Idaho provides long-term care resources to seniors through the Idaho Department of Health and Welfare. Idaho offers a unique coordinated health plan for dual-eligible Medicare and Medicaid seniors. This program, the Medicare-Medicaid Coordinated Plan (MMCP), offers one set of comprehensive benefits, one accountable entity to coordinate the navigation and delivery of services, and one care management team to develop care plans and coordinate benefits. The MMCP is administered by Blue Cross of Idaho. The name of this plan is True Blue Special Needs Plan.
In addition to the MMCP program, Idaho offers alternatives to seniors who need a nursing home level of care through a Medicaid home-and-community-based (HCBS) waiver program. Idaho’s HCBS waiver gives adults who are elderly or physically disabled more choices for long-term care. Eligible adults will be able to choose services that allow them to stay in their own homes or communities. You can talk to staff at your nearest Medicaid office to find out if you qualify.
Medicaid Waiver Program for Assisted Living and In-Home Care
Idaho Aged & Disabled Medicaid Waiver (HCBS A&D Waiver)
The goal of the Aged & Disabled Waiver (A&D Waiver) is to assist Idaho’s elderly and disabled citizens. They must meet the nursing facility level of care to live in a home or community rather than in an institution. Individuals seeking A&D waiver services will complete an application for Medicaid with Self-Reliance staff in the Division of Welfare, a division within the Idaho Department of Health and Welfare. The Division of Welfare determines financial eligibility for the waiver. The Division of Medicaid’s Bureau of Long-Term Care (BLTC) administers the waiver.
When possible, A&D waiver services should be available in the consumer’s own home and/or community regardless of their age, income, or ability, and should encourage the involvement of natural supports, such as family, friends, neighbors, and volunteers. The Aged & Disabled Waiver offers services in settings such as the home or apartment of the participant or in homes or apartments where the participant lives with a family member.
Services included in the A&D Waiver include Certified Family Homes and Residential Assisted Living Facilities, Chore Services, Environmental Accessibility Adaptations, Home Delivered Meals, Personal Emergency Response System, Skilled Nursing, Specialized Medical Equipment and Supplies, Non-Medical Transportation, Homemaker, Attendant Care, Companion Services, Consultation, and Respite.
- Health: Applicants for the A&D waiver must meet the Nursing Home Level of Care.
- Financial: Applicants for the A&D waiver must meet certain income and asset limits to be eligible for the waiver program. For 2022, an individual’s Special Income Limit (SIL) is $2,523 per month (calculated at 300% of the SSI Federal Benefit Rate). The asset, or resource limit, is $2,000 for an individual and $4,000 for a married couple. If your income is too high to qualify under the criteria, the A&D waiver allows for a Miller Trust (or Qualified Income Trust) to funnel your income into and pay for care while becoming eligible for Medicaid. There are also additional requirements regarding the treatment of assets if the applicant is married and the spouse is not applying for the A&D waiver, commonly referred to as the “community spouse.” The A&D waiver sets certain Spousal Impoverishment Standards, which outline the rules for the treatment of assets and other financial requirements on the community spouse. For 2022, the community spouse is allowed to keep $137,400 in assets (known as the Community Spouse Resource Allowance, or CSRA).
The A&D waiver program will only cover up to 100% of the costs of nursing home care if the applicant requires treatment in a facility when determining an applicant’s eligibility. There are currently the following certified locations under the HCBS program:
- Adult Day Health Centers – 53 service sites
- Developmental Disability Agencies – 75 service sites
- Certified Family Homes – 2,212 service sites
- Residential Assisted Living Facilities – 352 service sites
Idaho’s Aged and Disabled Waiver is a good option for seniors who would rather reside in their homes or a community setting than a nursing home but require a nursing home level of care. The number of A&D waiver-qualified locations makes this program accessible. In addition, the ability to use a Miller Trust to help lower your income to meet the income and asset limits for Medicaid’s financial eligibility means that Medicaid planning for these services may help you access the care benefit under Medicaid if your income and assets are above the limit.
Access all state Medicaid Waiver pages.