What is Community Medicaid? Does Medicaid Offer Long Term Care in the “Community”?

Summary
Two types of Medicaid Long Term Care offer benefits in the community – Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. These two programs will provide long-term care services and supports to seniors in their home, the home of a loved one and other places in the community. Collectively, this is known as Community Medicaid. Its benefits vary by state, program and individual, as do the financial and medical eligibility requirements.

What is Community Medicaid and Does It Include Long Term Care?

Community Medicaid refers to the long-term care benefits provided in the community by two programs – Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. These benefits might include:

  • Personal care assistance with bathing, dressing, eating, mobility and toileting
  • Homemaker services such as light cleaning, laundry, shopping for essentials and cooking
  • In-home skilled nursing and doctor visits
  • Medical equipment and supplies
  • Case management
  • Adult day care
  • Home modifications for safety and accessibility like wheelchair ramps and bathroom grab bars
  • Vehicle modifications
  • Assistive technology such as pill dispensers
  • Meal delivery
  • Transportation
  • Respite care for primary caregivers

The availability of these benefits varies by state, program and individual. For example, two seniors may both receive in-home personal care through the same HCBS Waiver, but one has 10 hours per week covered while the other has 20 hours per week covered, and the difference would be due to their condition and circumstances. Some Community Medicaid programs will allow beneficiaries to select and pay caregivers of their choice, including family members, through Consumer Directed Care.

 

Where Can You Receive Community Medicaid Benefits?

Where Community Medicaid benefits can be delivered depends on the state and program. Some will only provide long-term care goods and services to beneficiaries in their own home or the home of a family member in cases where the beneficiary is living with an adult child or some other family member. Other states and programs will deliver benefits to seniors in a wide range of places, such as assisted living facilities, memory care units for Alzheimer’s and other dementias, adult foster homes and adult day care, as well as their own home or the home of a loved one. However, Medicaid will almost never cover room and board expenses in any of these locations.

 

Long Term Care Programs that Provide Community Medicaid

There are three types of Medicaid Long Term Care relevant to seniors, and, as we’ve already mentioned, two of them provide Community Medicaid – Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. The third, Nursing Home Medicaid, covers long-term care in nursing homes.

HCBS Waivers

While the number and nature of HCBS Waivers depends on the state, in general they provide the widest range of benefits to the most Medicaid beneficiaries who live in the community. Applicants must require a significant level of care to qualify for HCBS Waivers, in most cases a Nursing Facility Level of Care (NFLOC), in addition to meeting the financial requirements discussed below. Almost all HCBS Waivers have a limited enrollment spots. When these spots are full, additional applicants are placed on a waitlist.

ABD Medicaid

Applicants aren’t required to need any level of care to qualify for basic healthcare coverage through ABD Medicaid, but if they want long-term care benefits through the program they must show a medical need for those benefits. Also unlike HCBS Waivers, ABD Medicaid is an entitlement, which means all eligible applicants are guaranteed by law to receive benefits without wait. However, long-term care benefits through ABD Medicaid are available depending on the programs, funds and caregivers in a beneficiary’s location. ABD Medicaid is available through the state plan and can be referred to as Regular Medicaid for seniors, but it should not be confused with the Regular Medicaid that’s available to financially limited people of all ages.

 

Financial Eligibility Requirements for Community Medicaid

The financial eligibility criteria for Community Medicaid depends on the state, the marital status of the applicant and the program providing the long-term care benefits – HCBS Waivers or ABD Medicaid.

In most states in 2024, the individual asset limit for both programs is $2,000. This means that single applicants can only have assets with a combined value of $2,000 or less. Most assets are counted toward the limit, such as bank accounts, retirement accounts and cash, but many assets are exempt, including the home in most cases. The individual income limit for HCBS Waivers is $2,829/month in most states in 2024, and it’s between $943/month and $1,751/month for ABD Medicaid. Again, these limits vary by state and the applicant’s marital status.

 Simple Eligibility Tool: The easiest way to find the exact financial requirements for your specific situation is to use our Medicaid Eligibility Criteria Search Tool.

More information is available on applying for HCBS Waivers and applying for ABD Medicaid.