Elderly Waiver: Long-Term Care Planning for Assisted Living and Community-Based Services

We’ve previously discussed planning for long-term care in a nursing home. This post will focus on planning for long-term care when assisted living or community-based services are required.

Elderly Waiver (“EW”) is a federal Medicaid waiver program that funds home and community-based services. EW is the only medical assistance program that pays for assisted living. However, what most people do not know is that EW only covers the service portion of the assisted living contract and not the room-and-board charges.

EW eligibility requirements:

  1. Must be 65 or older
  2. Require a nursing facility level of care as determined by a Long-Term Care Consultation
  3. $3,000.00 or less in available assets for a single person
  4. If married, the community spouse can retain $126,420.00 in assets, their primary residence, one vehicle, a pre-funded burial plan and personal property
  5. Income requirements – EW has three different income limits. These limits are based on the individual’s current income and whether they are residing at home or in an assisted living facility

Applying for EW can be very complex, especially if you are planning to reside in an assisted living facility opposed to receiving in-home services.

Assisted living facility contracts are what are known as housing with services contracts. Housing with services contracts are two distinct contracts. One portion of the contract is for housing and the other is for services. EW only covers the service portion of the contract. However, room-and-board is usually a substantial portion of the cost of in living in an assisted living facility.

There is only one program that pays for room-and-board in an assisted living facility. The income limit to qualify for this program is $922.00 per month. Due to the high cost of room-and-board in assisted living facilities it is often not cost effective or financially feasible for individuals to reside in an assisted living facilities.

Further, when looking at assisted living facilities it is important to determine whether the facility accepts EW and whether they have a private pay requirement. Many assisted living facilities require a two- or three-year private pay requirement prior to accepting EW.

It is extremely important to consult with an elder law attorney prior to applying for EW or signing an assisted living contract. There are many things the facility will not tell.

Contact one of our attorneys or schedule an appointment today to discuss your long-term care planning needs.

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