Long Term Care and Home and Community Based Services Medicaid

Are you disabled? Is your monthly income below $2,742 before taxes? Do you or a loved one need nursing home-level care? If so, you may want to think about Medicaid. That’s right. Medicaid. Medicaid provides certain eligible individuals with the assistance needed to perform the activities of daily living through the Long-Term Care (LTC) and Home and Community-Based Services (HCBS) Programs. This article sheds some light on those programs.

Let’s start with LTC Medicaid. LTC Medicaid is for individuals who are disabled and need nursing home-level care, which is defined as being unable to perform or needing significant supervision performing at least three to four of the following activities of daily living: dressing, transferring, mobility, bathing, eating, and toileting. The inability to perform these activities is functionally assessed by the Colorado Department of Health Care Policy and Financing.

If you meet these age and medical requirements, you must then meet income and asset requirements to be eligible for LTC Medicaid. Currently, this means having less than $2,742 in income per month and less than $2,000 in assets if you are single. If you are married, you can have up to $3,000 in assets. Income includes work earned from a job or unearned income such as social security retirement benefits but does not include certain things such as reverse mortgage payments. Income for LTC Medicaid is also measured individually, meaning your spouse’s income is not included in the calculation. Assets include things such as cash in checking or savings accounts, stocks, bonds, retirement funds and revokable (whole) life insurance policies, but do not include your primary house or vehicles that together are worth less than $7,000. Most personal property also does not count as an asset. Assets are measured by household, meaning your spouse’s assets will also count toward the asset threshold.

If you meet these income and asset requirements, you may receive long-term care in a nursing facility without having to pay the out-of-pocket costs normally associated with such care. Instead, individuals with LTC Medicaid pay their gross monthly income minus a $95.97 deduction for personal needs to receive nursing facility care. This means that your monthly income will go toward the cost of your care, except for $95.97, which you will receive as a personal needs allowance. In certain circumstances, you may be eligible for other deductions that can allow you to keep more money in your pocket. 

The second program that you may want to think about is Home and Community Based Services (HCBS). HCBS offers several programs for individuals with different functional impairments. However, the HCBS program that is most ubiquitous for older adults is the Elderly, Blind, and Disabled (EBD) Waiver program and it is the program that we will discuss in this article.  This program is for adults who need nursing home-level care but are physically and financially better off receiving that care at home or in their community. Under the HCBS-EBD program, you may receive things such as nurse assistance, house cleaning, meal preparation, and assistance with bathing and dressing, if you have a functional need demonstrated via a Single-Entry Point evaluation or home visit.

The HCBS-EBD Waiver program has two categories. The first category is for adults 65 or older. If you fall within this category, you need to meet the same medical, income, and asset requirements as in an LTC Medicaid application. However, unlike LTC Medicaid, the HCBS-EBD Waiver Program, like other HCBS programs, does not require individuals to pay any portion of their income toward the cost of their care. The HCBS-EBD program is available to adults between the ages of 18 and 64, but only if they are blind or physically disabled, or if they have HIV or AIDS. There are also four children’s HCBS waiver programs.

As we age, we sometimes must accept the fact that we need assistance with some of the activities of daily living. Luckily, the State of Colorado offers both the LTC and HCBS programs to certain low-income individuals who need assistance with their activities of daily living. If you feel like you need this assistance, contact Benefits in Action at 720-221-8354 or via email at info@benefitsinaction.org. Our experienced counselors can help you determine whether the LTC or HCBS programs are a potential fit for you and, if so, can help you with the application process.

Leave a Reply