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Massachusetts Home Care and Long-Term Care Programs

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Home and Community-Based Services Waivers (HCBS)


Home and Community-Based Services Waivers
♦ Frail Elder Waiver: 1-800-AGE-INFO - Aging Services Access Points (ASAP's)
♦ Intellectual Disabilities Waiver: 617-727-5608 - DDS Area Office Locator
♦ Autism Waiver: 1-888-367-4435 - DDS Area Office Locator
♦ Traumatic Brain Injury Waiver: 1-800-223-2559 (MRC)
♦ Acquired Brain Injury Waiver: 1-866-281-5602 - ABIinfo@umassmed.edu
♦ Money Follows the Person Waiver: 1-800-223-2559 (MRC) or contact your facility case manager
health services at home
NOTE: Glossary words are highlighted. Click on any glossary word to see its definition.

What are Home and Community-Based Services (HCBS) Waivers?

Home and Community-Based Services Waivers (HCBS) are programs for low-income Massachusetts residents who qualify for nursing facility or other institutional care but want to live at home. The HCBS waivers allow MassHealth to pay for a wide range of health care and support services that are provided in residents' homes or community settings rather than in an institution.

Home and Community-Based Services Waivers (HCBS) help:

  • frail elders
  • people with intellectual disabilities
  • young children with autism spectrum disorders
  • adults with traumatic brain injuries (TBI)
  • and adults with acquired brain injuries (ABI)

to live safely in their communities, to prevent or delay institutionalization, or to return to their communities after living in an institution for a period of time. HCBS Waivers give Massachusetts residents more choices about where to live, and also help the government save money.


Am I eligible?

Eligibility rules depend on the type of HCBS waiver you need. For all HCBS waivers:

  • you must be a Massachusetts resident
  • you must be able to live safely at home or in the community with one or more support services
  • you must choose to receive services at home or in the community
  • you must meet the MassHealth HCBS waiver income and asset limits

Some types of waivers have cost limits. For waivers with cost limits, you will not be eligible for the waiver if the cost of the services you need is greater than the cost limits.

Each type of waiver also has other specific requirements. See Types of HCBS Waivers for the eligibility requirements that apply to the type of waiver you need.


What are the income and asset limits?

For adults, the income and asset limits for Home and Community-Based Services (HCBS) waivers are:

  • Your countable income must be no greater than $2130 per month in 2013.

    Note: This income limit is three times the federal SSI benefit amount. In 2013, the federal SSI benefit amount is $710 per month. Countable income for HCBS uses the same rules as countable income for SSI. See SSI Financial Eligibility Requirements.
  • Your countable assets must be no greater than $2000. You must not have gotten rid of assets just to become eligible for MassHealth.
  • If you are married, your spouse's income and assets are not counted for this program.
  • If your income or assets are too high, you can meet a deductible or spend down your assets to qualify.

Children must meet the eligibility requirements for MassHealth Standard based on family income. See MassHealth Financial Eligibility Requirements. There are no asset limits for children.


What benefits will I get?

You will get MassHealth Standard medical coverage and HCBS waiver services. Waiver services are health care and support services that you get at home or in the community, instead of in a hospital, nursing home, or other institution.

The specific waiver services that you will get depend on your individual needs and the type of HCBS waiver you get. See Types of HCBS Waivers for details about benefits.

If your waiver allows you to choose your own service providers, you may, in some cases, be allowed to pay relatives to provide waiver services. Your relatives must be qualified to provide the services, and cannot be your spouse or other adults who are legally responsible for your care.


How do I apply?

Each type of HCBS waiver has its own application procedure. See Types of HCBS Waivers for information about how to apply for a specific type of waiver.

MassHealth may limit the number of people who are allowed to enroll in each waiver program. There may be a waiting list. Some waiver programs may accept applications only during Open Enrollment periods. 


Types of HCBS Waivers:

Frail Elder Waiver

Description: The Frail Elder Waiver allows elders who are eligible for nursing home care, but prefer to remain in their homes, to get the services and supports they need to be able to live safely at home. MassHealth and the Executive Office of Elder Affairs run the Frail Elder Waiver program.

Eligibility: You may be eligible for the Frail Elder Home and Community-Based Services Waiver (HCBS) if you meet all other HCBS Waiver eligibility requirements and you:

  • are age 60 or older
  • if under 65, are totally and permanently disabled
  • are certified by the state as medically eligible for nursing home care
  • would be institutionalized in a nursing facility if you did not receive waiver services
You are medically eligible for nursing facility care:
 
  • if you need at least one skilled nursing or therapist service daily (for example, an IV, feeding tube, oxygen, sterile dressings, catheters, skilled-nursing evaluation, physical therapy, speech therapy, occupational therapy)
  • OR if you need a nursing service at least 3 times per week, plus two other services. Other services can be assistance with Activities of Daily Living (ADLs), or additional nursing services. Activities of Daily Living are personal care activities such as bathing, dressing, toileting, getting in or out of a bed or chair, walking (or moving a wheelchair), or eating
A nurse will come to your home to check your physical and mental health, your ability to care for yourself, and your ability to do basic tasks. The nurse will fill out a form which will be used to decide if you meet MassHealth (Medicaid) nursing facility eligibility standards.

Services: If you qualify for the Frail Elder HCBS Waiver, your Aging Services Access Point (ASAP) will assess your needs to determine the type and amount of services you will get. Waiver services for frail elders may include:

  • personal care services
  • housekeeping, chore services, and laundry
  • home health aide, home care aide, and/or skilled nursing care
  • companion services
  • supportive day program
  • home delivered meals and grocery shopping
  • transportation
  • wander response system
  • respite care
  • accessibility adaptations (such as ramps, grab bars, bathroom modifications)
  • transitional assistance (for people moving from an institution to a community residence)

If you have a high need for support services and are at imminent risk of entering a nursing facility may qualify for the Community Choices Program.

Community Choices Program

The Community Choices Program is a special program for frail elders who are at risk of entering a nursing facility very soon unless they get extra help at home. Elders currently in a nursing facility who want to return home are also eligible. Case managers develop service plans, arrange for services, and monitor progress.

To qualify for Community Choices, you must be enrolled in (or eligible for) the Frail Elder HCBS Waiver program. In addition, you must meet other requirements that show you are at risk for immediate nursing home placement unless you get additional services. For example, you might be at risk and need extra services if you recently had a major medical problem.

Your Aging Services Access Point (ASAP) can explain the Community Choices rules to you and let you know if you are eligible.

How to apply: You should call a local Aging Services Access Point (ASAP) to apply for the Frail Elder Waiver or the Community Choices program. See the list of ASAPs below from the Senior Connection web site, or call 1-800-AGE-INFO to find the ASAP that serves your community.

A case worker will do a quick eligibility screening over the phone. If you appear to be eligible, a case worker will conduct a home visit to further assess your needs and complete the application.


Intellectual Disabilities Waiver

Description: The Intellectual Disabilities Waiver allows adults who need the level of care provided by an intermediate-care facility for people with intellectual disabilities, to get the supports they need to live safely on their own, in a family home, or in a supervised community residence. MassHealth and the Department of Development Disabilities run the Intellectual Disabilities Waiver program.

Eligibility: You may be eligible for the Intellectual Disabilities HCBS Waiver if you meet all of the other HCBS Waiver eligibility requirements and you:

  • are age 18 or older
  • if under 65, are totally and permanently disabled
  • have an intellectual/developmental disability in accordance with DDS standards
  • are certified by the state to be in need of inpatient care at an intermediate-care facility for people with intellectual disabilities

Services: There are three types of Intellectual Disabilities Waivers: Adult Supports, Community Living, and Residential. The type of waiver you get depends on how much family support you have, the level of assistance you need, and whether you require 24-hour supervision.

Intellectual Disabilities Waiver services may include

  • individual, group, or center-based day supports
  • residential, community, and/or day habilitation
  • homemaker and chore services
  • live-in caregiver or adult companion
  • physical, occupational, and speech therapy
  • behavioral supports and stabilization
  • transportation and vehicle modification
  • supported employment
  • specialized medical equipment and assistive technology
  • housing modifications
  • respite
  • family training and peer support
  • individual goods and services
  • transitional assistance

The services you get depend on your needs. You and your family help design your own service plan and can choose your own service providers.

How to apply: To apply for the Intellectual Disabilities HCBS Waiver, contact your local Department of Developmental Services office. For contact information, see DDS Area Offices or use the DDS Area Office Locator.


Autism Waiver

Description: The Autism Waiver allows children birth through age 8 who would otherwise be institutionalized due to a diagnosed autism spectrum disorder, to receive the intensive support services they need to remain at home with their families. MassHealth and the Department of Developmental Disabilities run the Autism Waiver program.

Eligibility: Your child may be eligible for the Autism Spectrum Disorders Waiver if your child meets all other HCBS Waiver eligibility requirements and:

  • is under nine years of age
  • has a confirmed diagnosis of an autism spectrum disorder
  • is certified by the state to be in need of inpatient care at an intermediate-care facility for people with intellectual disabilities
  • has a legally responsible adult who is willing and able to direct the child's waiver services
  • the expected cost of needed services is less than the Autism Waiver cost limits

Services: Your child will get one-on-one interventions through a service called Expanded Habilitation, Education, as well as support services and respite care. Autism Waiver services are provided by a trained clinician in your home or a community setting. You can design the program you want for your child and choose your own service providers. Your family will have an individual budget based on your child's assessed needs.

How to apply: To apply for the Autism HCBS Waiver, you should call the Autism Division of the Department of Developmental Services (DDS) at 1-888-367-4435. For more information, see DDS Autism Waiver Services on the DDS web site. Applications are accepted during open enrollment periods.


Traumatic Brain Injury (TBI) Waiver

Description: The Traumatic Brain Injury Waiver allows adults with TBI who would otherwise need care in a nursing facility or hospital, to get the support services they need to live safely in their homes or other community settings. MassHealth and the Massachusetts Rehabilitation Commission run the Traumatic Brain Injury Waiver program.

Eligibility: You may be eligible for the Traumatic Brain Injury (TBI) Waiver if you meet all other HCBS Waiver eligibility requirements and you:

  • are age 18 or older
  • if under 65, are totally and permanently disabled
  • have an externally caused traumatic brain injury as defined by the Massachusetts Rehabilitation Commission (MRC)
  • need one or more services administered by the MRC under the HCBS

Services: If you qualify for a Traumatic Brain Injury Waiver, your services may include:

  • day programs and respite
  • community or residential habilitation
  • homemaker, chore, and adult companion services
  • supported employment
  • physical, occupational, and speech therapy
  • transportation
  • personal care
  • community-based substance abuse treatment
  • specialized medical equipment
  • home accessibility adaptations
  • transitional assistance (for people moving from an institution to a community residence)

You and your case manager will work together to develop a plan of services.

How to apply: To apply for the TBI Waiver, contact the Massachusetts Rehabilitation Commission at 1-800-223-2559; or contact MassHealth Waiver Information at 1-866-281-5602.


Acquired Brain Injury (ABI) Waiver

Description: The Acquired Brain Injury Waiver allows adults with brain injuries who are inpatients in nursing homes or hospitals to get the support services they need to move safely to their own homes, family homes, or supervised community residences. MassHealth and the Massachusetts Rehabilitation Commission run the Acquired Brain Injury Waiver program.

Note: The Acquired Brain Injury Waiver resulted from a class action suit by institutionalized individuals with brain injuries who wanted to return to their communities but were unable to get needed supports and services. For more information, see ABI Waiver Program from the Brain Injury Association of Massachusetts, and Hutchinson v. Patrick from the Center for Public Representation.

Eligibility: You may be eligible for the Acquired Brain Injury (ABI) Waiver if you meet all other HCBS Waiver eligibility requirements and you:

  • are age 22 or older
  • if under 65, are totally and permanently disabled
  • acquired a brain injury after age 22
  • are an inpatient in a nursing home or chronic or rehabilitation hospital for 90 continuous days or more at the time you apply for the waiver
  • meet clinical requirements and are in need of one or more ABI waiver services
  • need waiver supports and services that cost less than the ABI Waiver cost limits

Services: There are two types of Acquired Brain Injury Waivers:

  • the ABI Waiver with Residential Habilitation (ABI-RH) for people who need to be placed in a residence that has 24-hour support and staffing
  • the ABI Waiver with Non-Residential Habilitation (ABI-N) for people who do not need 24-hour support and supervision

The ABI Waiver services you get will depend on the type of waiver you need and the Individual Service Plan that you develop with your case manager. ABI Waiver services may include:

  • residential or community habilitation
  • assisted living and day services
  • supported employment
  • physical, occupational, and speech therapy
  • transportation
  • personal care and homemaker services
  • specialized medical equipment
  • home accessibility adaptations
  • companion services
  • respite care
  • other approved support services
  • see 130 CMR 630 Home and Community Based Services Waiver Services 630.405(A) and 630.405(B) for details

How to apply: To apply for the Acquired Brain Injury Waiver, call ABI Waiver Information toll-free at 1-866-281-5602, or download an application from the MassHealth ABI Waiver web site at Acquired Brain Injury Waivers. For more information, see ABI Waivers: Questions and Answers from MassHealth and the MRC, or send an e-mail to ABIinfo@umassmed.edu.


Money Follows the Person (MFP) Waiver

Description: The Money Follows the Person Waiver allows adults who have been living in a nursing facility or other institution for 90 days or more to safely return to their communities and get needed supports and services. MassHealth and the Massachusetts Rehabilitation Commission run the Money Follows the Person Waiver program.

Money Follows the Person is part of the Massachusetts Community First initiative that supports the right of elders and people with disabilities to live with dignity and independence in their communities.

Eligibility: You may be eligible for the Money Follows the Person (MFP) Waiver if you meet all other HCBS Waiver eligibility requirements and you:

  • are age 18 or older
  • if under 65, are totally and permanently disabled
  • are an inpatient in a nursing facility or chronic disease or rehabilitation hospital
    (or a psychiatric hospital if age 18 through 21 or age 65 or older)
  • have lived in the facility for 90 continuous days or more (excluding Medicare-paid rehabilitation days)
  • have received MassHealth inpatient benefits
  • are eligible for MassHealth when you are discharged from the facility
  • choose to take part in Money Follows the Person
  • need one or more MFP Waiver support or services
  • are moving to a qualified residence that can be:
    • a home owned or leased by you or your family
    • a community home with no more than four unrelated residents
    • an assisted living unit where services are not included in the lease
  • see 130 CMR 519 MassHealth Coverage Types  519.007(H) for eligibility details

Services: There are two types of Money Follows the Person (MFP) Waivers:

  • the MFP Residential Supports Waiver (MFP-RS) for adults who need residential support services in a 24-hour supervised setting
  • the MFP Community Living Waiver (MFP-CL) for adults who do not need a 24-hour supervised setting

In addition, the MFP Behavioral Health Managed Care Waiver is available to physically disabled and elderly MFP Waiver participants who need behavioral health services. The MFP Waiver services you get will depend on the type of waiver you need and the Individual Service Plan that you develop with your case manager.

MFP Waivers offer a wide range of residential and community-based services and supports, including behavioral health services and transitional assistance. See 130 CMR 630 Home and Community Based Services Waiver Services 630.405(C) and 630.405(D) for details.

How to apply: If you are interested in the Money Follows the Person Waiver, contact the Massachusetts Rehabilitation Commission at 1-800-223-2559, or your Aging Services Access Point (ASAP). You may also ask your facility case manager or your medical provider for information.


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