What Are Medicaid Waivers

Answering Questions on the Medicaid Waiver Program

by: Matthew Boyle

As we age, our ability to perform day-to-day tasks weakens, in fact, some individuals require the help of an assisted living facility or caregiver in order to perform these daily functions. Unfortunately, the cost of assisted living, nursing homes, and caregivers can add up and in some cases, individuals cannot afford the type of care that they require.

With that said, there are options available for you or your loved one if you do need this type of care. For example, there are Medicaid waivers available in many states to help patients get the type of quality care that they deserve.

Understanding What a Medicaid Waiver Is

For those with limited financial resources, Medicaid helps some individuals pay for nursing homes. For people wishing to live at home or an assisted living facility, Medicaid will sometimes pay for care in some of these locations if it can be done at a lower cost than a nursing home.

Assisted living waivers are done in many states across the country, including Texas. These waivers help individuals qualify for a nursing home can often receive the same level and quality of care in an assisted living residence at a lower cost.

A Medicaid waiver is meant for people with limited financial resources, Medicaid helps pay for nursing home care. There are a number of different types of waivers depending on which state you are in. For example, in Texas, STAR+PLUS is in place to help disabled adults and Texans aged 65 and older that require nursing facility level of care. Under this waiver, both medical and non-medical long-term care services are covered.

Who Is Eligible for Medicaid Waivers?

Eligibility for these types of waivers is dependent on what the requirements are for each state. With that said, many of the requirements are fairly consistent. In Texas, for the STAR+PLUS, there are functional and financial requirements for receiving this type of waiver.

Candidates for a Medicaid waiver in Texas must have a need for services that are typically provided in nursing homes. Essentially, this means that people who are unable to properly manage day-to-day activities without assistance, some of these individuals may even require around-the-clock medical supervision that caregivers or assisted living facilities can provide.

Again, in order to qualify for this type of a Medicaid waiver, there are financial restrictions. The monthly income limit for an applicant for STAR+PLUS from Texas Medicaid is just over $2300. The income limits become more complicated for married applicants.

The Benefits of Local Medicaid Waiver Programs

Again, to fully understand the benefits and details of a waiver program, you need to look at your program that is offered in your state specifically. For the STAR+PLUS waiver program in Texas, there are a number of different services and benefits that are offered. Some of these benefits include:

Some long-term care and support services include things like helping people in your home with basic day-to-day activities, short-term care to give caregivers a break, help with getting tasks done, and more.

How to Apply for Medicaid’s Waiver Program

All of this is great and useful information, but what are the next steps? How do you apply to get these types of Medicaid waivers?

These Medicaid waiver programs are available statewide in most states across the nation. Generally, these programs have a website to learn more about the details of the services offered. For example, the STAR+PLUS website has much more information about specific services that are offered and eligibility requirements.

After you apply, if you are accepted and approved for STAR+PLUs, you will get a packet in the mail that will tell you about the program and the medical plan options in your area. You will have 15 days to pick a medical plan

Overall, aging causes many problems and can lead to an inability to perform necessary day-to-day activities. When this happens, it is important to seek out resources like assisted living facilities or caregivers to help keep you or your loved one safe during this period. Assisted living programs can help provide your loved one with access to medical care and other services like memory care to help with any disorders, problems, or ailments that they may have. Moreover, many assisted living facilities can provide residents with access to social activities to keep them healthy during this period of their lives as well.

About The Author

Matthew Boyle is the Chief Operating Officer at Landmark Senior Living, a series of top-rated senior living communities in the Midwestern United States. He has been working in the healthcare space for 7 years and graduated from Duke University in 2011 Summa Cum Laude. Guided by a relentless pursuit of excellence, Matthew and the team at Landmark are dedicated to creating a supportive environment for the elderly.