Medicaid Basics in Maryland, Part 2 - Programs and Waivers

Medicaid in Maryland

Medicaid eligibility rules can be complicated, and many seniors don’t know where to begin when they apply for assistance. To receive Medicaid Long Term Care (LTC) benefits in Maryland, a resident must meet certain medical and financial criteria. Each applicant must undergo a financial and medical assessment to determine their needs, which Medicaid will use to determine their eligibility.

Medicaid in Maryland covers payment for nursing homes by default. In other words, seniors who meet the financial and medical guidelines for Medicaid can qualify for coverage for up to 100% of their nursing home fees. The standard LTC program does not cover alternative types of care, however, including assisted living facilities and in-home care. For these services, residents of Maryland can apply for a Medicaid Waiver to receive assistance

Maryland Medicaid offers several different Home and Community-Based Services waivers, each with its own focus and goal. The right waiver for your loved one is dependent on their health condition, their financial resources, and the type of care they need.

Home and Community Based Options Waiver

The Home and Community-Based Options (CO) Waiver is one of Maryland’s newest Medicaid programs, and combines two of the state’s previous programs: the Older Adults Waiver and the Living at Home Waiver. The CO Waiver is available to anyone over the age of 18, but residents of at least 50 years of age have different eligibility requirements. Disabled adults and seniors who require skilled nursing, but wish to remain living at home while they receive care, may qualify for the CO Waiver.

Recipients of the CO Waiver can use it to cover assisted living and home health. It can also cover a variety of other medical supplies and services, including Durable Medical Equipment (DME) and meals delivered to home. To receive the waiver, an applicant must meet Medicaid’s general financial requirements, and their monthly income must not exceed 300% of the Supplemental Security Income (SSI) benefits.

It is common to be put on a waiting list when you apply for the CO Waiver in Maryland, due to its popularity. It is important to note this potential wait as you plan for long-term care, and apply for the CO Waiver early if you believe you or your loved one may require its benefits.

Community First Choice

Maryland residents who need assistance with daily activities may qualify for a Community First Choice (CFC) Medicaid Waiver. The CFC Medicaid Waiver helps seniors pay for personal assistance and home care as an alternative to institutional care. Applicants to the CFC Waiver program must undergo a medical assessment to determine their eligibility. For applicants to be eligible for the program, the assessment must specify that they need an institutional level of care. Applicant’s must also meet Maryland Medicaid’s general financial requirements.

Hopkins ElderPlus (PACE)

The Hopkins ElderPlus program serves as Maryland’s Program of All-Inclusive Care for the Elderly (PACE). It is a voluntary health program put in place to provide Maryland seniors with preventative, primary, and long-term care services. Recipients of Hopkins ElderPlus can use the program to pay for community-based care as an alternative to a nursing home. The program also covers a list of other services, including medications, meals, and medical equipment.

To qualify for the Hopkins ElderPlus program, the applicant must:

  • Be at least 55 years of age;

  • Reside in one of the following Maryland zip codes: 21202, 21205, 21206, 21213, 21214, 21217, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237 or 21052;

  • Require care at an institutional level;

  • Be able to live in their community safely without posing a danger to themselves or others.

If admitted, the individual will receive full coverage for health care from the ElderPlus program, excluding emergency care. Medicaid will pay for ElderCare for Maryland residents whose monthly income does not exceed 300% of their SSI benefits, and those with assets totaling less than $2,000. Those who receive Medicaid and are eligible for the Hopkins ElderPlus program can use it to pay for their long-term care.

What LTC Services Does Medicaid Provide in Maryland?

Depending on the patient’s eligibility and waiver status, Medicaid in Maryland may provide assistance with the following long-term care services:

Nursing Home Care

Medicaid covers nursing homes for any benefits recipient over the age of 65, provided they meet certain criteria. Medicaid will cover an individual’s nursing home fees if it is medically necessary for them to receive care at an institutional level, and they meet Medicaid’s financial eligibility requirements. If the patient’s income and assets are particularly high, they may need to participate in a spend-down program.

Assisted Living

Unlike nursing home care, Medicaid does not cover assisted living by default, instead requiring the individual to apply for a Medicaid Waiver to cover their costs. An individual must qualify for the CO Waiver if they want Medicaid to pay for community-based care. The CO Waiver is given to low-income Maryland residents who require a nursing home level of care, but do not wish to reside in a nursing home. This is the primary waiver Maryland Medicaid recipients use to pay for Assisted Living, as it can cover a large portion of their fees.

In-Home Care

In-home care is the preferred choice for many seniors, but Medicaid won’t cover it unless the applicant is approved for a waiver. The Community First Choice Waiver is an option for Maryland residents who need assistance paying for in-home care. To qualify for the waiver and have Medicaid cover the costs of in-home health care, an individual must prove they require skilled nursing care, in addition to meeting the program’s financial requirements.

Contact a Wayside Legal Elder Law Attorney Today

Wayside Legal LLC is an award-winning law firm located in North Bethesda, Maryland, with experience handling Medicaid issues in Maryland, D.C., and Virginia. If you are facing a situation where you need assistance with long term planning, contact a Wayside Legal attorney today for a consultation to discuss your specific elder law issues.