Medical Assistance (MA) coverage for home and community based services through a waiver program

People who are assessed to need certain levels of care may get services through a home and community-based services waiver program if:

• You qualify for MA
• You have had a Long-Term Care Consultation that shows you have a need for the services

Contact your county or tribal office to find out how to get an assessment to find out if you are eligible.

The income limit depends on which home and community-based services waiver program you qualify for. Only your income is counted even if you live with a spouse or a parent.

Yes, your home and one vehicle usually do not count toward the asset limit for MA. Children do not have an asset limit.

Yes, but adults may have an asset limit for MA. Children do not have an asset limit.

There are three other rules that apply for anyone who needs MA to help pay for home and community-based services through a waiver program.

• In the 60 months prior to your request for MA help with your home and community-based services through a waiver program, you must not have given away income, or given away assets without getting paid the amount the assets were worth. If you have done this, you may have a transfer penalty which prevents MA from paying for services.  There are some exceptions to this rule.
• Your equity in your home has to be under the home equity limit. The home equity limit increases annually. Ask your worker what the limit is.
• Some annuities that you or your spouse own have to name the Department of Human Services as the preferred remainder beneficiary.

Effective July 1, 2023, parents are no longer assessed a parental fee for children receiving home and community-based services (HCBS) waivers. Parents are still responsible for parental fees assessed for children receiving HCBS waivers before June 30, 2023. 

Parental fees may still be assessed for children who have a developmental disability, or a physical disability or emotional disturbance in 24-hour care outside the home. This includes a: 

• medical facility such as a nursing home or an intermediate care facility for a person with a developmental disability,
• state-operated psychiatric hospital for children, or
• psychiatric residential treatment facility

No, your spouse will not have to use their income for your home and community-based services.

Adults may also have copays for some services. Children do not have copays.

After you are approved, coverage may start:

• The date you start receiving home and community-based services or are eligible for MA payment of your home and community-based services, whichever is later.
• The day after your transfer penalty ends, if you have one, as long as you still meet all of the eligibility rules.

You may still get coverage. You must tell us if you:

• Have Medicare or other health insurance, including long-term care insurance
• Could be covered under someone else's insurance
• Could get coverage through an employer or military service

Sometimes we can help pay the cost of your Medicare or other insurance so you can keep that coverage.

There are other programs that help people so they can live in their home. To get more information about these kinds of services, call your county or tribal office.

• County and tribal offices
• DHS Health Care Consumer Support (HCCS)