Home and Community-Based Services Waiver (HCBS)

What is the Home and Community-Based Services Waiver?

The Home and Community-Based Services Waiver (HCBS) is a program for low-income Massachusetts residents who qualify for nursing facility or other institutional care but want to live at home. The Waiver allows MassHealth members to get needed health care and support services at home rather than in an institution. MassHealth does not cover these home-based services without a waiver.

The goal of the program is to help frail elders, people with intellectual disabilities, and young children with autism spectrum disorders live safely in their communities, and to prevent or delay institutionalization.

Am I eligible?

You are eligible for the Frail Elder Home and Community-Based Services Waiver (HCBS) if you are a resident of Massachusetts and you:

• are age 60 or older
• are certified by the state as medically eligible for nursing home care (see below) 
• are able to live safely at home with one or more support services
• meet the HCBS waiver income and asset limits

You are eligible for the Home and Community-Based Services Waiver (HCBS) for Persons with Intellectual Disabilities if you:

• have an intellectual or other developmental disability in accordance with Department of Developmental Services standards
• are certified by the state to be in need of inpatient care at an intermediate-care facility for people with intellectual disabilities
• are able to live safely at home with one or more support services
• meet the HCBS waiver income and asset limits

You are eligible for the Home and Community-Based Services Waiver (HCBS) for Young Children with Autism Spectrum Disorders if you:

• are a child under nine years of age
• have a confirmed diagnosis of an autism spectrum disorder
• are certified by the state to be in need of inpatient care at an intermediate-care facility for people with intellectual disabilities 
• are able to live safely at home with one or more support services
• meet the eligibility requirements for MassHealth Standard
• Note: Enrollment in this program may be limited.  

Am I medically eligible for nursing facility care?

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 find out about your physical and mental health, the amount of nursing care you need, the prescription medicines you are taking, your ability to care for yourself, and your ability to do basic tasks (prepare meals, do housekeeping, use transportation, manage finances, etc.). The nurse will fill out a form which will be used to decide if you meet Medicaid nursing facility eligibility standards.

Note: If you are not medically eligible for nursing facility care, but you still need help at home, you may qualify for the Massachusetts Home Care Program.

What are the income and asset limits?

For adults, the income and asset limits for the Home and Community-Based Services Waiver program are:

• Your countable income must be no greater than $2022 per month in 2009.
   
  Note: This income limit is three times the federal SSI benefit amount. In 2009, the federal SSI benefit amount is $674 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 Waiver services. Waiver services are health care and support services that you get at home or in the community, instead of in a hospital or other instituion.

Frail Elder Waiver:

For frail elders, waiver services may include personal care services, housekeeping and chore services, laundry, home health aide, skilled nursing, companion services, supportive day program, home delivered meals, grocery shopping, transportation, wander response system, respite care, environmental accessibility adaptation, and transitional assistance. Your Aging Services Access Point (ASAP) will assess your needs to determine the type and amount of services you will get.

Waiver clients with a high need for support services and who are at imminent risk of entering a nursing facility may qualify for the Community Choices Program.

Intellectual Disabilities Waiver:

Services include in-home and community-based services such as personal care, transportation, supported employment, adaptive technology, housing modifications, and respite. The services you get depend on your needs. Waiver participants and their families help design their own service plan and can choose their own service providers.

Autism Waiver:

Young children with autism will get one-on-one interventions through a service called Expanded Habilitation, Education, as well as support services and respite care. Services are provided by a trained clinician in the child's home or community. Parents can design the program they want for their child and choose their own service providers.

What is the Community Choices Program?

The Community Choices Program is a special program for frail elder waiver members 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.

Community Choices gives more hours of services than other home care programs. Total cost of services must be less than the cost of nursing facility care.

To qualify for Community Choices, you must be enrolled in (or eligible for) the Home and Community-Based Services 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 do I apply?

Frail Elder Waiver:

Elders should call a local Aging Services Access Point (ASAP) to apply for the Home and Community-based Waiver program 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.

• Massachusetts Area Agencies on Aging (AAA's) and Aging Services Access Points (ASAP's)

• AgeInfo line: 1-800-AGE-INFO (1-800-243-4636)

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:

Contact the Department of Developmental Services. For contact information, see the Department of Developmental Services listing under Disability Agencies.

Autism Waiver:

Parents should call the Autism Division of the Department of Developmental Services (DDS) at 1-888-367-4435. You can download an Autism Waiver Program Eligibility Request Form from the DDS web site at DDS Autism Waiver Services.

Useful links:

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1. MassHealth Coverage Types - 130 CMR 519
   Section 519.007 describes the eligibility requirements for people who would be institutionalized if they were not receiving home and community-based services, including the Kaileigh Mulligan Program, the senior Home and Community Based Services (HCBS) Waiver, PACE, HCBS Waiver for Persons with Intellectual Disabilities, and HCBS Waiver for Young Children with Autism.

2. MassHealth Provider Regulations
   including Nursing Facility Regulations 130 CMR 456.409

3. SSI Federal Payment Amounts
   Monthly maximum federal SSI payment amounts (before the Massachusetts state supplements are added) that are used to calculate income eligibility for the HCBS Waiver. From the Social Security Administration.

4. DDS Autism Waiver Services
   Overview of the Autism Waiver Program and eligibility request forms. From the Massachusetts Department of Developmental Services.

5. DDS Home and Community Based Services Waiver
   Information about the HCBS Waiver, including a description of the program and services. From the Massachusetts Department of Developmental Services.

6. Medicaid Waivers - Details for MA Frail Elder
   Information about the MA Frail Elder HCBS Waiver, including a description of the program, eligibility requirements, and benefits. From the Centers for Medicare and Medicaid Services.

Home and Community-Based Waiver section last updated on 10/27/09