Nursing Home Waiver in Jeopardy! 

CMS trying to change the rules for Nursing Home Waiver! 

By Arlene A. Wilson

Background

After years of advocacy by the disability and aging communities, New York State prepared an application for the Nursing Facility Transition and Diversion Medicaid Waiver. The waiver application was submitted to the Centers for Medicare and Medicaid Services (CMS) for their approval. During the waiver approval process, CMS notified the state that it is changing a longstanding interpretation of federal rules on how income should be handled if there is a community or non-disabled spouse. 

Under the old interpretation (which is currently the approach for eligibility for people in nursing homes or the other waivers), institutional income and resource rules apply post-eligibility. This means that a “community spouse” gets to keep up to a total of $2,489 in monthly income. If the “community spouse” does not personally receive that much income, they can receive the difference from the “institutional or disabled spouse.” 

Issue 

Under the new CMS interpretation, these rules won’t apply to the Nursing Facility Transition and Diversion Waiver! Under this new interpretation, CMS won’t allow the “community spouse” to receive ANY additional income from their spouse. This policy change will particularly hurt older women who typically receive much smaller social security payments because they have more limited work histories. They will be forced to institutionalize their disabled spouse in order to have the income they need for basic survival. Under the new CMS interpretation middle income and poorer people simply will not be able to afford to participate in the waiver!

CMS has changed a longstanding even-handed policy where institutional income and resource rules apply post-eligibility for Medicaid waivers. This new CMS policy interpretation reduces the monthly income for people living on the waiver and creates a strong financial incentive for people to institutionalize their disabled spouse. We must tell CMS to return to the original interpretation NOW!

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