Medicaid Home and Community-Based Services are Available for Some - Waiting Lists Keep People Waiting

Medicaid waivers allow in-home long-term care for those who qualify, but waiting lists keep some from getting care. With long-term health care one of life's biggest risks, planning will ensure quality care and asset protection.

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Medicaid Home and Community-Based Services are Available for Some - Waiting Lists Keep People Waiting
3 Min Read December 28th, 2022

A new analysis by the Kaiser Family Foundation (KFF) shows that about 656,000 people across the country were on state waiting lists for home and community-based services financed through Medicaid waivers.

Home and community-based services (HCBS) allow those who qualify for Medicaid to receive assistance in their home or community rather than in nursing homes.

Medicaid will pay for long-term care services and supports for those with little income and assets. While much of this care is provided through Medicaid-approved nursing homes, Medicaid waivers allow for in-home care services. However, wait lists delay the ability of people to receive desired in-home care.  

KFF says that waiting lists can sometimes overstate the need for services. Not all states screen for Medicaid eligibility before adding people to their lists. The waiting lists can inflate the numbers, including people who may never be eligible for services.

Over Half of People on Waiting Lists for Home and Services May Not Be Eligible to Receive Those Services.

In all years since 2016, over half of the people on waiting lists lived in states that did not screen people on waiting lists for eligibility, the KFF analysis found. This also is a key reason that waiting lists are not comparable across states.

Need for Long-Term Health Care Understated

Waiting lists can also understate need. They reflect the populations a state chooses to serve and the resources it commits to. In many cases, people may need additional services, but because the state doesn't offer them—or doesn't offer them to specific populations, such as people ages 65 and older—they would not appear on a waiting list.

People experience a decline in their health, mobility, and cognitive abilities as they age. Even frailty due to aging can means someone needs help with daily living activities or supervision due to dementia. Traditional health insurance and Medicare, including supplements, pay little or nothing toward most long-term care services. 

While Long-Term Care Insurance will pay for these services, including in-home care, many people ignore the problem until they experience health or aging problems. Often, they are uninsurable when they start thinking about Long-Term Care Insurance - Waiting On Long-Term Care Insurance Can Lead to Decline.

Medicaid Budget Pressured by Long-Term Health Care Expenses

Other people don't obtain coverage since they have little income and assets, and purchasing coverage is not recommended. The pressure on the Medicaid budget is substantial between people ignoring the problem and those with few assets to start with. 

Medicaid spent approximately 138.9 billion U.S. dollars on long-term care services in 2021; according to the Congressional Research Service, 43% of long-term care services are paid for by the Medicaid program.

Several states are considering following the State of Washington's lead in instituting what some call the "LTC Tax." Washington is providing a minimal long-term care benefit ($36,500) funded by a tax on income for everyone age 18 and older who does not own a qualified Long-Term Care Insurance policy.

Much of the tax revenue will help fund the Medicaid program. The $36,500, while helpful, barely touches the costly long-term care services that many people will need, either for in-home care, assisted living, a nursing home, or a memory care facility.

Long-Term Care Costs Increasing

The cost of long-term care services is exploding to increasing demand, inflation, and higher labor costs. The cost will vary depending on where you live - LTC NEWS Cost of Care Calculator.

Experts say one of the advantages of Long-Term Care Insurance is access to quality care, including care at home. Few people want to be in a nursing home, nor do many want to spend their assets to qualify for Medicaid or place the burden of caregiving on their adult children.  

However, for those with little income and assets, the promise of home and community-based services through Medicaid seems like a dream as people wait for home care services to be forced into nursing home care or family caregivers.

For people with a 401(k) and other savings, Long-Term Care Insurance can ensure quality care, asset protection, and time for loved ones to remain family instead of becoming caregivers. 

Most people obtain coverage in their 50s. However, for people who live in states that are considering the LTC Tax, younger people with higher income -- or who expect higher income in the future, are getting LTC Insurance to avoid the tax.

The consequences of long-term health care impact more than just finances. Many American families get burdened dealing with the crisis of a parent getting older. Planning will help reduce this burden.

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About the Author

An LTC News author focusing on long-term care and aging.

LTC News Contributor James Kelly

James Kelly

Contributor since August 21st, 2017

Editor's Note

Have you taken any time to think about your future aging? What about long-term care? Too many people think about nursing homes and rationalize that they will never need long-term care.

Of course, this is silly. First, most long-term health care is not delivered in a nursing home. Most people can maintain a good quality of life by staying at home with professional caregivers or moving to assisted living.

Sure, some people need a nursing home, but ignoring the risk and the reality of aging and declining health will not make it go away. Also, don't expect your adult children to stop their lives and become your future caregiver. This is not realistic or fair to them.

Family caregiving is very demanding and attempting to juggle a career and a family with being a caregiver is too overwhelming. Plus, family caregivers are not trained or prepared for the job, and the quality of care suffers.

The solution is to plan and be prepared. Being prepared will ensure quality care, including in-home care, without burdening those you love or adversely impacting your income and assets.

Locate a Reliable and Experienced LTC Expert

Make sure to get the proper kind of professional assistance. A knowledgeable Long-Term Care Insurance specialist can assist you in navigating the many options from all the top insurance companies. Premiums vary over 100% between insurance companies, and each company has its own underwriting rules. 

A general insurance agent or financial advisor lacks this expertise.

Seek help from a qualified Long-Term Care Insurance specialist and get accurate quotes and professional recommendations from all the top companies - Find a Long-Term Care Specialist.

Have Questions About Long-Term Care Planning?

You probably have questions about long-term health care planning, and LTC NEWS provides the answers for many of the most asked questions here - Frequently Asked Questions. Find all the tools and resources that are available on LTC NEWS - Resources for Long-Term Care Planning.

The cost of long-term health care is exploding. This calculator is an outstanding tool whether you are helping someone find care today or you are planning for yourself for the decades ahead.

Find the current and future cost of long-term health care where you live - LTC NEWS Cost of Care Calculator.

Loved Ones Need Help Now?

Get help finding quality caregivers or long-term care facilities and get recommendations for a proper care plan, whether a person has a policy. - Filing a Long-Term Care Insurance Claim.

If your loved one is lucky enough to own a Long-Term Care Insurance policy, be sure they use it. Sometimes families wait, thinking they can save the benefits for a rainy day. Waiting on using available Long-Term Care Insurance benefits is not a wise idea. 

If your parent or parents need help, be sure to get them quality care. LTC NEWS can help. We have put together several comprehensive guides to help you in your process.

Start by reading our four guides -  

The Benefits of Today's Reverse Mortgages

Some people have a large portion of their savings in their homes. With the help of reverse mortgages, you can find ways to pay for quality in-home care, pay for LTC Insurance, and even assist with cash flow during retirement.

Yes, today's reverse mortgages may be the perfect way to pay for a Long-Term Care Insurance policy or even cover the cost of in-home care if you or a loved one is currently in need.

Asking an expert with your questions will help you learn more. Mike Banner, a columnist for LTC NEWS and the host of the television program "62 Who Knew," will respond to your inquiries about long-term care, reverse mortgages, aging, and health.

- Just "Ask Mike." - Reverse Mortgages | LTC News.

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