The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Alabama Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. This means that eligible Alabama residents who apply are guaranteed by law, aka entitled, to receive Nursing Home Medicaid benefits once their application has been approved. More. If the nursing home is not Medicaid certified, he or she would have to transfer to a NF to be covered by the Medicaid NF benefit. Under this waiver, candidates are eligible to receive the following types of care and support. To be eligible for Alabama Medicaid, a person has to meet certain financial and functional (medical) requirements. There are a limited number of participant slots available, so in some areas, there may be waiting lists for services. Can Medicaid Take My Home: Interactive Tool Youll be contacted within one business day. These programs provide care at home or in the community. Expedite's ability to receive uploaded forms and documents guarantees the attachments will . Assistive Technology / Durable Medical Equipment While ones home is generally safe from Medicaids asset limit, it is not safe from Medicaids Estate Recovery Program. Furthermore, applicant spouses are able to transfer a portion of their income to their non-applicant spouse to ensure they have sufficient funds from which to live. Financial Requirements UnitedHealthcare Connected general benefit disclaimer. The applicant has a disabled child living in the home. More on how Medicaid counts income. Alabama has another program with self-direction that may be of interest to the reader: the SAIL Waiver. Alabama Medicaid Agency Gateway To Community Living, Class Of 2023 Inducted Into Alabama Senior Citizens Hall Of Fame, ADSS Seeks Vendors for Financial Management Services. The E&D Waiver is for Alabama residents who are elderly (65+), or younger if disabled, and at risk of nursing home placement. Medicaid Waiver for the Elderly and Disabled (E&D Waiver), The Elderly and Disabled Waiver program provides services to the elderly and individuals with disabilities at risk for nursing facility placement. Irreversible means that the terms of the trust cannot be changed or canceled. If the non-applicant spouse has income equivalent to $2,465 / month or more, the applicant spouse cannot transfer any monthly income to the non-applicant spouse. The services provided through these programs allow individuals to remain in the community. It is a 1915(c) Medicaid Waiver. Other exemptions include personal belongings, such as clothing, household furnishings, an automobile, and generally ones primary home. For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through Alabama Medicaid is $2,000 per spouse, and the income limit is $2,742 / month per spouse for a total of $5,484 / month. Alabama follows the income-first rule. Find what you need Top Ranked Nursing Homes Facilities in Alabama There are 227 nursing homes facilities in AL and the median cost of care is $5,099. The Bureau of Home and Community Services is the parent agency for the statewide Medicare/Medicaid Certified Home Health Program that serves all Alabama counties. Income is counted differently when only one spouse applies for Regular Medicaid / Medicaid for Elderly and Disabled; the income of both the applicant spouse and non-applicant spouse is calculated towards the income eligibility of the applicant. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. How do I apply? Learn More Summary 3) Regular Medicaid / Medicaid for Elderly and Disabled (E&D) This is an entitlement program; anyone who is eligible will receive services. There are three categories of Medicaid long-term care programs for which AL seniors may be eligible. It supports clients receiving LTSS in the least restrictive setting of their choice. These individuals are knowledgeable about Medicaid law nuances in each state and can help to restructure an individuals or familys excess income into Miller income trusts and maximize exempt (non-countable) assets. Examples include getting food into their mouth, the ability to move from a bed to a wheelchair, and correctly administering their medications. Having income and / or assets over Medicaids limit(s) does not mean an applicant cannot still qualify for Medicaid. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, the state uses the Alabama Home and Community Based Program Assessment (HCBS-1) form. You may be eligible for Medicaid coverage in a nursing home even if you haven't qualified for other Medicaid services in the past. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner. Find assistance to prepare for Medicaid. This is because Medicaid has a Look Back Rule and violating it results in a Penalty Period of Medicaid ineligibility. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. It is vital that Alabama Medicaid applicants be certain that all eligibility requirements are met prior to applying for benefits. There are 219 nursing homes in Alabama that accept Medicaid, and about 25% of them are located in just 3 of the states 67 counties Jefferson County, Mobile County and Madison County. Alabama Medicaid Long Term Care Programs It is also called aMiller Trustor a Qualified Income Trust (QIT). Furthermore, the state of Alabama Medicaid authorities must be listed as the remainder beneficiary. Please This waiver offers seniors 65 years of age and over, as well as disabled Alabama residents, financial assistance for ongoing personal care services at home or in the home of a friend or family member. However, a Spousal Impoverishment Provision permits the non-applicant spouse of a Medicaid Nursing Home or Waiver applicant a Community Spouse Resource Allowance (CSRA). By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaids Estate Recovery Program. Prepaid burial contracts and burial funds are also exempt up to $5,000. Functional Requirements By using our website, you agree to our terms of use and privacy policy. 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 (eating, bathing, moving, dressing, toileting). Elderly & Disabled (E&D) Waiver The Alabama Home and Community Based Program Assessment (HCBS-1) form is used to determine if the E&D Waiver applicant does require a Nursing Facility Level of Care. One can contact their local district Medicaid office for assistance. UnitedHealthcare Dual Complete Select (HMO-POS D-SNP) For an elderly person to be eligible for nursing home care, assisted living, adult foster care, or in-home care from Medicaid, they must have limited income and assets. Key Medicaid Information for Alabama Protections for the Community Spouse Community Spouse Resource Allowance (CSRA): Minimum: $29,724.00 Maximum: one-half of countable assets up to $148,620.00 Increased CSRA: Not permitted. As of the program's start date, 253,991 Alabama . The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Assets The CMS data also showed that Alabama nursing homes averaged just 10 health deficiencies from 2019-2022, which is well below the national average of 25.7 health deficiencies per nursing home for the same time period. 1) Standard ABD Benefits Adult Day Health (Adult Day Care) Education, health screening, therapeutic and recreational activities, transportation, etc. Countable vs. Non-Countable Assets The table below provides a quick reference to allow Alabama seniors to determine if they might be immediately eligible for long-term care from a Medicaid program. This is in addition to the $2,000 the applicant spouse is able to keep. Financial Requirements For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Copyright 2023 All rights reserved. Please Note: The term spend down refers to spending down ones excess assets to meet the E&Ds asset limit. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required. The value of countable assets are added together and are counted towards Medicaids asset limit. ), Meet certain medical criteria, Those goals are: to Improved education and outreach about LTSS options; More comprehensive and integrative case management; and Increased percentage of the LTSS population residing in the HCBS setting. 1) Choice - Not all nursing homes accept Medicaid. 7/1/23 6/30/24). Nursing Home Medicaid is an entitlement. So, even if an applicant is eligible for an HCBS Waiver program in Alabama, they are not guaranteed by law to receive the benefits. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. For reporting purposes, nursing facilities shall refer to the Notifiable Disease Case Report, Alabama Department of Public Health, Form ADPH-EPI-22/Rev. If the individual exhausts assets and is eligible for Medicaid, and the nursing home is also a Medicaid certified nursing facility, the individual may continue to reside in the nursing home under the Medicaid NF benefit. All assets of a married couple are considered jointly owned. This is a Spousal Impoverishment Rule and is the minimum amount of monthly income to which a non-applicant spouse is entitled. Some assets are not counted towards Medicaids asset limit. If he / she has income equal to or greater than the MMMNA (currently $2,288.75), the applicant spouse is not able to transfer any of his / her income to the non-applicant spouse. Call (855) 481-6777 to speak to a Family Advisor for FREE for immediate assistance PDF Medicaid for the Elderly and Disabled - adph.org The plan of care and case management services are based on individual client needs. Help & Services Medicaid Waiver Programs The Alabama Department of Senior Services (ADSS) is the operating agency for several Medicaid Waiver Programs. Home Modifications (b) Every nursing facility participating in the Medicaid program in the State of Alabama shall be reimbursed according to the reimbursement methodology contained in Chapter 560-X-22 of the Alabama Medicaid Agency Administrative Expedite ensures immediate receipt of Medicaid applications by the Alabama Medicaid Agency. After being approved for nursing home coverage through Alabama Medicaid, you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. View the ADSS Personal Choices Program Page here. Non-Medical Companion Services In addition to providing companionship and supervision, limited assistance with personal care and homemaker tasks may be provided. The home is also exempt, regardless of applicant circumstances, if a spouse lives in the home. When only one spouse of a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. Treatment of Assets for a Couple Further complicating financial eligibility are the facts that the requirements change annually, vary with marital status, and that Alabama offers multiple pathways towards Medicaid eligibility. To be eligible for the Medicaid programs listed above, you must: Be living in Alabama, Be a U.S. citizen (You must provide proof of citizenship and identity unless you have been approved for Medicare or SSI. For these persons, Medicaid planning exists. Hospital to Home helps individuals return home after a hospitalization. Examples include cash, stocks, bonds, investments, promissory notes, bank accounts (credit union, savings, and checking), any remaining funds from Covid-19 stimulus checks, and real estate in which one does not reside. Other examples that indicate that a nursing home level of care is required are the regular use of oxygen, behavioral issues associated with Alzheimers disease and related dementias, such as frequent wandering, and extensive bedsores. Elderly AL residents who are over the income and / or asset limit(s), or are unsure if they are, should strongly consider Medicaid planning for the best chance of acceptance into a Medicaid program. It is designed to offer older adults and individuals with disabilities more choices and exibility in the type of care they receive. 3) Alabama Community Transition Waiver (ACT) Assists nursing home residents with transitioning back to living in their home or the home of a family member. Frank Willis Named Ombudsman of the Year . Almost all income is counted IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. This site is for information purposes; it is not a substitute for professional legal advice. The TA waiver provides services to individuals age 21 or older with complex skilled medical conditions who are ventilator dependent or have a tracheostomy and who would otherwise require care in a long-term care setting to remain in the community. IMPORTANT: Not meeting all of the criteria does not mean one is ineligible or cannot become eligible for AL Medicaid. Income Limit. Alabamas Elderly and Disabled (E&D) Waiver program, a Home and Community-Based Services (HCBS) Medicaid Waiver, gives seniors who are frail, high-needs, and would qualify to be admitted to a 24-hour skilled nursing facility a way to afford care assistance outside of this setting. Some of the things that Alabama Medicaid wont cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary. Alabamas Elderly and Disabled Waiver (E&D Waiver) provides home and community-based services (HCBS) for elderly and disabled Alabama residents who are at risk of being institutionalized (being placed in a nursing home). 1115 Substance Use Disorder Demonstrations Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations Health Related Social Needs Managed Care Managed Care Authorities Enrollment Report Managed Care Entities Persons who are qualified to be hired as caregivers include sons, daughters, adult grandchildren, nieces, nephews, and in some cases, spouses. This site is for information purposes; it is not a substitute for professional legal advice. Theres only two nursing homes in Shelby County, which is the sixth biggest and just south of Jefferson County. Alabama Medicaid The Elderly & Disabled Medicaid waiver is available statewide throughout Alabama. Use or replication of this content by other web sites or commercial entities without written permission is strictly prohibited. While Alabama Medicaid will cover some services in all of those settings, it will not cover room and board costs. Alabama residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. While Alabama has a look-back period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they dont give away their assets to get under the limit, there is no look-back period for ABD Medicaid applicants. Benefits include home modifications, respite care, personal emergency response systems, companionship services, and adult day care. Long-term care insurance In Alabama, Medicaid is administered by the Alabama Medicaid Agency. Thats in line with data collected by CMS from 2019-2022 which shows that only 1.1% of Alabama nursing home residents reported depressive symptoms. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Alabama Medicare assistance program options | medicareresources.org This is because Alabama has a Medicaid Look-Back Period that immediately precedes ones application date. And the Alabama Nursing Home Association reported that 86% of residents are satisfied with their care in Alabama nursing homes and would recommend their facility, and 85% of families of residents were satisfied and would recommend their facility. Unfortunately, there is not an option for elderly and disabled AL residents to apply online. The overall goal of nursing home care is to assist individual residents to attain or maintain their highest practicable physical, mental, and psychosocial well-being. ABD Medicaid can sometimes be referred to as Regular Medicaid for Seniors, but it should not be confused with the Regular Medicaid that is available for low-income people of all ages. Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Alabama Medicaid recipients who require a Nursing Facility Level of Care remain, or return to, living in the community instead of living in a nursing home. Case Management: A case manager is a person who works with the client to determine what help is needed to remain safely at home. ABD Medicaid beneficiaries qualify for these benefits and services one at a time, which is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. An overview of Alabama Medicaid's long term care programs, benefits and eligibility requirements including nursing home care, assisted living and in-home care. Persons sometimes mistakenly think that the U.S. Federal Gift Tax Rule extends to Medicaid eligibility. Program participants must require a level of care consistent to that which is provided in a nursing home residence. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. View the ADSS Personal Choices Program Page here.View the ADSS Personal Choices brochure here. The E&D Waiver is for Alabama residents who are elderly (65+), or younger if disabled, and at risk of nursing home placement. The word waiver means something like voucher in this instance. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits. This allows beneficiaries to hire family members, including spouses in some cases, as caregivers. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets. Speak with a Senior Care Expert Today (For Free). 1) Alabama Elderly and Disabled Waiver (E&D) Assists seniors in living in the community by providing benefits that promote independent living, such as meal delivery, homemaker services, personal care assistance, and adult day health. Completed applications should be mailed to ones Medicaid district office. The Nursing Home Compare search can be filtered by overall rating, health inspections, staffing and quality measures, so that can be a good place to start. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. The E&D waiver is administered by the Alabama Department of Senior Services (ADSS) and the Alabama Medicaid Agency (AMA). The ACT waiver provides services to individuals with disabilities or long-term illnesses who live in a nursing facility and wish to transition to a home or community setting. A senior living alone might receive in-home personal care assistance and homemaker services to promote independent living, while a program participant with an informal family caregiver might be eligible for adult day health care and respite care to supplement the care already being provided. CMS has a thorough Nursing home checklist you can use to evaluate a nursing home while visiting. PDF Nursing Facilities Rules - Alabama Department of Public Health You can also submit a paper application, which you can find on the state website ( here ), or get assistance applying via an attorney. Thats significantly lower than the national average of 8.1%. 2023 Federal Poverty Guidelines COVID-19 Stimulus Impact Eligibility by Type of Care Nursing Home Eligibility Home Care Eligibility Assisted Living Eligibility Assisted Living that Accepts Medicaid IRAs, Pensions & 401Ks and Eligibility Gifting Impact on Eligibility Eligibility by Annuity Life Insurance Impact on Eligibility Inheritance Impact
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