MN Elderly Waiver Explained

As people age, they may face various challenges that affect their ability to live independently and safely in their homes and communities. They may need assistance with personal care, household tasks, health care, transportation, or social activities. However, many seniors prefer to remain in their familiar surroundings rather than move to a nursing home or other institutional setting. That’s where the Elderly Waiver (EW) comes in.

The EW is a Medicaid program that provides home and community-based services to seniors who necessitate the level of care given in a nursing home but choose to live in the community. The program aims to support seniors’ dignity, choice, and quality of life while reducing the costs of institutional care.

This article thoroughly explores the EW, including its eligibility requirements, services and supports, and caregiver compensation. 

Overview of the EW

The EW is one of the five Medicaid waivers in Minnesota that offer home and community-based services to seniors and people with disabilities or chronic conditions. The program was established in 1988 and is administered by the Minnesota Department of Human Services (DHS) in collaboration with county agencies.

The EW serves seniors who:

• Are 65 years old or older
• Are eligible for Medical Assistance (MA), Minnesota’s Medicaid program
• Meet the level of care criteria for a nursing facility
• Have an assessed need for at least one EW service
• Choose to receive services in their home or community instead of a nursing facility
• Have a person-centered service plan that meets their needs and preferences
• Have a case manager who coordinates their services and supports

The EW provides services and support tailored to each senior’s needs and goals. These include:

• Case management/care coordination
• Adult day services
• Adult day services bath
• Chore services
• Consumer-directed community support (CDCS)
• Customized living (including 24-hour customized living)
• Environmental accessibility adaptations
• Extended home health services
• Family caregiver services (includes caregiver training and caregiver counseling)
• Home-delivered meals
• Homemaker
• Personal emergency response systems (PERS)
• Respite
• Specialized equipment and supplies
• Transitional services
• Transportation (non-medical)

The EW also offers a self-direction option called Consumer Support Grant (CSG), which allows seniors to choose, hire, and pay their service providers, including family caregivers.

Eligibility Requirements

To be eligible for the EW, seniors must meet the following requirements:

• Be 65 years old or older at the time of application. Seniors enrolled in the EW can continue to receive services as long as they remain eligible.
• Be eligible for Medical Assistance (MA), Minnesota’s Medicaid program. 
• Meet the level of care criteria for a nursing facility, determined by a comprehensive assessment of the senior’s functional abilities, medical needs, behavioral needs, and risk factors. 
• Have an assessed need for at least one EW service. The estimated need is based on the senior’s strengths, preferences, goals, and challenges. The senior works with a case manager to develop a person-centered service plan that identifies the services and supports to help them achieve their desired outcomes.
• Choose to receive services in their home or community instead of a nursing facility. The senior must live in a setting that meets the federal Home and Community-Based Services (HCBS) settings rule, which ensures that seniors have privacy, autonomy, access to community resources, and freedom from coercion and restraint.
• Have a case manager who coordinates their services and support. The case manager is assigned by the county or tribal agency or chosen by the senior from a list of qualified providers. The case manager helps the seniors apply for the EW, develop their service plan, arrange their services, track their progress, and advocate for their rights.

Services and Supports

The EW provides various services and supports designed to help seniors live independently, participate in their communities, and achieve their goals. The services and supports are based on the senior’s person-centered service plan, which reflects their needs, preferences, and choices.

The EW services and supports include:

• Case management/care coordination: This service helps seniors access and coordinate their EW services and other resources. The case manager assists the seniors with applying for the EW, developing their service plan, arranging their services, monitoring their progress, and advocating for their rights.
• Adult day services: A service that provides structured activities to seniors who need supervision and support during the day. The activities may include skill development, community integration, leisure, recreation, wellness, and socialization. A licensed or certified provider in a facility or community setting provides the service.
• Adult day services bath: A service that offers personal care assistance to seniors who attend adult day services and need help with bathing or showering. A qualified staff member at the adult day services site offers the service.
• Chore services: A service that assists with household tasks essential for the senior’s health and safety. The duties may include cleaning, laundry, minor home repairs, yard work, snow removal, and pest control. The service is provided by a qualified provider or reimbursed to the senior or their representative.
• Consumer-directed community support (CDCS): A service that allows seniors to choose, hire, and pay their service providers, including family caregivers. CDCS gives seniors more flexibility and control over their EW services and budget. Seniors can decide what services they need, how they are delivered, who provides them, and how much they are paid. Seniors can also use their CDCS budget to buy goods and services not covered by the EW or MA state plan.
• Customized living (including 24-hour customized living): A service that provides supervision, assistance, and training to seniors who live in a licensed residential setting with up to four other EW recipients. The service may include room and board, personal care, household services, social and recreational activities, transportation, and medication management. Customized living can be provided on an hourly or 24-hour basis, depending on the senior’s needs.
• Environmental accessibility adaptations: A service that provides physical changes to the senior’s home or vehicle that improve their accessibility, safety, or independence. The service may include assessment, design, installation, maintenance, and repair of the modifications.
• Extended home health services: A service that provides skilled nursing, home health aide, or personal care assistant services to seniors who need more than the MA state plan limit of 180 hours per year. A licensed home health agency or a qualified individual provider provides the service.
• Family caregiver services: A service that provides training and counseling to family members who provide care to seniors enrolled in the EW. The service may include education, support groups, respite, and referrals to other resources. The service is provided by a qualified provider or reimbursed to the senior or their representative.
• Home-delivered meals: A service that offers nutritious meals to adults who cannot prepare their own meals or access other food sources. The service may include breakfast, lunch, dinner, snacks, and special diets. The service is provided by a qualified provider or reimbursed to the senior or their representative.
• Homemaker: A service that assists with household tasks essential for the participant's health and well-being. The duties may include cleaning, laundry, shopping, meal preparation, and errands. The service is provided by a qualified provider or reimbursed to the senior or their representative.
• Personal emergency response systems (PERS): A service that provides an electronic device that allows seniors to call for help in an emergency. The device may be worn as a pendant, bracelet, or belt clip and connected to a phone line or cellular network. The service may include installation, maintenance, and monitoring of the device.
• Respite: A service that temporarily relieves the senior or their primary caregiver. The service may be provided by a qualified provider in the senior’s home or in another licensed setting.
• Specialized equipment and supplies: A service that provides items necessary for the senior’s health, welfare, or functioning. The items may include medical supplies, personal care items, adaptive clothing, incontinence products, and nutritional supplements.
• Transitional services: A service that helps seniors move from a nursing facility to a community setting. The service may include expenses for security deposits, utility deposits, household items, furniture, moving costs, environmental modifications, and other one-time costs.
• Transportation (non-medical): A service that provides access to transportation for seniors who need assistance to access their EW services or other community resources. The service is provided by a qualified provider or reimbursed to the senior or their representative.

Compensation for Caregivers

One of the benefits of the EW is that it allows seniors to self-direct their services and supports, which means that they can choose, hire, and pay their own service providers. This option is called a Consumer Support Grant (CSG).

CSG is a monthly cash grant for older adults to pay for services and support that help them live independently in their homes and communities. Participants can decide what services they need, how they are delivered, who provides them, and how much they are paid. They can also use their CSG grant to purchase goods and services not covered by the EW or MA state plan.

One of the advantages of CSG is that it enables older adults to hire and pay family members as caregivers. Family caregivers can provide personal care assistance, home health aide, homemaker, chore services, respite care, transportation services, or other services approved by the county agency. Family caregivers can include spouses, parents, children, siblings, grandparents, grandchildren, aunts, uncles, cousins, nieces, nephews, or other relatives.

The amount of compensation for family caregivers depends on several factors, such as the type and amount of services provided, the senior’s CSG budget, and the prevailing wage rates in the area. Family caregivers must comply with the CSG policies and procedures, such as completing a background check, signing a service agreement, submitting timesheets and invoices, and paying taxes.

Family caregivers can also receive training and support from CSG staff or consultants to help them perform their duties effectively and safely. They can also access respite services to take a break from their caregiving responsibilities.

A Note from Givers

If you are interested in applying for the EW or learning more about its benefits, please fill out this form to get in touch with one of our experts. We will help you navigate the eligibility process and find the best services and support for your situation.