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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.

Frequently Asked Questions