Understanding Medicaid Waivers: Protecting Elder Rights and Access to Long-Term Care

Medicaid Waivers: An Overview

Medicaid waivers are specific programs that permit states in the United States to provide Medicaid services that differ from the standard federal Medicaid regulations. They are designed to meet the unique needs of specific individuals, some of whom are described below:  

• People with disabilities
• People with chronic illness
• Individuals needing long-term care or assistance
• Low-income individuals
• Elderly individuals

Home and Community-Based Services (HCBS) Waiver – Section 1915(c)

The Home and Community-Based Service Program, as outlined in section 1915(c) of the Social Security Act, provides services that are not otherwise available through the Medi-Cal program. These services provide support to people in their own homes and communities. This waiver program recognizes the importance of maintaining independence and family ties by enabling individuals to remain in the comfort of their own homes. The Home and Community-Based Service Program is beneficial for the elderly population for the following reasons: 

• Supports independent living – Most elderly individuals want to age in their own homes or communities. It is essential to live in their own homes to ensure their comfort and safety. HCBS provides services such as personal care, meal delivery, and transportation to patients.
• Improves the quality of life – Staying in familiar living spaces will ultimately lead to better mental health outcomes for patients. It will enable them to feel secure in their daily routines and within their community ties.
• Flexible care – Services are more tailored to the individual’s needs, rather than the rigid structure of institutional care.

Pros and Cons of Medicaid Waivers

Like anything, many pros and cons come along with Medicaid waivers. Most elderly individuals prefer to age at home, close to their communities. Long-term care offers just that and helps to delay the need for nursing home care. Receiving care through Medicaid waivers is also cost-efficient for the state, another benefit to the program. With these benefits come disadvantages: 

• Enrollment limits – Each waiver has a set number of spaces available for an individual.
• Services vary – Even if an individual qualifies for the program, that doesn’t automatically guarantee them the services.
• Waiting lists – Once spots are filled, a waiting list forms, and the wait for services can be several months to many years.

Trump Administration Policy Changes

Recently, the Trump administration has made efforts to scale back Medicaid and long-term care services. The argument goes back to returning Medicaid to its “original purpose,” ultimately refocusing the program towards its original target population, including the following individuals: 

• Low-income individuals
• Individuals with disabilities

These service cuts include the following: 

• The Home and Community-Based Service Program
• Work requirements
• Per-capita funding caps
• Roll-back of Medicaid expansion
• Funding Medicaid through block grants

Rights of Patients

Medicaid must tell people about their right to a hearing in the following situations: 

• When someone applies for Medicaid
• When Medicaid denies or reduces benefits, services, or eligibility

This notice should incorporate the language listed below to ensure that it is accessible to all individuals: 

• Every application should be informed in writing of their rights to a fair hearing
• All notices should be in plain language (accessible to individuals with disabilities)

How KAASS LAW Can Help

At KAASS LAW, we are committed to protecting the rights of elderly individuals and helping them navigate the complexities of Medicaid. Navigating Medicaid waivers can be overwhelming, especially for elderly patients and their families. Our experienced attorneys at KAASS LAW can assist you and help you receive the compensation that you deserve. 

Conclusion

Medicaid waivers are crucial for elderly individuals seeking long-term care in their own homes. Understanding your rights and getting the proper support can make all the difference. If you or a loved one is facing the challenges related to Medicaid services, learn how we can help. Contact KAASS LAW for a confidential consultation.