabled Waiver is one of five waivers offered in Indiana and is designed as an alternative to institutionalization.  To qualify for the waiver, a person must meet level of care to receive services in an institution, but choose to receive services in the community.  The applicant’s local area agency on aging is charged with managing the waiver, determining whether the individual meets level of care, formulating the service plan, and submitting the service plan to the State for approval.

Services available under the Aged and Disabled waiver are extensive-from home maker services to adult day care to assisted living care.  For a comprehensive list of services, click here.

How Does One Qualify for the Aged and Disabled Waiver?

Eligibility for Aged and Disabled Waiver services is a two-pronged determination.  First, an applicant must need nursing home level of care.  This is determined by the local area agency on aging.

Once an individual is approved for waiver services, the individual must meet financial eligibility criteria for Medicaid and then file a Medicaid application with the Indiana Family and Social Services Administration (“FSSA”).  An elder law attorney can assist the individual to implement a legal plan to protect assets and meet these Medicaid financial eligibility requirements.

Once the individual is approved for Medicaid benefits and waivered services, services will begin.

Must One be Completely Impoverished to Receive Services under the Aged and Disabled Waiver?

No.  Certain assets are excluded for purposes of determining Medicaid eligibility. So, with legal planning one can often convert an asset that counts toward the Medicaid resource limit into one that is exempt under the program. As a result, modest savings are protected for the spouse living at home or to supplement the care of the single applicant (like additional home care hours).

Alternatively, many individuals seek to divest themselves of assets (make gifts) to get their countable assets below the resource limit. Because many types of transactions will be penalized, an individual should use caution and seek legal counsel. When Medicaid planning through transfers, an elder law attorney can work with an individual to protect a good portion of the individual’s savings while using the remainder to cover the costs of care through the penalty period.

In addition, in working with an elder law attorney, Janet was able to get assistance for Max in his home.  Max was able to shelter some of his assets to supplement this care and provide outside assistance.  Janet and her siblings were able to have the peace of mind that Max was receiving the assistance he needed in the environment he was happiest.

If you or someone you know wants to protect assets and obtain Medicaid covered home and community based long term care services, please contact us to schedule an appointment.

Jeff is Certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation, a distinction held by only a handful of lawyers in Indiana. For almost 20 years, he has focused on elder law, estate planning, long-term care planning, Medicaid planning, Veterans Affairs benefits planning, special needs planning, guardianships, and estate administration.

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