Waiver Description
This Maine Medicaid (MaineCare) Elderly and Adults with Disabilities Waiver is designed to help the elderly by funding services and supports to allow nursing home qualified individuals to remain living at home or in their communities. Typical services include home care, medical alert systems, transportation, and chore assistance (a complete list can be found further down this page).
Individuals choosing this waiver can have the state manage their care services or they can choose to self-direct their care under the Participant-Directed Option. Self-direction gives participants the flexibility to choose their own personal care providers. Some family members, including the adult children of aging parents, can be hired to provide personal care. (Spouses cannot be hired to provide care).
The Participant-Direction Option requires participants to use a third-party financial management company to assist in their role as “employers.” The financial management company helps with managing payroll and paying employer taxes.
This waiver is administered by Maine’s Department of Health and Human Services’ Office of Aging and Disability Services.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
To qualify for services under this MaineCare waiver, the state considers several factors: the applicant’s age and level of disability, and their income and assets.
General Requirements
- Applicants must be residents of Maine.
- They must be age 65 or older.
- Applicants must require the level of care provided in a nursing home as determined during a medical review.
Financial Requirements
Income Limits
Unmarried or widowed applicants must have income no higher than 3 times the Supplemental Security Income rate. In 2024, an applicant’s monthly income cannot be above $2,829. If a married couple is applying, the spouses are looked at as if they are two separate applicants. This means each spouse can have monthly income up to $2,829.
However, a more common scenario is for one spouse of a couple to apply. In this situation, the $2,829 a month income limit still applies for the applicant, but the non-applicant spouse’s income is not considered. In addition, the applicant spouse is able to allocate some of their income to the non-applicant spouse in order to prevent that spouse from becoming impoverished.
As of 2024, up to $3,853.50 a month can be allocated to the non-applicant spouse. This is called a monthly maintenance needs allowance. If the non-applicant spouse already has monthly income equal to, or above, this figure, a transfer of income is not permitted from the applicant spouse.
Asset Limits
The asset limit for single MaineCare applicants in 2024 is $10,000 in countable resources. Married couples with two applicants are permitted $15,000. (Unlike income, assets of a married couple are considered jointly. Learn more here.) If one spouse is not seeking assistance, the applicant spouse is permitted up to $10,000, and the non-applicant spouse can retain up to $154,140. (This figure that the non-applicant spouse can keep is called the community spouse resource allowance).
Emphasis should be put on the fact that these limits are for countable assets. There are non-countable / exempt assets, which include a family home provided its equity value does not exceed $750,000 (in 2024), household goods, and a vehicle, provided it is in use and not an investment or high-value collector’s item. These types of items are not counted toward the asset limit.
Over the Financial Limits?
Fortunately, there are options for residents whose finances are greater than the allowable income and / or asset limits. MaineCare offers a Medically Needy exception for persons with high recurring medical costs that consume most of their income. This option, which is often referred to as a Spend Down Program, works similarly to a deductible program. Once the applicant spends down their excess income on medical bills and meets the income limit, the applicant is eligible for the Elderly and Adults with Disabilities Waiver for the remainder of the six-month “spend down” period.
Unfortunately, the medically needy option does not assist applicants with excess assets to meet the asset limit. Rather, applicants can spend assets that are over the limit on non-countable ones. This might be upgrading one’s heating and/or plumbing, adding a first floor bedroom for easier access, or paying off credit cards and other debt. When “spending down” excess assets, it is crucial that no assets are gifted or sold for under value. This is because Medicaid has a look-back period of 5-years. During this period of time, Medicaid reviews all transactions to ensure this rule has not been violated, and if it has, an applicant will not be eligible for Medicaid for a period of time.
Working with a Medicaid planner is another approach for families who cannot afford their care costs. Planners help families qualify for MaineCare by re-allocating their excess income into annuities and by converting resources into non-countable assets. These and other approaches are complicated and require expertise. Read more here.
Confused by the Eligibility Requirements?
Assistance is available to sort through these complexities.
Benefits and Services
Each applicant receives a customized care plan that can include any of the below mentioned benefits. Certain services, such as personal care and in-home respite care, can be consumer-directed.
- Assistive Technology
- Care Coordination
- Chronic Disease Self-Management
- Environmental Modifications / Home Modifications – Stair lifts, roll-in showers, grab bars, etc.
- Fall Prevention
- Fiscal Management Services – For consumer-direction of care
- Home Health Services – Nursing and therapies (speech, occupational, and physical)
- Homemaker – Housecleaning and meal preparation
- Independent Living Assessment
- Personal Care / Attendant Care
- Personal Emergency Response Systems
- Respite Care – In-Home / Out-of-Home
- Skills Training
- Non-Emergency Transportation
- Home Delivered Meals
