Nevada Medicaid Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. This article focuses on Nevada Medicaid Long Term Care for seniors. This is different from regular Medicaid, which is for low-income people of all ages. In Nevada, Medicaid is administered by the Nevada Department of Health and Human Services. Nevada residents can receive long term care benefits through Nevada Medicaid in a nursing home, in their own home, the home of a loved one, group residential facilities or an assisted living residence through one of three programs – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Medical Assistance to Aged Blind and Disabled (MAABD).
Nevada Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Nevada Medicaid will cover the cost of long term care in a nursing home for eligible Nevada residents who require a Nursing Facility Level of Care. Nursing home coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services. These can include skilled nursing care, physician’s visits, prescription medication, medication management, mental health counseling, social activities and assistance with the Activities of Daily Living (eating, bathing, moving, dressing, toileting).
Some of the things Nevada Medicaid won’t cover in a nursing home are a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example), personal reading items, plants, flowers, and any care services not considered medically necessary.
Nursing Home Medicaid is an entitlement. This means that eligible Nevada residents who apply are guaranteed by law, aka “entitled,” to receive Nursing Home Medicaid benefits once their application has been approved.
Any Nevada Medicaid beneficiary who receives nursing home coverage must give most of their income to the state to help pay for the cost of the nursing home. They are only allowed to keep a “personal needs allowance” of $35 / month. This can be spent on personal items such as snacks, books, haircuts, etc.
Home and Community Based Service (HCBS) Waivers
Home and Community Based Service (HCBS) Waivers will pay for long term care services and supports that help Nevada Medicaid recipients who require a Nursing Facility Level of Care, or are at risk of nursing home placement in the next 30 days, remain living “in the community” instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long term care services for Nevada residents who live in the home of a loved one, group residential facilities or an assisted living residence. While Nevada’s HCBS Waivers will cover some long term care services and supports in those settings, it will not cover room and board costs.
Nevada’s HCBS Waiver programs that provide long term care benefits to seniors are the Waiver for the Frail Elderly and the Waiver for Persons with Physical Disabilities.
1) Waiver for the Frail Elderly
Nevada’s Waiver for the Frail Elderly, which is also known as the Frail Elderly Waiver or the FE Waiver, is intended to delay or prevent nursing home placement for Nevada Medicaid beneficiaries who live in their own home, the home of a loved one, a residential group facility or an assisted living residence. FE Waiver applicants must require a Nursing Facility Level of Care or be at risk of being placed in a nursing home in the next 30 days without some of the benefits provided by the FE Waiver. The state will assess FE Waiver applicants to determine their level of care needs.
Benefits of the FE Waiver include adult day care, companion services, housekeeping help, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits are made available depending on each individual’s needs and circumstances.
The Nevada FE Waiver had 2,954 enrollment spots per year as of 2022. Once those spots are full all additional eligible applicants are placed on a waiting list.
2) Waiver for Persons with Physical Disabilities
Nevada’s Waiver for Persons with Physical Disabilities, which is also called the Physical Disabilities Waiver or PD Waiver, is intended to delay or prevent nursing home placement for any Nevada Medicaid beneficiary with a physical disability who lives in their own home, the home of a loved one or an assisted living residence. PD Waiver applicants must also be at risk of nursing home placement if they don’t receive some of the benefits provided by the PD Waiver. The Nevada Division of Health Care Financing and Policy and the state’s Aging Disability Services Division will make the determination if an applicant has the type of physical disability that could require placement in a nursing home.
Benefits of the PD Waiver include case management, home modifications, chore services, meal delivery, housekeeping services and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). PD Waiver benefits are made available depending on each individual’s needs and circumstances.
Medical Assistance to Aged Blind and Disabled Medicaid
Nevada’s Medical Assistance to Aged, Blind and Disabled (MAABD) Medicaid, which is similar to Aged Blind and Disabled (ABD) in other states, provides healthcare and long term care services and supports to low-income Nevada residents who are aged (age 65+) or disabled and live “in the community.” Living “in the community” can mean living in their home, the home of a loved one, group residential care facilities or assisted living residences. While MAABD Medicaid may cover some services in all of those settings, it will not cover room and board costs. MAABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages.
Nevada’s MAABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.
Nevada MAABD Medicaid beneficiaries can receive long term care personal service benefits through the state’s Personal Care Services Program.
Personal Care Services (PCS) Program
Nevada’s Personal Care Services (PCS) Program provides long term care services to Nevada residents who receive Medical Assistance to Aged, Blind and Disabled (MAABD) Medicaid and are at risk of being placed in a nursing home without the benefits of the PCS Program. The intention of the PCS Program is to delay nursing home placement by providing program participants with personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).
A licensed caregiver can provide those benefits, but PCS Program participants also have the option of self-directing their benefits and selecting a caregiver of their choice. This can include a family member, as long as that family member is not legally responsible for the PCS Program participant, so spouses and legal guardians can not be hired. An Intermediary Services Organization helps the program participant with many of the responsibilities of being an “employer,” such as background checks, tax withholding and payments.
Like Nevada’s MAABD Medicaid itself, the PCS Program is an entitlement. This means that all eligible applicants are guaranteed by law to receive program benefits.
Program of All-Inclusive Care for the Elderly (PACE)
PACE coordinates medical, social service and non-medical personal needs into one comprehensive plan and delivery system for ABD Medicaid recipients, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. Although Nevada does not have a PACE program of its own as of 2023, neighboring California has 21 PACE programs located throughout the state. While individuals can not transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in their new state as soon as they relocate without any waiting period. More.
Eligibility Criteria For Nevada Medicaid’s Long Term Care Programs
To be eligible for the Nevada Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home / Institutional Medicaid, Home and Community Based Service (HCBS) Waivers or Medical Assistance to Aged Blind and Disabled (MAABD) Medicaid.
Nevada Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Nevada Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Nevada Medicaid beneficiaries who reside in nursing homes are only allowed to keep $35 / month of their income as a “personal needs allowance” and must give the state the rest to help offset nursing home costs.
For married applicants with both spouses applying, the 2023 asset limit for nursing home coverage through Nevada Medicaid is $3,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
Nevada Nursing Home Medicaid applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Nevada has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Nevada Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. The Nevada Medicaid Level of Care (LOC) assessment tool is used to determine the level of care required. This tool takes into consideration an applicant’s ability to manage their own medication, their need for supervision and their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).
Nevada Medicaid Home and Community Based Service (HCBS) Waivers Eligibility Criteria
Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2023, the asset limit for HCBS Waivers in Nevada is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $2,742 / month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2023 asset limit for HCBS Waivers in Nevada is $3,000 combined, and the income limit is $2,742 / month per spouse. For a married applicant with just one spouse applying, the 2023 asset limit is $2,000 for the applicant spouse and $148,620 for the non-applicant spouse, and the income limit is $2,742 / month for the applicant. The income of the non-applicant spouse is not counted.
Nevada HCBS Waiver applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they don’t, Nevada has a “look-back” period of five years. This means the state will look back into the previous five years of the applicant’s financial records to make sure they have not given away assets.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers through Nevada Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home, or being at risk of nursing home placement in the next 30 days without the long term care services and supports provided by the HCBS Waiver. The Nevada Medicaid Level of Care (LOC) assessment tool is used to determine the level of care required. This tool takes into consideration an applicant’s ability to manage their own medication, their need for supervision and their ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and other housework).
Nevada Medical Assistance for the Aged Blind and Disabled Medicaid Eligibility Criteria
Financial Requirements
Nevada residents have to meet an asset limit and an income limit in order to be financially eligible for Medical Assistance for the Aged Blind and Disabled (MAABD) Medicaid. For a single applicant in 2023, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the red box below for more details), and there are other non-countable assets like funeral trusts and Medicaid-approved annuities. The 2023 income limit for a single applicant is $914 / month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2023 asset limit for Nevada’s MAABD Medicaid is $3,000 combined, and the income limit is $1,371 / month combined. This applies to married couples with both spouses applying or with just one spouse applying.
While Nevada has a “look-back” period of five years for Nursing Home Medicaid and Home and Community Based Service Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no “look-back” period for MAABD Medicaid applicants. However, MAABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.
Functional Requirements
The functional requirements for Nevada’s Medical Assistance for the Aged Blind and Disabled (MAABD) Medicaid are being disabled, blind or aged (65 or over). For MAABD Medicaid applicants who require in-home services and supports, Nevada Medicaid will conduct an assessment of their ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of services the applicant needs and the state will cover.
One’s home is often their most valuable asset, and if counted toward the asset limit, it would likely cause them to be over the limit for eligibility. However, in some situations the home is not counted against the asset limit. If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage / debt) is less than $688,000 (as of 2023) then the home is exempt. If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives. If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $688,000. These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. More on Medicaid & Homeownership.
Applying For Nevada Medicaid Long Term Care Programs
The first step in applying for Nevada Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Medical Assistance for the Aged Blind and Disabled (MAABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Nevada Medicaid coverage when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Nevada Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents include five years of quarterly bank statements from all accounts; the most recent monthly or quarterly statements from all investments, IRAs, 401Ks, annuities and any other financial accounts; a letter from the Social Security Administration showing the applicant’s gross Social security income and deductions; tax forms to verify income streams including wages, pensions, royalties and interest; lists of items of any trusts; proof life insurance (if the applicant has any) and a list of beneficiaries; Power of Attorney documentation.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Nevada residents can apply online at Access Nevada. They can also download an application here or call their local Division of Welfare and Supportive Services office for an application.
Choosing a Nevada Medicaid Nursing Home
After an applicant has been approved for nursing home coverage through Nevada Medicaid, they need to choose which Medicaid-approved nursing home they will live in. Even though Nevada Medicaid nursing home coverage is an entitlement, Nevada Medicaid will only cover stays and care in approved nursing homes. Nevada residents can use Nursing Home Compare, which is a federal government website that has information about more than 15,000 nursing homes across the country, to help them find a nursing home. All of the nursing homes on this site are either Medicaid- or Medicare-approved.