Medicaid for Nevadans Needing Assisted Living or Home Health Care

Page 2 of 2 of When Medicaid in Nevada Will Pay for a Nursing Home and Long-Term Care

For elderly or disabled Nevadans who qualify financially and require nursing home or medical facility care, Medicaid will pay for the care. Medicaid "waivers" will also pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These waivers can help an individual maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.

The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. (For more information, see Nolo's article on Nevada Medicaid and nursing homes.) There is one primary difference that applies to the waiver programs with regard to income eligibility. Waiver recipients cannot use a Qualified Income Trust to meet the income cap. This means that if you have over $2,163 per month in income, you do not qualify for the Medicaid waiver programs.

Nevada's Assisted Living (AL) Waiver

Nevada's assisted living (AL) waiver is a Medicaid program that will provide assisted living supportive services to individuals in a residential facility offering 24-hour supervised care. To be eligible for the waiver, you must:

  • be over 65 years old
  • require nursing home placement
  • meet Medicaid's income and assets limits, and
  • live in an assisted living facility that currently receives a Low-Income Housing Tax Credit.

Unfortunately, most assisted living facilities do not meet the criteria for this waiver program. Medicaid will NOT pay for a standard assisted living or senior living facility. An individual will have to pay privately for most assisted living facilities.

Nevada's Home and Community Based Waiver (HCBW)

The Home and Community Based Waiver (HCBW – formerly the CHIP program) of Nevada's Aging and Disability Services Division (ADSD) provides nonmedical services to older persons to help them maintain independence in their own homes instead of going into a nursing home.

Applicants for the HCBW waiver must:

  • be at least 65 years old
  • require a nursing home level of care (or would require a nursing home within 30 days if the HCBW services were not available)
  • have a continued need for services, and
  • meet Medicaid's income and assets limits.

Note that the HCBW program provides only nonmedical services, so care from a nurse is not included in this program.

A licensed social worker will be assigned to each individual to determine what services he or she needs. The social worker will then coordinate and oversee the needed services. Some of the services provided under this waiver program include assistance with personal care such as bathing, grooming, transferring, eating and homemaker help with meal preparation, laundry, and shopping. This program also will provide some services for adult day care (not medical day care), an adult companion, and a personal emergency response system (for reporting falls). ADSD will hire all of the service providers in this program, although there are some limited instances in which you could hire a family member to provide services to you. You should contact ADSD for more details.

There are limited slots available for this waiver program. The Aging and Disability Services Division uses a wait list to prioritize applicants. When funding becomes available, the applicant will be processed based upon the level of care needed, the risk factors for that individuals, and the date of the waiver application.

Nevada's Waiver for Elderly Adult Living in Residential Care (WEARC)

In some cases, Nevada's Medicaid program will pay for care in a residential care setting, also called a group home. To be eligible, you must:

  • be over 65 years old
  • be ambulatory
  • need an intermediate level of care, and
  • meet Medicaid's income and assets limits.

Ambulatory means that you can walk unassisted or with a cane/walker or that you can transfer independently from a wheelchair. An intermediate level of care is less than skilled nursing; a group home typically provides a lower level of care than a nursing home would.

As with the home waiver program, the group home (WEARC) waiver will not provide services from a nurse.

The Nevada Aging and Disability Services Division will assess each individual to determine if he or she is medically qualified for assistance (that is, needs an intermediate level of care). During that assessment, individuals' care requirements are determined in a “Plan of Care.” Approved applicants are assigned a case manager who coordinates the care services with the group home in which they will reside.

Not all group homes will accept the WEARC waiver. You should talk to and visit the group home you intend to reside in before agreeing to move there. You should make sure they will accept the payment from Medicaid as a payment source and that you will be comfortable living there.

The WEARC program usually has a wait list similar to that in the HCBW programs. It is possible you could have a substantial wait for both of these programs if funding is not available when you apply.

For more information on all of these programs and to apply, you should contact your local Nevada Aging and Disability Services Division office.

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