Medicaid long-term care benefits are statutorily authorized only for nursing home care. But the law permits the federal government to grant “waivers” to states allowing them to expand Medicaid to include home and community-based services. Pennsylvania has such a program. The downside is that receiving care in a nursing home is an entitlement, while getting care at home is not.

Medicaid is a joint federal-state program that provides health care coverage to low-income children, seniors, and people with disabilities. In addition, it covers care in a nursing home for those who qualify. Each state operates its own Medicaid system. Pennsylvania’s is operated by the Pennsylvania Department of Human Services. State Medicaid programs must conform to federal guidelines in order for the state to receive federal money, which in Pennsylvania pays for more than half of that state’s Medicaid costs. (The state picks up the rest of the tab.) A Medicaid waiver allows states to waive some of the federal rules with the intention of providing services to individuals who wouldn’t normally be covered by Medicaid. The waiver must be approved by the federal government.

The most common type of Medicaid waiver expands Medicaid to cover home care to individuals who need a high level of care, but who would like to remain at home rather than enter a nursing home. Care that may be provided by a waiver includes personal attendants, home health aides, medical supplies and equipment, respite care, counseling services, transportation, homemaking services, hot meal delivery, and more.

Pennsylvania offers a variety of home waiver programs, most of which target specific narrow situations rarely applicable to most Medicaid applicants. But the main one, referred to as “Community Health Choices” or “CHC”, applies to anyone who meets the medical criteria for Medicaid eligibility in a nursing home. Unfortunately, the CHC waiver carries an income cap that disqualifies many who would qualify for Medicaid in a nursing home.  The point of the waiver is to allow an individual who requires a nursing home level of care to remain at home, and at a lower cost than required in a nursing home.

The downside of state waiver programs is that waivers are not an entitlement, meaning that states are allowed to limit the number of people who qualify for services under a waiver. In Pennsylvania, the enrollment process for the CHC Waiver is typically long, difficult, and often frustrating.

Contact Vasiliadis Pappas Associates to learn more about your options and other measures to protect yourself.