HCBS Overview

January 7, 2010

HCBS OVERVIEW

Home & Community Based Services or HCBS is a Medicaid program offered in Colorado for persons who need long term care and are not residing in a nursing home. The person applying for this type of Medicaid assistance could be living in his or her own home, a residential group home that accepts Medicaid, or an assisted living facility that accepts Medicaid.

Overview

Medical Eligibility

As with Medicaid benefits for nursing home services, HCBS applicants must also meet the same medical qualifications as for a resident of a nursing home; the applicant must need 24-hour per day care or supervision, seven days a week or "24X7" care.  This is a high standard to meet.  An examiner completes an assessment, the ULTC.100.2, on which the applicant is scored based on their ability to care for themselves and their need for supervision to be safe in their homes. 

Safety is always a major factor for persons with dementia.  Certain patients who can be safe at home or an assisted living with limited visitation and supervision can benefit greatly from the HCBS program.  The program can extend the recipient's stay at home or the assisted living before needing a higher level of care.  Colorado also does not have to pay for the higher expense of a nursing home: a "Win-Win" situation for the resident and the State.

Financial Eligibility

Medicaid, of course, is a means-tested program.  The applicant has to be indigent; he or she may have neither resources, counted assets, nor income greater than the maximums allowed by law. Rarely is the applicant's income too high.  A recipient and the spouse may own a home¹, one motor vehicle, an irrevocable burial plan, personal property, among other assets, that are not counted.  See my separate handout on Medicaid rules for more details.

If an applicant has made a gift, other than to his or her spouse, since February 8, 2006, then eligibility may be delayed.

How it Works

The financial qualifications are the same for a person applying for HCBS services as they are for someone residing in a nursing facility. A single applicant may have no more than $6,909.00 per month gross income in the Denver Metro area in 2010.

The Income Trust: Dealing with the "Cap"

There is an  "income cap" of $2,022 per month of gross income in 2010. If an applicant has gross monthly income of more than $2,022, but less than $6,909.00 per month in the Denver Metro area in 2010, they will place some or all of the excess income in an "income trust" bank account. That money is not available to the Medicaid recipient and does not count toward the $2,000 resource allowance. If the Medicaid applicant has a spouse that is not applying for Medicaid, the community spouse, then that spouse may share in part of the applicant’s income as additional financial support.

Resources

The single applicant may have no more than $2,000 in counted assets in 2010;  a community spouse can keep up to $109,560 in countable resources. If both spouses will be applying for Medicaid, they may keep up to $4,000 in total countable resources depending on their living accommodations.

Resident Income Allowance for Assisted Living

If a person receives HCBS in an assisted living facility or group home, they generally will get to keep about $100.00 of their monthly income, and the balance will go to the facility. Medicaid may make allowances for health insurance premiums, and of course, takes into account income to a community spouse or dependent child.

Minimum Resident Payment
 
Individual must pay that minimum monthly payment to the facility if the person has sufficient income. In 2008 that figure was $584 per month. If someone receives HCBS at home, there are generally no payments made except for income in excess of $2,022 that must be kept in the income trust.

The Assessment Process

A person applying for HCBS must be assessed by an employee of a Single Entry Point agency (SEP) which is contracted with the State of Colorado to perform medical and functional assessments of the applicant. The assessments cover cognitive deficits as well as the Activities of Daily Living. The SEP must be contacted to make the referral on the day of, or the day before, the applicant files both Part 1 and 2 of the financial Medicaid Application in the county where the applicant resides or is resident in a care facility. The SEP will generally not agree to perform the medical assessment until they know that Part 1 and 2 have been filed in the appropriate county human services office.

Services Available

HCBS services are more limited than nursing home services. If someone resides at home, the main benefit of HCBS is medical care that is paid for by Medicaid, with limited co-pays for medical visits and prescription drugs. The recipient can receive some very limited services at home: help with bathing (not daily) and limited help with food shopping and preparation if needed, limited help with housekeeping, transportation to medical appointments, grocery store, and the like. Medicaid will provide for adult daycare services Monday through Friday, if needed, and up to 30 days of respite care in a nursing home to alleviate the burden on a spouse or other family care giver.

Services in an Assisted Living Facility

Services include some help with bathing, help to the dining room and limited assistance with eating, dressing and toileting. Prescription drug monitoring and dispensing are provided by the facility if appropriate. They do not provide 24/7 hands-on care in an assisted living facility on Medicaid. If the SEP determines that the applicant needs a higher level of care, then Medicaid will not be approved unless the person is moved to a nursing facility that accepts Medicaid.