My father has Alzheimer’s and we working to get him into a memory care facility for long term care. We have been told he will more than likely qualify for Medicaid. However we are mixed signals as to how to get the process started. Do get a Medicaid waiver or are we looking for Medicaid in nursing home. What is the difference?
What a waiver does is shift $ that is dedicated funding under Federal law to go instead to fund another program for same demographic. (Fwiw Federal budget has all sorts of waivers not just health care stuff.)
Under Medicare initial public laws, $ dedicated only for SNF aka a NH. Waivers - as they are not dedicated - require submission to CMS as to why, how, cost benefit, on a time frame, etc for approval. Renewal not guaranteed. Some States flat do not want to deal with waivers at all, some do for teeny tiny % of beds in nonSNF and importantly State can get the waiver to use the $ to go to programs with wider service of population use rather than 1-on-1 waiver, which AL would be. So bc of all this, even in States with a AL or MC waiver, some AL MC have zero interest in participating as more oversight + reporting and if the waiver stops they are stuck with an impoverished resident that the States will not pay a penny for.
So to encourage participation, States can allow for AL to do a private pay waiting list. This is the 2 yr system that JoAnn refers to for her State of NJ. For my State -LA- it has AL waivers but are being phased out with payment for those currently in one but no new ones as $ shifting to PACE whenever possible. For my moms tiered (IL 2 NH) facility in TX, the limited # of waiver beds in AL used exclusively by longtime residents as placeholder beds for the NH, like those in the AL waiver bed were 100% ready for SNF and just soon as someone died in the NH they moved over to the NH.
You need to ask clearly as to precisely how this facility runs its system and then determine if it can work financially. Hopefully they allow a waiver from Day 1 of entry. If not, I’d suggest that you try to do whatever to get dad’s health chart beefed up to show he is definitely “at need” for skilled nursing care, so he can have placement in a NH.
So it may cover a portion of in-home care.
Source: https://en.wikipedia.org/wiki/Medicaid_waiver
FYI Medicaid rules and coverage may vary by state.