Medicaid for the Elderly, Blind or Disabled

Home and Community Based Waivers (HCBW)

These plans enable people who are elderly, blind, or disabled to live in community settings rather than in state institutions or nursing homes. They pay for community services which normally are not covered by Medicaid. To receive long-term care services through these programs, you must:

• Meet level of care requirements as determined by your care manager.
• Meet all program rules.
• Reside in a setting allowed by HCBW policies.
• Have a disability determination, if you are under the age of 65.
• Contribute toward the cost of your waiver services if required.
• Have assets at or below the asset limit. (The assets limit for one person is $2,000. The asset limit for married couples is described in the Spousal Impoverishment Section).

There are three different HCBW groups (A, B and C). You cannot be in more than one group at the same time. You may have a cost share that must be paid each month to keep getting HCBW benefits. Your Letter of Decision will let you know if you have a cost share and how much it is. In addition to a cost share, certain services you get will require a copay.

Group A Waivers

Group A members must meet the HCBW functional eligibility and also meet the income/asset and all other rules for the Medicaid, BadgerCare Plus Standard or Medicaid Purchase Plans, so no additional financial test is required.

As a Group A member, you are not required to pay a monthly cost share, but still need to pay any monthly amount associated with the Medicaid, BadgerCare Plus Standard and Medicaid Purchase Plans.

Group B Waivers

Group B members must meet all the HCBW rules and have monthly gross income less than the Community Waiver/Family Care Medicaid Level 1 income limit.

If you are a Group B member you may have to pay a cost share. The Group B cost share is based on your income and allowable credits. The Group B cost share is calculated by subtracting the following credits from your monthly gross income:

Special Housing Credit

This amount is the total of housing costs (listed) minus $350.

Group C Waivers

Group C members must meet all HCBW rules but have monthly gross income over the Institutions Medicaid Level 1 income limit (see Income Test.)

To meet the income test for Group C, the applicant’s income must be below the Medicaid Level 2 income limit after all credits have been applied. To determine your countable income, subtract the following credits from your Gross Income.

*Information provided by care manager.

If the counted income is below $591.67, you are able to enroll in the HCBW in the Group C category. You may also have to meet a monthly spenddown amount to remain enrolled.

Determining the Group C Spenddown Amount

The spenddown is the amount of expenses a Group C member must incur and/or pay monthly to remain enrolled in Medicaid under the Group C plan. If you do not have a community spouse, you must pay the spenddown amount each month to stay enrolled. Your care manager monitors and documents this monthly.

Group C Cost Sharing Calculation for Member with a Community Spouse

Once the eligibility determination is made, you can give some of your monthly income to your community spouse, if you are married and your spouse does not reside in an institution. The cost sharing calculation for members with a community spouse or a community spouse with dependent children (or other dependent relatives) is calculated as follows:

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Last Revised: February 06, 2013