3 Types of Medicaid Long-Term Care: Nursing Home, HCBS Waivers & ABD

There are 3 different types of Medicaid programs that provide long term care. These programs differ in that they provide different types of care services, in different locations and they have different eligibility requirements.

1. Nursing Home Medicaid – provides the highest level of care and is available only to persons who reside in nursing homes.
2. Home and Community Based Services (HCBS) Waivers – provides care services to individuals that require a “nursing home level of care” but live at home or in a “community” such as an assisted living residence.
3. Aged Blind and Disabled (ABD) Medicaid – provides care services at home or in the community but to a lesser extent than HCBS Waivers.

Note that while these 3 programs exist in every state, there are large differences between the states in how they work, the benefits they offer and their eligibility requirements.

 

 

1) Nursing Home / Institutional Medicaid

In a lot of ways, “Nursing Home Medicaid” is exactly what it sounds like, and it’s what most of us think of when we think of a nursing home, or of Medicaid. It’s long term care that is provided in an institutionalized setting. Nursing home Medicaid covers:

-Room and board at the facility
-Personal help as needed with those all-important activities of daily living (i.e., bathing, eating, getting around)
-Administration of daily meds
-Skilled nursing services as necessary

The nursing home Medicaid program is for anyone who is in significant need of assistance with activities of daily living, are unable to afford the care, and can demonstrate that fact with a deep-dive into their finances. Every state has different specific financial requirements, but the broad strokes are that there is a cap on monthly income as well as a cap on the amount of assets a recipient can hold.

Nursing Home Medicaid is an entitlement, and that simply means that if you meet the requirements, you will receive the benefits, no wait-lists, no exceptions. Waivers, in contrast, are not entitlements.

Nursing Home Medicaid must be provided in a Medicaid-certified nursing home facility, meaning the facility has to accept Medicaid. More on Nursing Home Medicaid eligibility.

 

2) Home and Community Based Service (HCBS) Waivers

Nursing home care is extremely expensive, and the administrators of Medicaid programs know that care at home can be less expensive and preferred by many individuals. Coupled with the fact that it is often a long period of time between “needing a little help” and “needing full-time assistance”, Medicaid has expanded in certain ways… Home and Community Based Services (HCBS) Waivers, are one such way.

Long-term Services and Supports (LTSS), which are provided through Waivers, are one way to look at that space between “a little help” and “full-time help”. Among many other benefits, LTSSs often include:
-Adult day care
-In-home assistance with activities of daily living (ADLs)
-Homemaker services
-Home health care services
-Home modifications to facilitate safe movement throughout the home
-Medical alert services
-Respite care for unpaid caregivers

HCBS waivers help a Medicaid recipient to obtain assistance with long-term supports and services, either in their own home, in a community setting like a caregiver’s home or adult day care, or in an assisted living residence or memory care community. However, unlike Nursing Home Medicaid, HCBS Waivers are prohibited, by law, from paying for room and board.

As with Nursing Home Medicaid programs, HCBS Waivers have state-specific financial requirements. However, these differ from Nursing Home Medicaid in that they must allow the beneficiary enough income to cover their home costs or their room and board in assisted living. Obviously, these are expenses an individual living in a nursing home would not have.

Waivers are not entitlements. That means there are a limited number of people who are allowed in the program, and even if all the qualifications are met, they may experience a wait of a few months to a few years before services are actually available. Waiting lists exist and prioritization for the waiting lists differ with each HCBS Waiver. Some waivers are first-come, first-serve and other prioritize those persons with the greatest need. More on HCBS waivers eligibility.

 

3) Aged, Blind and Disabled (ABD) Medicaid

Where Nursing Home Medicaid offers full-time care in an appropriate facility, and HCBS waivers allow you to receive that level of care outside of a nursing home, ABD (Aged, Blind, Disabled) Medicaid can best be thought of as an expansion of regular Medicaid. Think Medicaid health insurance expanded for aged, blind of disabled persons. One qualifies for each service and support separately as opposed to the suite of services one receives in a nursing home.

ABD Medicaid is not referred to by the same name in every state, but states typically use a variation on that state such as Aged or Disabled (AD), the ABD Pathway, Elderly, Blind and Disabled, or EBD.

Typically, ABD Medicaid programs do not offer the same wide range of services and supports that are provided under nursing homes or waivers. In most states, care is limited to home health care and personal care assistance or attendant care.

Every state’s ABD Medicaid program is an entitlement, so just like with the Nursing Home Medicaid, if you meet the eligibility requirements, the state must pay for the benefits. It’s not like waiver programs that have a cap on the number of participants. More on ABD Medicaid eligibility.

 

Quick Comparison Table

Comparing 3 Types of Medicaid Long Term Care Programs
Type of Medicaid Long Term Care Program Entitlement? Care Locations Level of Care Eligibility Criteria
Nursing Home Yes Nursing homes only All care needs and room and board Permits higher income limits but income must be surrendered to Medicaid
HCBS Waiver No State-dependent but typically at home, in assisted living or adult day care Most care needs but no room and board Permits higher income limits with allowances for room and board
Aged, Blind or Disabled Yes State-dependent but typically at home only Limited care needs Most restrictive income limits