MD Home and Community-Based Options Waiver

The Home and Community-Based Options Waiver in Maryland, also known as the Community Options Waiver, is a Medicaid program that allows eligible individuals to receive care services in their home or a community setting instead of a nursing facility. In this blog post, we will explain the Home and Community-Based Options Waiver, how it works, and how it can help you as a caregiver.

Overview of Home and Community-Based Options Waiver

The Home and Community-Based Options Waiver is a Medicaid program approved by the Centers for Medicare and Medicaid Services (CMS) in 2014. The waiver aims to provide home and community-based services (HCBS) for Maryland residents who are elderly and disabled, require assistance with activities of daily living, and are at risk of nursing home admittance. The waiver also seeks to promote independence, community integration, and consumer choice for the participants.

The Home and Community-Based Options Waiver serves individuals who are eligible for Medicaid and meet the following criteria:

• They are age 18 or older.
• They need a nursing facility level of care, which means they need ongoing supervision, assistance, or support to perform daily living activities.
• They live in their own home, a family home, or an alternative living unit (ALU), a small group living facility providing personal care services.
• Their monthly income does not exceed 300% of the Supplemental Security Income (SSI) benefit, which is $2,382 in 2023
• Their countable assets do not exceed $2,000 or $2,500 (depending on eligibility category)
• They are not enrolled in another Medicaid waiver program.

The Home and Community-Based Options Waiver has an annual budget of $180 million and serves up to 5,000 individuals annually.

Services and supports

The Home and Community-Based Options Waiver offers a range of services and supports tailored to each individual's needs and preferences. Some of the services and supports available under the waiver are:

• Assisted living: This service provides personal care, meals, medication administration, laundry, housekeeping, social activities, and transportation in an ALU setting
• Medical day care: This service provides nursing care, personal care, meals, medication administration, social activities, and transportation in a licensed facility during the day
• Family training: This service provides education, training, counseling, support groups, and other resources to help family caregivers enhance their skills, knowledge, and well-being
• Case management: This service provides coordination, monitoring, advocacy, and linkage to other services and supports for the participants
• Senior center plus: This service provides social activities, meals, personal care, transportation, and supervision in a senior center setting during the day
• Dietitian and nutritionist services: This service provides assessment, counseling, education, and intervention to address the nutritional needs of the participants
• Behavioral consultation: This service provides assessment, counseling, education, intervention, and crisis management to address the behavioral needs of the participants

In addition to these services and supports, waiver participants are also eligible to receive Medicaid services such as:

• Community First Choice Services: These services include personal assistance services (PAS), support planning (SP), nurse monitoring (NM), personal emergency response systems (PERS), assistive technology (AT), environmental assessments (EA), accessibility adaptations (AA), consumer training (CT), transition services (TS), and home delivered meals (HDM)
• Other Services: These services include hospital and physician care, pharmacy, laboratory services, home health, mental health services, and medical equipment and supplies.

Compensation for caregivers

One of the benefits of the Home and Community-Based Options Waiver is that it allows individuals to self-direct some of the services they receive. Self-direction means they can choose who provides the service, how it is provided, when, and where it is delivered. Self-direction also means they can hire and pay their workers, including family members or friends.

The Home and Community-Based Options Waiver offers one option for self-direction: self-directed PAS. Under this option, individuals can hire workers to assist with ADLs such as bathing, dressing, eating, and toileting. The workers can be family members (except spouses or legal guardians), friends, neighbors, or anyone else who meets the qualifications and passes a background check.

The workers are paid through a fiscal intermediary agency that handles payroll, taxes, insurance, and other administrative tasks. The workers are paid at an hourly rate determined by the state. The current rate for self-directed PAS is $13.50 per hour, while the current rate for agency-provided PAS is $15.00 per hour. These rates are subject to change based on state regulations.

By choosing self-direction, individuals can have more control over their services and support. They can also compensate their caregivers for the valuable work that they do.

A note from Givers

If you are interested in applying for this waiver or determining eligibility for caregiver compensation, please fill out this form. We will get back to you as soon as possible with more information.