Medicaid Approval Program for the State of Ohio
Medicaid Approval Program for the State of Ohio
Medicaid Approval Program for the State of Ohio

Medicaid Approval Program for the State of Ohio

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What is a Medicaid Waiver? Your Guide to Medicaid Home and Community Based Services

 

The financial burden of long-term care is daunting for many, particularly those with low income and limited resources. Thankfully, all across the United States, there are programs available to help people get the long-term care they need to live fulfilling lives.

One such program is Medicaid Home and Community Based Services – a Medicaid waiver that helps people stay in their home instead of receiving care in a nursing home or other institution.

But Medicaid and its waiver programs can be difficult to understand, and applying for coverage can be a confusing process for many to navigate. So let us help you discover everything you need to know about Medicaid waivers and how to access home and community-based services.

Medicaid Explained

Medicaid is a federal and state program that provides health coverage to some individuals who have limited income and resources. 

But it’s important to realize that Medicaid is not the same as Medicare. They are separate, government-run programs that typically serve different groups of people and are funded by different parts of the government.

Medicare is a federal program that provides health care to all individuals over the age of 65 as well as people with disabilities under the age of 65. Medicaid, on the other hand, is for people with very limited resources and income. Because Medicaid is run by each individual state, the specific eligibility requirements and programs available vary from state to state. States are also able to opt-out of new Medicaid funding and requirements. 

If you’re eligible for both Medicare and Medicaid, you can have and use both for the services you need. While both programs provide health insurance, the services they cover are not always the same. For example, Medicaid offers coverage for things like personal care services while Medicare does not. 

 

A Definition of Medicaid Waivers

A Medicaid waiver is a provision in Medicaid law which allows the federal government to waive rules that usually apply to the Medicaid program. The intention is to allow individual states to accomplish certain goals, such as reducing costs, expanding coverage, or improving care for certain target groups such as the elderly or women who are pregnant.

Thanks to these waivers, states can provide services to their residents that wouldn’t usually be covered by Medicaid. For instance, in-home care for people who would otherwise have to go into long-term institutional care.

What Are the Different Types of Medicaid Waiver?

There are several different types of Medicaid waivers, all of which serve different purposes. All waivers, no matter what type or state, are under the authority of Sections 1115 and 1915 of the Social Security Act.

  • Section 1115 waivers – Often referred to as research and demonstration waivers, these allow states to temporarily test out new approaches to delivering Medicaid care and financing. For these waivers to be approved, they must be budget neutral for the federal government – meaning that the federal government can’t be spending more because of the waiver than they would if it wasn’t in place. As more states look for new ways to utilize the additional federal funding provided with the Affordable Care Act, these waivers have become more popular. 
  • Section 1915(c) waiversHome and Community-Based Services (HCBS) waivers are designed to allow states to provide home and community-based services to people in need of long-term care. This means they can stay in their own home or a community setting (such as a relative’s home or a supported living community) instead of going into a nursing facility.
  • Section 1915(b) waivers – “Freedom of choice waivers” allow states to provide care via managed care delivery systems. These organizations contract with state Medicaid agencies, and are paid from the state Medicaid fund for providing health care services to the beneficiaries, thus limiting the individual’s ability to choose their own providers.
  • Combined Section 1915(b) and 1915(c) waivers – These waivers allow states to provide home and community-based services by contracting with the managed care organizations that are defined in Section 1915(b). The contracted managed care organizations deliver the home and community-based health care services to qualifying individuals.

In this article, we’re going to be focusing on HCBS waivers and how they can help people get better and more appropriate long-term care in their own homes.

What Care is Provided Under an HCBS Waiver Program?

As outlined above, the purpose of an HCBS waiver is to let states provide care to certain individuals in the community, rather than putting them into institutional care. Beneficiaries may live in their own home, at a relative’s home, or in a senior living community that isn’t a nursing home.

Those who are accepted into their state’s HCBS waiver program will receive a range of medical and non-medical care, which can vary depending on the individual’s needs and situation, as well as state guidelines. This may include:

  • Personal care services and supervision, at home or in an assisted living facility
  • A home health aide
  • Nursing
  • Medical supplies and medical equipment
  • Chore and homemaking services, such as shopping, laundry, and cleaning
  • Hot meal delivery services
  • Respite care to relieve a primary caregiver
  • Counseling services
  • Home and/or vehicle modifications, such as ramps and safety rails, to increase independence
  • Support and case management
  • Assistance transitioning from a nursing home into the community
  • Access to senior centers or adult group day care
  • Transport to and from non-emergency medical appointments
  • Non-medical transportation services
  • Personal emergency response systems

Services provided may vary on a case by case basis and will be affected by the state in which the beneficiary resides. 

Benefits of Medicaid Waivers

For those who are a part of an HBCS program, the biggest benefit is they get to stay in their own home or community, instead of being sent to a care institution. Staying at home has been shown to have many quality of life benefits, especially for seniors who get to age in place. Home is comfortable and familiar, allowing those to feel at ease compared to the jarring change of environment that a nursing home or other residential facility can bring. Not only has this been shown to improve recovery time after an injury or surgery, but it’s also been shown to improve mental health and reduce complications from dementia.