What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Waiver Description
The Home and Community-Based Alternatives Waiver Program was created for the target population of physically-disabled seniors who are either currently in nursing homes, intermediate care facilities, or are likely to need long term nursing home care within a month. Therefore, seniors who are in skilled nursing facilities on a temporary basis for rehabilitation following a hospitalization are an important target group for this waiver.
The program’s supports and services are designed to allow qualifying participants to return home or to continue living in their current residence. As such, the program assists participants in identifying and paying for their home assistance technology, emergency response service, and home accessibility modifications, in addition to their personal care and home health care.
The Home and Community-Based Alternatives (HCBA) Waiver allows for participant direction of personal care services. This means that program participants are able to hire the caregiver of their choosing. That includes specific relatives and friends. Generally, spouses and legal guardians are barred from receiving payment for providing care services. However, under certain circumstances, spouses and legal guardians can be authorized to be eligible as paid caregivers.
There are several other waivers for Californians with less severe care needs. The MSSP, ALWP, and CBAS programs provide support for home care, assisted living, and adult day care, respectively.
Eligibility Guidelines
General Requirements
Although open to California residents of any age, the HCBA Waiver has rigid financial and medical guidelines for qualification. The applicant must need a hospital level of care or nursing home level of care and already be residing in a hospital or nursing facility, or be at risk of institutionalization within 30 days without services from this waiver. Qualified applicants must be able to safely and sustainably receive their required care in their homes. Applicants who are currently residing in a residential care facility will be prioritized for funding.
Financial Requirements
Income Limits
For 2023, the income limits are $1,564 / month for an individual and $2,106 / month for a couple when both spouses are applying for Medicaid. Individuals or couples who have gross monthly incomes that slightly exceed these limits may still qualify by deducting health insurance premiums from their countable income.
When a married applicant has a healthier spouse (a non-applicant spouse) who continues to work or has unearned income from a pension or Social Security, their income is not used to determine the applicant’s eligibility. Furthermore, income may be transferred from an applicant spouse to a non-applicant spouse as a monthly maintenance needs allowance. Not only does this lower the applicant spouse’s countable income, it also ensures a non-applicant spouse does not become impoverished. As of 2023, up to $3,715.50 a month can be transferred to a non-applicant spouse. However, the spousal income allowance cannot put the non-applicant spouse’s monthly income above this level.
This waiver requires full Medi-Cal eligibility. Therefore, higher income individuals who only qualify for Aged and Disabled Medi-Cal with a “Share of Cost” are not eligible for services under this waiver.
Asset Limits
In 2023, the asset limits are $130,000 for individuals and $195,000 for couples with both spouses as applicants. Unlike with income, the couple’s assets are considered jointly owned. However, the non-applicant spouse is allowed to keep a greater portion of the assets. Called a community spouse resource allowance, the non-applicant spouse can keep up to $148,620 of the couples assets, while the applicant spouse is able to keep $130,000. Learn more here.
The primary residence is considered exempt from one’s countable assets, regardless of equity value interest. Please note, California is set apart from the rest of the states. This is because it is the only state that does not have a limit on home equity interest for exemption purposes. Other asset exemptions include household furnishings, certain sentimental items, such as wedding rings, and a vehicle.
Persons whose income or assets exceed the California Medicaid limits and couples where only one spouse is seeking Medicaid should consult with a professional Medi-Cal planner to structure their assets and income appropriately to enable them the best possibility of acceptance into Medi-Cal.
Please note that California updates financial eligibility guidelines in March of each year.
Benefits and Services
The HCBA waiver is designed to allow individuals to remain living at home or return to living in their homes after an extended stay in a skilled nursing facility. This initiative is formally referred to as the California Community Transitions (CCT) Project. As the goal is to move persons out of nursing homes, the benefits available to participants are chosen with this objective in mind. Participants may receive any of the following:
- Case management
- Home health aide services
- Home modifications to enable improved access
- Personal care
- Medical equipment maintenance and recurring expenses
- PERS (personal emergency response service, installation and fees)
- Respite care (both at home and in residential care on a temporary basis)
- Skilled nursing services
- Training for family caregivers
- Habilitation services
How to Apply / Learn More
This program is current and available throughout California. However, because this is a waiver program and not an entitlement program, there can be waiting periods for services to start. The enrollment caps increase annually from approximately 7,150 participants in 2021 to approximately 9,871 in 2024.
More information and an application are available on the Department of Human Services webpage. The complete process can take between two to five months to get a care plan started and transition the patient out of the facility.
