Nursing Facility Waivers
This section specifically discusses Nursing Facility waivers.
These waivers are for children and adults whose needs are primarily
medical and assist a person to:
- Be as independent as possible
- Live in the least restrictive environment possible while
maintaining safety in the home
Aged and Disabled Waiver (A&D)
The Aged and Disabled Waiver provides an alternative to nursing
facility admission for people who are aged, blind, or disabled.
There is not an age requirement to qualify for this waiver. The
waiver is designed to provide services to supplement informal
supports for people who would require care in a nursing facility if
waiver services or other supports were not available. Available services for A&D
Waiver
Traumatic Brain Injury Waiver (TBI)
The Traumatic Brain Injury Waiver provides services to Medicaid
eligible people of any age who have experienced an external insult
resulting in a traumatic brain injury and who require services
ordinarily only available in a nursing facility. This waiver is
designed to provide supports, such as personal assistance, limited
habilitation services, and respite care, as well as limited
environmental modifications. Available
Services for the TBI Waiver
Who is Eligible?
You must meet financial and medical guidelines, including
meeting criteria for aged, blind, or disabled, in order to be
eligible for a Medicaid waiver. Family income is not considered for
children under age 18. The individual must be:
A&D Waiver
- Aged or disabled;
- Meet Nursing Facility Level of Care;
- Medicaid eligible based on 300% of maximum SSI amount (Parental
income for children under 18 years of age is disregarded; Spousal
impoverishment protection is the same as if a spouse was in a
nursing facility).
Traumatic Brain Injury Waiver
- Aged or disabled;
- Meet Nursing Facility Level of Care or ICF/IID Level of
Care;
- Determined to have a Traumatic Brain Injury;
- Medicaid eligible based on 300% of maximum SSI amount (Parental
income for children under 18 years of age is disregarded).
Nursing Facility Level of Care
To be medically eligible for the waiver program, an individual
must meet the required "Level of Care." Level of Care is the
minimum need an individual must have to be considered eligible for
the waiver. For the Aged and Disabled or the Traumatic Brain Injury
Waivers, a person must have either an unstable complex medical
condition which requires direct assistance from others for the
following conditions: decubitus ulcers, comatose condition, or
management of severe pain; OR direct assistance from others for
medical equipment, such as ventilator, suctioning, tube feeding,
central intravenous access (I.V.); OR direct assistance for special
routines or prescribed treatments from others such as tracheotomy,
acute rehabilitation conditions, administration of continuous
oxygen; OR medical observation and physician assessment due to a
changing, unstable physical condition; OR other substantial medical
conditions.
The initial Level of Care determination is made by the Area
Agency on Aging. Level of Care is required in order for the person
to be admitted into a nursing facility or initially start waiver
services. The waiver case manager will complete an annual Level of
Care evaluation for waiver services.
Eligibility Tables
The tables below show the current eligibility requirements for
waiver. Notice that members must meet both financial and medical
need criteria.
|
|
A&D Waiver |
TBI Waiver |
|
Financial Eligibility
|
- 300% of SSI
- Parental income and resources disregarded for children under
18
- Spousal impoverishment protections similar to those for nursing
homes
|
- 300% of SSI
- Parental income and resources disregarded for children under
18
|
|
Medical Eligibility
|
- Nursing Facility Level of Care
|
- Nursing Facility Level of Care
- Diagnosis of Traumatic Brain Injury
- ICF/IID Level of Care
|
Available Waiver Services
Available Services- A&D
Waiver
- Adult Day Service
- Adult Family Care
- Assisted Living
- Attendant Care
- Self Directed Attendant Care
- Case Management
- Community Transition
- Environmental Modifications
- Health Care Coordination
- Homemaker
- Home Delivered Meals
- Nutritional Supplements
- Personal Emergency Response System
- Pest Control
- Respite
- Specialized Medical Equipment and Supplies
- Transportation
- Vehicle Modifications
Available
Services- TBI Waiver
- Adult Day Service
- Adult Family Care
- Assisted Living Service
- Attendant Care
- Behavior Management/ Behavior Program & Counseling
- Case Management
- Community Transition
- Environmental Modifications
- Health Care Coordination
- Homemaker
- Home Delivered Meals
- Nutritional Supplements
- Personal Emergency Response System
- Pest Control
- Residential Based Habilitation
- Respite
- Specialized Medical Equipment and Supplies
- Structured Day Program
- Supported Employment
- Transportation
- Vehicle Modifications
Applying for a waiver
When should I apply?
It is helpful to apply as soon as you identify a need for waiver
services. Applications can also help the state government and
service systems plan for and be ready to meet needs in years to
come. If you have been denied Medicaid eligibility in the past, you
should re-apply when waiver services are or become available.
Where Do I Apply?
Go to your
local Area Agency on Aging (AAA). There are 16 Area Agencies on
Aging throughout the State. The FSSA
website can direct you to the appropriate AAA.