Elderly and Disabled (E&D) Waiver Explained

Learn about the significance of the Elderly and Disabled Waiver and how it empowers older and disabled adults to receive essential care.
Published on
August 25, 2023
Written by
Katie Wilkinson
Reviewed by
Max Mayblum
Certified Senior Advisor (CSA)®
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The Elderly and Disabled Waiver is available in:

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The demand for long-term care for older or ill adults is soaring, and the Elderly and Disabled (E&D) Waiver stands as a beacon of hope. This Medicaid waiver is crucial in addressing the needs of those who require nursing home-level care but wish to remain in their homes or community. By diverting Medicaid funds traditionally used for nursing home care, the E&D Waiver enables the delivery of personalized services that cater to the needs and preferences of individuals.

The E&D Waiver also acknowledges family caregivers' indispensable role in the healthcare system by financially compensating them through the Personal Choices program. This is monumental, as family caregivers have historically been under-recognized and underpaid, despite being the backbone of long-term care in the United States.

This article sheds light on the Elderly and Disabled Waiver, focusing on caregiver compensation through the Personal Choices program. We explore how this waiver functions, impacts recipients' lives, and the compensation family caregivers can receive.

Overview of Elderly and Disabled Waiver

The Elderly and Disabled (E&D) Waiver is a pivotal Medicaid program designed to support elderly and disabled individuals who necessitate the level of care typically provided in nursing homes. The waiver aims to redirect the focus from institutional care to home and community-based services, which is particularly significant as it aligns with many older adults' preferences, who often desire to age in place and remain integrated within their communities.

The target population for the E&D Waiver includes elderly individuals, typically those aged 65 and older and adults with disabilities. The waiver is intended for those requiring a nursing home level of care, meaning they need assistance with multiple daily living activities such as bathing, dressing, or meal preparation. However, the waiver is not limited to individuals who are bedridden or critically ill. Instead, it aims to serve a broad spectrum of needs, ranging from moderate assistance to extensive care.

One of the unique aspects of the E&D Waiver is the Personal Choices program, which grants eligible individuals a cash benefit. This cash benefit empowers recipients to have a say in their care by allowing them to hire and pay their caregivers, including family members. This is a significant step in recognizing and valuing the role of family caregivers, often the unsung heroes in long-term care.

The overarching goals of the E&D Waiver are multifaceted:

  1. It aims to provide elderly and disabled individuals with more control over the type of care they receive and the setting in which they receive it.
  2. It seeks to alleviate the financial burden associated with long-term care by providing financial assistance and enabling self-directed care options.
  3. The waiver acknowledges and supports the invaluable contribution of family caregivers in the healthcare system by including the option for participants to hire family members as caregivers.

Alternate names for the Elderly & Disabled Medicaid Waiver

The Elderly & Disabled waiver may be known by different names depending on the state or region. Some alternative names for the Elderly and Disabled Waiver or similar programs include:

  1. Home and Community-Based Services (HCBS) Waiver for the Elderly and Disabled
  2. Aged and Disabled Adult Waiver
  3. Elderly and Disabled Supportive Living Waiver
  4. Elderly and Disabled Long-Term Care Waiver
  5. Aged, Blind, and Disabled (ABD) Waiver
  6. Community Choices Waiver for the Elderly and Disabled
  7. Elderly and Disabled Home- and Community-Based Services Waiver
  8. Aging and Disability Resource Center (ADRC) Waiver
  9. Elderly and Disabled Alternative Care (AD) Waiver
  10. Elderly and Disabled Services Program (EDSP) Waiver

Eligibility Requirements

To be eligible for the Elderly and Disabled (E&D) Waiver, individuals must meet specific criteria related to their income, level of disability, and other factors. Below are the key requirements:

  1. Age and Disability: The applicant must be either 65 or older or an adult with a disability. The nature of the disability must be such that the individual requires assistance with daily living activities.
  2. Level of Care: The applicant must require a nursing home level of care, implying that the individual needs assistance with multiple activities of daily living, such as bathing, dressing, eating, and managing medications.
  3. Financial Eligibility: There are income and asset limits that applicants must meet. While these limits can vary by state, an individual's income generally must not exceed a specified limit, usually set at a percentage of the Federal Poverty Level (FPL). Additionally, there are limits on the total countable assets that an applicant can have.
  4. Residency: The applicant must be a resident of the state where they apply for the E&D Waiver.
  5. Assessment: The applicant's healthcare needs must be assessed to ascertain that home and community-based services are appropriate for their situation.

Application Process and Determining Eligibility

The application process for the E&D Waiver typically starts with contacting the local Medicaid office or the agency responsible for Medicaid Waiver programs in the applicant's state. Some states may also have online portals where individuals can apply. It's crucial to have documentation ready, such as proof of residency, income, assets, and medical records that show the need for a nursing home level of care.

After the application is submitted, an assessment is conducted by a healthcare professional to evaluate the applicant's level of need. The application and assessment process can take some time, so applying well before the services are needed is advisable.

For individuals uncertain if they meet the eligibility criteria, consult with a Medicaid planner or elder law attorney. They can advise about eligibility requirements and help navigate the complexities of the application process.

The Elderly and Disabled Waiver program is available in several states, including:

Other states may also offer a similar program, so checking with the local Medicaid office for the most current information is essential.

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Services and Supports

The Elderly and Disabled (E&D) Waiver encompasses an extensive range of services and supports designed to cater to the diverse needs of elderly and disabled individuals. The waiver aims to ensure that participants can live in their homes or communities as independently as possible while receiving the necessary care. Here are some of the services and supports available under the E&D Waiver:

  1. Personal Care Services: These services include assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, eating, and mobility. Personal care attendants may also help with light housekeeping and meal preparation.
  2. Home Health Aide Services: These services encompass medical care provided by certified home health aides, including medication administration, wound care, and health monitoring.
  3. Case Management: Case managers work with participants to develop a personalized care plan, coordinate services, and meet individual needs.
  4. Respite Care: Respite services provide temporary relief for primary caregivers, allowing them to take a break. This can be provided in-home or in a facility.
  5. Adult Day Health Services: This service offers daytime care in a community setting, providing social activities, meals, and essential health services.
  6. Personal Emergency Response System (PERS): A system that allows individuals to call for help in an emergency, such as a fall.
  7. Home Modifications: This includes modifications to the home to improve accessibility and safety, such as installing grab bars and ramps or widening doorways.
  8. Assistive Technology: Equipment and devices that aid individuals in performing tasks that they would otherwise be unable to or have difficulty doing, such as communication devices, mobility aids, or adaptive eating utensils.
  9. Nutrition and Meal Services: Includes meal delivery services and nutritional counseling to ensure that individuals receive a balanced diet.
  10. Skilled Nursing Services: Registered nurses provide medical care, including administering medications, wound care, and managing chronic conditions.
  11. Transportation Services: Non-emergency transportation to medical appointments and community activities.
  12. Personal Choices Program: This component of the E&D Waiver allows participants to receive a cash benefit which they can use to hire and pay caregivers, including family members, for services that align with their care plan.

The E&D Waiver is designed to be flexible and person-centered, allowing participants to receive a combination of services that best meet their needs and preferences. Through these services, the waiver fosters a better quality of life, greater independence, and a more integrated community living experience for elderly and disabled individuals.

Compensation for Caregivers

One of the noteworthy features of the Elderly and Disabled (E&D) Waiver is the compensation for family caregivers through the Personal Choices Program. The waiver includes a cash benefit that allows eligible participants to hire and pay caregivers, including family members, which recognizes family caregivers' invaluable role in the healthcare system.

For a family caregiver to access compensation under the E&D Waiver, the individual receiving care must be enrolled in the Personal Choices Program. Once registered, a budget is established based on the person's needs. Then, family caregivers are hired formally, often requiring a written agreement outlining responsibilities and payment terms.

Family caregivers must also maintain documentation of the services provided, such as timesheets or care logs, and submit these for review and payment processing. This documentation is crucial for accountability and ensuring that funds are utilized appropriately.

It is important to note that there might be state-specific requirements or variations in the program, so family caregivers should consult with the local Medicaid office or the agency managing the E&D Waiver in their state for detailed information on the process and requirements for compensation.

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Limitations and Challenges

While the Elderly and Disabled (E&D) Waiver offers invaluable services and support, it is not without its limitations and challenges.

  1. Funding Constraints: The E&D Waiver is a Medicaid program that works with a limited budget. As a result, the services provided may only partially meet the needs of the participants at times.
  2. Waiting Lists: There is often a higher demand for the services provided under the E&D Waiver than available resources. Therefore, eligible individuals may have to wait an extended period before accessing these services.
  3. Geographical Disparities: Depending on the location, the availability and quality of services may differ. Rural areas may require greater access to specific services than urban areas.
  4. Navigational Complexity: Applying and checking eligibility can be complicated and overwhelming for some people, especially seniors or those with cognitive issues.
  5. Gaps in Coverage: While the E&D Waiver covers a wide range of services, there may be gaps in coverage for certain specialized services or supports that are crucial for an individual's well-being.

Potential Improvements

  1. Increase Funding: Allocating more funding to the E&D Waiver program can help reduce waiting lists and expand the range of services provided.
  2. Streamline Processes: Making applying for benefits more straightforward can allow people to access them more easily. One way to do this is by assisting with the application process.
  3. Expand Services: The program could be enhanced by offering specialized services and support.
  4. Enhanced Outreach: Enhanced outreach and education programs would ensure that people in both urban and rural areas have equal access to information and services.
  5. Feedback and Adaptation: Regularly soliciting feedback from participants and caregivers and adapting the program based on this feedback can help ensure that the E&D Waiver continues to meet the evolving needs of its target population.

A Note from Givers

The Elderly and Disabled Waiver is a crucial lifeline, offering various services to support elderly and disabled individuals in their homes or communities. It holds special significance for unpaid family caregivers, including compensation through the Personal Choices Program.

Take a moment to complete our survey to determine your eligibility for compensation. Let's build a more compassionate and supportive community together.

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