Iowa Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Iowa Medicaid will cover the cost of long-term care in a nursing home for eligible Iowa residents who require a Nursing Facility Level of Care. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physicians visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living . Nursing Home Medicaid is an entitlement, which means that all eligible applicants are guaranteed by law to receive the benefits.
Some of the things Iowa Medicaid wont cover in a nursing home are a private room, specialized food, comfort items not considered routine , personal reading items, plants, flowers, and any care services not considered medically necessary.
Home and Community Based Service Waivers
Home and Community Based Services Elderly WaiverIowas HCBS Waiver for seniors is the Home and Community Based Services Elderly Waiver, which is commonly called the Elderly Waiver. This waiver provides long-term services and supports for Iowa Medicaid beneficiaries who live in their own home, the home of a loved one or an assisted living residence. The intention of the Elderly Waiver is to delay nursing home placement.
Aged Blind and Disabled / Regular Medicaid
What Is The Elderly Waiver Program
Iowa has a Medicaid program for helping people who need extra care to stay out of nursing homes and continue to live at home. For people over 65 the program is called the Elderly Waiver program. The program provides funding for services and personal care support in your home or an assisted living facility. The program is for people who would need to go to a nursing home or other medical institution if they did not get this in-home care. With the desire to stay in your home and the high cost of nursing home care, this is an important program for elderly Iowans.
What are the requirements for eligibility for the Elderly Waiver program?
For a single person in 2022: if your monthly income is $2,523 or less and your assets are $2000 or less and you need in-home care, you may be eligible for Elderly Waiver Program. You do not count your home, car, household goods, and certain burial/funeral funds or contracts. If your monthly income is over $2,523 you may still be eligible under certain conditions.
If you are married and only one of you needs help, the asset limits are more complicated. The spouse not applying for help may be able to keep assets up to $137,400 and possibly more.
- You must be an Iowa resident and a U.S. citizen or person with legal entry into the U.S.
- You must be 65 years of age or older.
- You must meet the income and assets requirements for Medicaid assistance for living in a nursing home facility.
- You must need nursing or skilled level of care.
The Seven Hcbs Waivers
If you wish to learn more about the HCBS Waiver Program, please read the HCBS Waiver Program brochure, “Are Home and Community Based Services Right for You?“
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What Are The Requirements To Receive Medicaid Title 19
In all states, Medicaid provides coverage for some low-income people, like the ones listed above. In some states, Medicaid has been expanded to cover all adults below a certain income level.
In order to qualify for this benefit program in the state of Iowa, you must be a resident of the state of Iowa, a U.S. national, citizen or permanent resident in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
You can view the household size to income chart to see if you and your family could qualify. You can also fill out an online questionnaire to get a better idea of whether or not you would qualify.
What Is An Elderly Waiver
The Iowa Home and Community Based Services Elderly Medicaid waiver provides services and support to help the elderly who are medically qualified for nursing home care. It is designed to allow individuals to remain living at home, or in retirement communities, and receive care in those locations instead of in nursing homes.
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What Makes Elderly Waiver Programs Appealing
Elderly Waiver Programs provide all the services youd get in a nursing home, except the care takes place in your residence. The level of care plus the lower costs makes these programs an attractive alternative to staying in an institution like a nursing home or skilled nursing facility.
You can choose who you get your care from. Anyone other than your spouse or legal guardian can be a caregiver. This could be someone you trust and are familiar with, such as a friend, relative, or neighbor. You wont be dealing with a stranger if you dont want to.
What Does Medicaid Cover
Medicaid covers a comprehensive range of healthcare services for Iowans who meet the programs eligibility criteria. These services can include healthcare, behavioral care, long term care, home and community based support services.
For a comprehensive list of what Medicaid can cover visit Iowas Department of Human Services Medicare Services webpage.
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What Are The Requirements To Receive An Elderly Waiver
Some of the requirements you need to meet in order to receive an Elderly Waiver in Iowa include:
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Being an Iowa and U.S. resident
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Being 65+ years old
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You have to be determined eligible for Medicaid as if the member was in a medical institution. Members may be Medicaid-eligible before accessing waiver services or be determined eligible through the application process for the waiver program. Additional opportunities to access Medicaid may be available through the waiver program even if the member has previously been determined ineligible.
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Be determined by the Iowa Medicaid Enterprise, Medical Services Unit, to need nursing or skilled level of care.
Hcbs Brain Injury Waiver
The HCBS BI is another waiver offered by the state of Iowa to keep individuals within their homes or communities instead of being medically institutionalized. Services under this waiver are much like the others, including adult day care, behavioral programming, case management, family counseling, home/vehicle modifications, personal emergency response systems, respite, specialized medical equipment, and transportation. Eligible individuals must be residents of Iowa, a US citizen or allowed legal entry into the US, be determined to have a diagnosis of a brain injury as confirmed by the Iowa Medicaid Enterprise/Medical Services Unit, be eligible for Medicaid, and be between the ages of one month and 64 years.
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Eligibility Criteria For Iowa Medicaids Long Term Care Programs
To be eligible for the Iowa Medicaid, a person has to meet certain financial and functional requirements. The financial requirements vary by the applicants marital status, if their spouse is also applying for Medicaid, and what program they are applying for Nursing Home / Institutional Medicaid, Home and Community Based Service Waivers or Aged Blind and Disabled Medicaid / Regular Medicaid.
Iowa Nursing Home Medicaid Eligibility Criteria
For married applicants with both spouses applying, the 2022 asset limit for nursing home coverage through Iowa Medicaid is $3,000 combined, and the income limit is $2,523 / month per applicant. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.
Iowa Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they dont, Iowa has a look-back period of five years. This means the state will look back into the previous five years of the applicants financial records to make sure they have not given away assets.
Iowa Medicaid Home and Community Based Service Waivers Eligibility Criteria
Iowa Aged Blind and Disabled Medicaid Eligibility Criteria
How Iowa Medicaid Counts the Home for Eligibility Purposes
Medicaid Home And Community Based Services Elderly Waiver
The Iowa HCBS Elderly Waiver is for seniors over the age of 65 who would rather live in their own home or community setting rather than a nursing home. The applicant must choose that they would rather receive a nursing home level of care outside of a nursing facility to be eligible. It provides an array of services, including assisted living and in-home care, as well as many additional long-term care services tailored to the specific waiver recipient.
Services
Services included in the HCBS Elderly Waiver consist of: Adult Day Care, Assistive Devices, Case Management, Chore Services, Consumer Directed Attendant Care, Emergency Response System, Home and Vehicle Modifications, Home Delivered Meals, Home Health Aide, Homemaker Services, Mental Health Outreach, Nursing Care, Nutritional Counseling, Respite, Senior Companions, Transportation, and Consumer Choices Option.
Eligibility
Members may be eligible for HCBS Elderly Waiver services by meeting the following criteria:
- Be an Iowa resident and a United States citizen or a person of foreign birth with legal entry into the United States
- Be 65 years of age or older
- Be determined eligible for Medicaid as if the member was in a medical institution.
Practical Considerations
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Whats The Difference Between Cdac And Cco In Elderly Waiver Programs
CDAC and CCO programs help restore freedom in their own ways.
With CDAC, youre getting assistance with taking medications, tube feeding, walking, and dressing.
CCO programs give you a budget as determined and approved ahead of time. These also expand your covered care options modifications that make your home easier to navigate, emergency devices, and homemaking are all examples of what CCO can do for you.
Iowa Medicaid Long Term Care Programs Benefits & Eligibility Requirements
SummaryMedicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Iowa Medicaid Long Term Care, which is different from regular Medicaid. In Iowa, Medicaid is also called IA Health Link. Iowa residents can receive long-term care benefits through Iowa Medicaid in a nursing home, in their home and in other residential settings through one of three programs Nursing Home / Institutional Medicaid, Home and Community Based Service Waivers or Aged Blind and Disabled Medicaid.
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Iowa Admin Code R 441
Payment will be approved for the following services to members eligible for the HCBS elderly waiver services as established in 441-Chapter 83 and as identified in the member’s service plan. Effective March 17, 2022, payment shall only be made for services provided in integrated, community-based settings that support full access of members receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
Adult day care services.Personal emergency response orportable locator system.Home health aideservices.Homemaker services.Nursing care services.
A unit of service is one visit. Nursing care service can pay for a maximum of eight nursing visits per month for intermediate level of care persons. There is no limit on the maximum visits for skilled level of care persons.
Respite care services.Chore services.“a,”Home-deliveredmeals.Home and vehicle modification.
Some Of The Available Services
Consumer Choices Option CCO Information FlyerConsumer Choices Option webpageConsumer Directed Attendant Care ServicesCDAC webpage
- Employment MatrixThe Department, in collaboration with the Iowa Association of Community Providers , the Iowa Coalition for Integration and Employment , and the managed care organizations , has developed an Employment Matrix. This tool was created to provide an easy to follow guide to HCBS-funded employment services and supports. The Employment Matrix also provides guidance regarding the employment service provider staff qualifications and training requirements and the processes for service authorization for employment services for both FFS and the MCOs.
- Employment First Guidebook The Department, in partnership with employment stakeholders, has developed an Employment First Guidebook. This Guidebook was created to provide case managers, care managers, service coordinators and Integrated Health Home care coordinators with critical information, resources and tools to help them do the best possible job of assisting transition-age youth and working-age adults with disabilities they support to work.
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What Is 100% Private Pay
Private assisted living includes homes or facilities that are privately owned rather than affiliated with a hospital or another medical organization. They are geared towards seniors who may no longer be able to live at home, but do not need the level of medical attention offered at, for example, a nursing home. Its important to know that Medicare typically does not pay for assisted living. Medicaid coverage is also highly unlikely, although it depends on individual state regulations.
Iowa Medicaid Waiver Programs
The State of Iowa currently has several Home and Community Based Services , waiver programs for those in need. The HCBS waivers are Medicaid Programs from the federal government which have rules set aside or waived. This gives you more choices about how and where you receive services. It is for people with disabilities and older Iowans who need services. These services may allow you to stay in your home. You must be eligible for Medicaid and also meet the requirements for the waiver you are applying for and/or receiving.
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Hcbs Health & Disability Waiver
The HCBS Health and Disability waiver is intended for individuals who would require care in an institution or nursing facility to stay within their own homes or communities. Members are able to have a DHS service worker or case manager that works with the individual and their families on a service plan that is customized to their needs. Some of the services that the waiver provides include adult day care, consumer directed attendant care, counseling services, meal delivery, home health, home/vehicle modifications, medical monitoring and treatment, respite, and personal emergency response systems.
To be eligible, participants must be a resident of Iowa, a US citizen or have legal entry into the US, receiving social security benefits, eligible for Medicaid, have total costs not exceeding $950 a month for nursing level care, and $2765 a month for skilled level care.
Applying For Iowa Medicaid Long Term Care Programs
The first step in applying for Iowa Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for Nursing Home Medicaid, Home and Community Based Service Waivers or Aged Blind and Disabled Medicaid / Regular Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Iowa Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, its important to start gathering documentation that clearly details the financial situation for the Iowa Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts a letter from the Social Security Administration showing the applicants gross Social security income and deductions tax forms to verify income streams including wages, pensions, royalties and interest lists of items of any trusts proof life insurance and a list of beneficiaries Power of Attorney documentation.
Choosing an Iowa Medicaid Nursing Home
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Hcbs Physical Disability Waiver
As with the above waivers, the HCBS PD helps to allow individuals the ability to stay in their home or their communities. The services for this waiver include consumer directed attendant care, home/vehicle modifications, personal emergency response systems, specialized medical equipment, and transportation.
To be eligible for this waiver, individuals must be a resident of Iowa, a US citizen or have legal entry into the US, have a physical disability, be eligible for Medicaid, and between the ages of 18 and 64 years. Individuals cannot be eligible for the Intellectual Disability waiver that is also offered by the HCBS.
What Is Medicaid
Medicaid provides medically necessary healthcare coverage for financially needy elderly people, parents with children, people with disabilities and pregnant women. The goal is for members to live healthy, self-sufficient lives.
Medicaid can help to cover the cost of assisted living including memory care. Since Medicaid is both a federal and state program, the eligibility requirements, available programs and benefits vary.
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