Learning the ins-and-outs of Medicaid has been the most complicated part of being a well-rounded agent. Hands down. I helped a lady two weeks ago who had repeatedly been told her income was too high to qualify for Medicaid. For many people, this would be true. In her case, no one ever asked the right questions. And they weren't knowledgeable enough on Medicaid Waivers.
What are Medicaid Waivers?
Medicaid Waivers help provide services to people who would otherwise be in a nursing home or hospital to receive long-term care in the community. The goal is to help states reduce costs, expand coverage, or improve care for certain individuals who wouldn't usually be covered by Medicaid. There are waivers for many conditions and many ages, and they vary by state.
In Colorado, there are six adult waivers that fall under the Home Care Based Services (HCBS) category. The categories are as follows: Elderly, Blind, and Disabled Waiver; Brain Injury Waiver; Spinal Cord Injury Waiver; Community Mental Health Supports Waiver; Supported Living Services Waiver; and Developmental Disabilities Waiver. You can locate more information at CO HCBS Adult Waiver Chart-May 2021 (colorado.gov).
The three that I most often assist people with are qualifying for through Medicaid are Spinal Cord Injury, Brain Injury, and the EBD waivers. The most overlooked one for my Medicare members is the EBD waiver by far. There are a few ways to apply for these waivers: call Medicaid at 800-359-1991, apply online at colorado.gov/peak, or Ask Me to help at 720-990-1680 - there's never a cost to you.
Why the Elderly, Blind, and Disabled Waiver Rocks for Medicare Beneficiaries
The purpose of the EBD Waiver is "to provide a home or community-based alternative to nursing facility care for elderly, blind, and disabled persons" over the age of eighteen. The waiver serves elderly people over age 65 who have functional impairment as well as blind and physically disabled individuals ages 18-64. Imagine the number of Medicare recipients who qualify and don't even know it!
This services this particular Medicaid waiver provides include home delivered meals, home modifications, in-home support services, medication reminders, non-medical transportation, personal care, respite care, medical equipment and supplies, and more.
Wow! Think of how often people's health conditions are changing. More than likely, no one has spoken to them about these tools that will help them age in place. Aging in Place is a huge topic for AARP (Aging in Place: A State Survey of Livability Policies and Practices (aarp.org)) and the Colorado Gerontological Society. According to AARP ""nearly 90 percent of people over age 65 want to stay in their home as long as possible." They need the tools allowing them and their caregivers this freedom.
Physically disabled folks have a tough road. As a matter of fact, most physically disabled individuals have to be on Social Security for 24 months before they can receive Medicare benefits. By the time they start Medicare, many have spent their assets and savings on hefty medical costs. This waiver alleviates some of the financial burdens of their disability by allowing for higher income and assets than regular Medicare Savings Programs.
Blind individuals also have a rough go when it comes to resources. Here's an example - about a third of the people on Medicare have diabetes. If the diabetes is not well-controlled, this can lead to visual impairment and blindness. I've also had several clients who lost vision after complications with other illnesses, medications, and hospital stays.
One of the most memorable clients we helped came from a food pantry. Finding food was a challenge. His glasses had only one side, which was pinned together. He held the paper up to his face and still couldn't see. He recently lost Medicaid and was subsequently bumped from his Dual Special Needs Medicare Advantage Plan. Oh, the struggles this man endured! Crossing paths with us was a Godsend for him. We spent 30 minutes on the phone with him straightening out his income and requesting the EBD waiver. We requalified him for Medicaid, which immediately added the Part B premium of $170.10 to his measly $500 per month Social Security check. Additionally, he was eligible for a DSNP which covered new glasses, a credit card for food and over-the-counter benefits, dental coverage, and host of other benefits. I can't even count the number of times he thanked us. Remembering his gratitude still brings a smile to my face.
If you or anyone you know is struggling to afford premiums, copays, medications, groceries, glasses, or anything else - Please call me at 720-990-1680. I don't want anyone to suffer when there may be programs that can help. I promise to ask you the correct questions.
For more information, visit insure-integrity.com/medicare-medicaid.
Live in another state? 44 states offer Medicaid waivers. Let us help you find the ones in your state.