If you are a senior in New York state, you may already be aware of the many resources that New York provides for the elderly. Medicaid in this state includes nursing home care as well as programs for home care and assisted living. You may not know, however, that if you are a senior who is on or seeking Medicaid that you may be eligible to participate in the NY Medicaid Waiver Program.
What is the NY Medicaid Waiver Program?
As part of the Social Security Act under section 1915 (c), waivers of requirements are granted by the Federal government that would otherwise apply to state-run Medicaid plans. Under these waivers, key requirements that apply to state Medicaid plan services are waived and target certain populations but with limitations such as diagnosis, age, or state geographical areas. The number of available waivers may also be limited. Financial eligibility requirements, as an example, may be waived by states to open up the Medicaid program to those who do not normally qualify due to income and resources.
Medicaid Waiver Program/Services for Long-Term Care
Currently in New York, there are approximately 64,000 who are receiving Medicaid waiver services. This includes developmentally disabled individuals participating in Home and Community-Based Services (HCBS), which is a special Medicaid waiver program.
In addition, New York provides a Medicaid Waiver for assisted living and in-home care, which is a program available to those who are medically eligible for nursing home placement but who opt for home care services. The Long Term Health Care Program or LTHHC provides payment for at-home services to eligible individuals that includes nursing and medical care as well as rehabilitative services. Under this program, an individual’s costs must be less than the costs of the county’s nursing home.
Services provided can include community transitional services, community support and home care services, meals, medical social services, home maintenance, respiratory therapy, transportation, social day care, and counseling and education.
Eligibility Requirements
Eligibility for New York’s waiver programs normally includes health and financial considerations. The Home and Community-Based (HCBS) Waiver Program is run by the Office for People With Developmental Disabilities (OPWDD). To be eligible you must be diagnosed with a developmental disability, be eligible for Medicaid, be eligible for a nursing home level of care, and opted for HCBS waiver services (as opposed to institutional care). The LTHHC Waiver program also requires the recipient to be eligible for nursing home level of care and meet certain income and asset limits.
