Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Waiver Program


Minnesota has had an Elderly Waiver program since 1988, which funds home and community services not normally covered under Medicaid for seniors who are at risk of nursing facility placement. The waiver program covers two types of services: those necessary to avoid institutionalization that are not offered in Minnesota's state plan, and those that are extensions of Minnesota's state plan services--"extended" to avoid institutionalization. Extended services allow more than the state plan in terms of type, amount, duration and scope of services and are only available to people eligible for waiver services.

The program is administered by the counties, and has a set number of slots. To date there has been no waiting list for waiver services in Minnesota. In the event that the state sees that the waiver slots are filling up, the state amends the waiver to include additional slots because it believes that the waiver services will save money by keeping people in the community. In FY 2002, the state served 12,208 waiver clients.

The Elderly Waiver program covers a wide range of services in a person's home or in certain residential care settings. Residential care settings include adult foster homes, both family and corporate, board and lodging homes, non-certified board and care homes, and apartment complexes called residential centers. Services include: skilled nursing, home health aide, homemaker, companion services, personal care assistants, adult day care, case management, home-delivered meals, respite care, supplies and equipment, transportation, limited modifications to the home and training for caregivers.

There are two packages of waiver services called Assisted Living and Assisted Living Plus, both of which are provided in approved residential care settings.

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