HCB Medicaid stands for Home and Community-Based Services. This health care program is also referred to as HCBS at times. These services are made available to those who meet financial eligibility requirements with assistance in the home. HCB Medicaid is an alternative to nursing home care for those in need of care services and who would like to attempt to remain in-home.
HCB has many things in common with long-term care services in a nursing facility, but there are also important differences. The commonalities: the financial requirements are exactly the same as the Medicaid eligibility requirements in the nursing home Medicaid program. Additionally, like the nursing home Medicaid state plan, HCB also restricts gifting, and applies the five year look-back period to any prior uncompensated transfers. On the plus side, Divisions of Assets for married couples are allowed for HCB services, allowing the couple to retain a portion, or even all, of the family’s assets while receiving Medicaid home care.
Unlike nursing home Medicaid, however, there is typically an income limit for those applying for Medicaid in-home services. In the event that the applicant’s income exceeds the applicable income limit, the applicant will be required to spend down a portion of the income before the Medicaid assistance will begin payment for the month.
Additionally, unlike nursing home Medicaid, HCB is not typically geared towards payment of ALL of an applicant’s person’s home health needs. A grant is made based on both physical and financial need, but that budgeted grant is typically insufficient to pay for all of the care recipient’s in-home needs.
Physical qualification: In addition to the financial requirements, the applicant must also physically qualify. The applicant’s needed level of care be assessed by the Department of Social Services or Human Services to ensure that caregivers are required. The assessment is typically based on an assessment of the applicant’s ability to handle the activities of daily living. If the applicant is determined to require assistance in his or her activities of daily living, the physical requirement test has been met and services will be available.
Once the applicant qualifies, the financial assistance can be used for in-home care, providing personal care and assistance with ADLs. The caregiver can be provided by a Medicaid certified home care agency, or could even be provided by a family member, loved one or friend (referred to as Consumer Directed Services). The financial assistance can also be used to pay for adult day care. These health services can also be used for short term respite care, if the physical need requirements have been met.
Separate from the typical HCB services for seniors, there are in-home services available to people with disabilities, intellectual disabilities and developmental disabilities (challenges such as autism), to be aware of, and HCBS waiver programs are available. The Missouri Department of Mental Health’s Division of Developmental Disabilities (Division of DD), along with the Centers for Medicare & Medicaid Services (medicare.gov), administers four Medicaid Home and Community Based (HCB) Medicaid Waiver programs for individuals with intellectual disabilities and developmental disabilities, addressing behavioral health. The four waivers are the Comprehensive Waiver, Community Support Waiver, Missouri Children with Developmental Disabilities Waiver (MOCDD or Sarah Jian Lopez Waiver); and Partnership for Hope. Case Management is handled by the Department of Developmental DD, and the Department of Mental Health
Authority for the Division of DD waivers is the result of a federal law enacted by Congress in 1981 that added a new section to the Social Security Act in 1915(c). Under Home and Community-based waivers, a state may use Medicaid funding for home and community-based services provided only to a target group of people for enrollment who have intellectual and developmental disabilities and whose care needs would otherwise require services in an institution. Federal law also allows a state to target services by geographic region. The Division of DD uses general revenue funds and local county dollars to match federal dollars to pay for HCB waiver services.