Medicaid Home & Community Based Services Waiver for Older Adults

Contact Dawn Day Morales, Client Services Coordinator Email Ph: (301) 600-1657 Department of Aging 1440 Taney Avenue Frederick, MD 21702 Fax: (301) 600-3554 Hours 8:30 am - 4:00 pm Monday - Friday

Services
The goal of the Medicaid Waiver is to enable adults to remain in a community setting even though their advanced age or disability would warrant placement in a long-term care facility. The Waiver allows services that are typically covered by Medicaid in a long term care facility to be provided to eligible persons in their own homes or in assisted living facilities. For eligible clients, the State will pay for covered services to enable them to stay in the community.

Eligibility
The client needs to be at least 50 years old, have a monthly income of no more than $2,022 as of January 1, 2010, have assets that exceed no more than $2,000, and meet Medicaid's long-term care admission criteria (nursing home level of care) -
Maryland Department of Aging Waiver information.


The Medicaid Waiver for Older Adults is currently not open to new applications. Therefore, anyone interested in the program should call and have their name placed on the Medicaid Waiver Registry (1-866-417-3480). You will need to give the Registry the person’s name, address, phone number, date of birth and social security number when calling. You will then receive a letter from the Registry confirming the person’s name has been placed on the list. When the person’s name comes up on the list, the person will receive a Medicaid Waiver application to complete. Please call the office for assistance with completing the application.

People who are currently receiving Long Term Care Medicaid (and have been qualified for Medicaid for 30 days) in a nursing home setting are qualified to apply for Medicaid Waiver services. Please call the office and request a financial application to begin the process. The client will have to remain in the nursing facility until the Medicaid Waiver has been approved.

Medicaid Waiver Process
Once the application is received at our office, it will be forwarded to the Division of Eligibility Waiver Services (DEWS) in Baltimore. The DEWS office will then determine financial eligibility for the Medicaid Waiver program.

After submitting the financial application to the Department of Aging, the client will be referred to the Adult Evaluation and Review Service (AERS) for a medical review. A medical review is a necessary part of the Medicaid Waiver process. Once the local AERS nurse has completed an evaluation, the medical paperwork is sent to a third party agency that will then determine a client’s medical eligibility for the Medicaid Waiver.

During this process, the AERS nurse, the family/client and the Medicaid Waiver case manager will begin working on the client’s plan of care (what services the client needs and the services that can be provided by the Medicaid Waiver program.)

Provider Enrollment
Anyone interested in becoming a Medicaid Waiver provider for the following services can contact the Client Services Coordinator for an application.

Assisted Living is a residential program that provides housing and supportive services for individuals who need assistance in performing activities of daily living, such as eating, toileting and dressing. Assisted living facilities may be licensed to provide up to three levels of care. Individuals determined eligible for Waiver services may receive Level 2 or Level 3 care. A resident who needs Level 2 care would be expected to require substantial support with some of the activities of daily living, monitoring to manage behavioral difficulties, and assistance with taking medications. Level 3 residents would be expected to need a higher level of care including intensive supervision. The maximum reimbursement rate for Assisted Living is $2,114/month and $2,557 for Levels 2 and 3, respectively, including room and board, for which a maximum of $420/month may be charged to the participant. Providers must agree to accept the lesser of their usual and customary charge or the Medicaid rate. Providers must also accept a 25% reduction in payment if resident attends a medical adult day care. Participants retain $71 for personal needs and all other income must be paid to the provider. The provider must be licensed and enrolled as a Medicaid provider to participate.

Services
Personal Care Services
Include a range of assistance provided by another person that enables the recipient of the service to accomplish tasks they are unable to perform independently. Such assistance is usually related to activities of daily living and instrumental activities of daily living.

Environmental Assessment
On-site assessment of an assisted living facility, home or other residence where the participant lives by a qualified occupational therapist to determine what environmental modifications or assistive devices may be necessary to ensure the safety of the participant.

Environmental Accessibility Adaptations
Physical adaptations to a participant’s home or residence which are necessary to ensure the health, welfare and safety of the individual or enable the individual to function with greater independence, without the individual requiring admission to or continued stay in a nursing facility.

Assistive Devices
Include equipment or appliances necessary to facilitate a participant’s independence, such as extenders to assist with reaching and special eating instruments.

Behavior Consultation Services
Include home visits by a qualified professional to evaluate and recommend treatment for a participant with disruptive or potentially dangerous behavior that places the participant at risk of institutionalization.

Respite Care Services
Services provided to individuals unable to care for themselves, furnished on a short-term basis because of the absence or need for relief of persons normally providing the care.

Personal Emergency Response System
A device enabling a participant to secure help in an emergency situation.

Home Delivered Meals
Include one or two meals delivered to a participant’s home.

Dietitian & Nutritionist Services
Includes home visits by a licensed dietitian or nutritionist to assess and assist participants and their caregivers with menu planning for participants with special dietary needs.

Family & Consumer Training
Includes home visits by a professional to train family members in their caregiving roles, or to train a participant in self-directing his or her own care.

Medical Adult Daycare
A program of structured group recreational activities, medically supervised care, assistance with activities of daily living and instrumental activities of daily living, and enhanced socialization provided in an out-of-home, outpatient setting. One nutritional meal is also included.

Senior Center Plus Services
A program of structured group recreational activities, supervised care, assistance with activities of daily living and instrumental activities of daily living, and enhanced socialization provided in an out-of-home, outpatient setting. One nutritional meal is also included.

All providers need to have a current Medicaid Waiver provider number to bill for services provided to any Medicaid Waiver client.