The Minnesota Elderly Waiver

What is the Elderly Waiver?

The Elderly Waiver is one of Minnesota's Medicaid “home and community-based services” waivers, administered by the Minnesota Department of Human Services (DHS). It lets Minnesotans who would otherwise need nursing-home care receive services in the community instead: in their own home, a family member's home, an adult foster home, or a licensed assisted living (customized living) setting.

The idea is simple. Many people who qualify for nursing-home-level care would rather not live in a nursing home, and community care often costs the state less. The Elderly Waiver makes that choice possible.

Who qualifies? Three requirements

To be eligible for the Elderly Waiver in Minnesota, a person must meet all three:

• Age 65 or older.
• Eligible for Medical Assistance, which is Minnesota's Medicaid, meaning they meet the income and asset limits below.
• Require a Nursing Facility Level of Care (NFLOC). A state assessment determines this by looking at how much help the person needs with daily activities like bathing, dressing, eating, mobility, and managing medications.

What the Elderly Waiver covers

The Elderly Waiver can pay for a range of services that support community living, including:

• Customized living, or assisted living services (the care and support in a licensed assisted living setting, meaning the services, not the rent and meals)
• Adult foster care
• Homemaker and chore services
• In-home personal care assistance
• Home-delivered meals
• Adult day services
• Respite care (short-term relief for family caregivers)
• Home modifications like grab bars and ramps
• Consumer Directed Community Supports (CDCS), which can let families hire and pay a family member as a caregiver
• Case management to coordinate it all

The room-and-board question (read this)

This causes the most confusion, so it is worth repeating. The Elderly Waiver pays for care services in assisted living, but not for room and board, which is the rent and meals portion of the bill.

So how do families cover room and board? Usually through private funds like Social Security, a pension, or savings. Eligible lower-income seniors may also get help through separate programs like Housing Support (formerly Group Residential Housing) and Minnesota Supplemental Aid (MSA) in participating settings. A CasperCare advisor can help you find communities that accept these arrangements.

Elderly Waiver vs. Alternative Care

Minnesota also has a related, state-funded program called Alternative Care (AC) for people who need nursing-home-level care but are not yet financially eligible for Medical Assistance. It is meant for those who would qualify within about 135 days of a nursing-home admission. Alternative Care offers more limited services and acts as a bridge until Medical Assistance eligibility begins. The Elderly Waiver is the main, longer-term path.

How the Elderly Waiver is delivered

Most Elderly Waiver recipients get their services through a managed-care health plan, either Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+). The plan coordinates their medical care and waiver services together. Some people receive services fee-for-service instead. Your lead agency explains the options available in your county.

Common mistakes families make

• Assuming Medicare will cover it. It will not, and that is exactly what the Elderly Waiver and Medical Assistance are for.
• Waiting until savings are gone to start, when the approval process takes months.
• Not planning the asset “spend-down” properly. Improper transfers can cause penalties, so get elder-law advice.
• Forgetting that room and board is not covered, so budget for it or line up Housing Support or MSA.
• Going it alone, when free help exists and prevents costly missteps.

How to apply, step by step

1. 1

   Contact your lead agency

   Reach your county or Tribal human services agency (or, for some, a managed care organization). You can also start with the Senior LinkAge Line, Minnesota's free statewide help line for seniors, at 1-800-333-2433.

2. 2

   Request a long-term care consultation / assessment

   A trained assessor evaluates whether your parent meets the Nursing Facility Level of Care requirement, looking at daily-living needs.

3. 3

   Apply for Medical Assistance

   Complete the Medical Assistance application, including the long-term-care asset review, to establish financial eligibility.

4. 4

   Develop a care plan

   If approved, a case manager works with your family to build a community support plan and arrange services and setting.

5. 5

   Choose a setting and start services

   Select a home or community that fits, and begin services. Expect the full process to take up to about three months, so start early if you can.