Minnesota Delays Stricter Eligibility Requirements for Medicaid Waiver Program

Minnesota Gov. Mark Dayton (D) has ordered his state to delay by at least one year a set of rule changes tightening eligibility requirements for a Medicaid waiver program that allows thousands of elders to live in their own homes and communities.

The rule changes would have limited program eligibility to elders who need help performing at least four activities of daily living (ADLs), up from just one.The stricter requirements were scheduled to go into effect on January 1; Dayton announced the delay on December 31.

“I have asked my administration to delay implementation for at least one year, to assure that the necessary community supports are in place to ensure those seniors will receive alternative care,” Dayton said in a statement.

Minnesota’s Medicaid waiver program, known as the Elderly Waiver Program, lets more than 22,000 Minnesotans aged 65 and older receive long-term care in their own homes, thus avoiding having to live in a nursing home.

In 2009, then Gov. Tim Pawlenty (R) set into motion the rule change requiring participants to display a need for help with four ADLs (or just one critical ADL, such as toileting). Implementation was put on hold several times in the intervening years.

Pawlenty said the rule change was necessary to stem the tide of rising Medicaid costs.

Approximately 2,600 Minnesotans would have been cut from the Elderly Waiver Program, saving the state $50 million over the next four years, the state estimated.

Fighting Back

But advocates for elders and the poor fought back, arguing that cutting frail and vulnerable elders out of the waiver program was unnecessarily cruel, and could end up costing the state more money in the long run.

Fred Johnson, a portfolio manager whose 83-year-old mother would lose her Elderly Waiver Program benefit under the rule change, told the Star Tribune that it “seems to make a whole lot more sense as a taxpayer to pay a few hundred dollars a month to help her stay in her own home, because if she falls again then it will cost the state many times more in hospital and nursing home bills.”

Some of the services offered through the Elderly Waiver program include home health aides and personal care assistants, who stand to lose hours — and wages — if the rule changes are put into effect.

The delay will allow the state to develop alternative supports for elders pushed out of the Elderly Waiver Program by the stricter eligibility standards, state official say.

— by Matthew Ozga