Medicaid Waiver Services and the Possible Pending Federal Legislation Impacts

Federal Medicaid offers certain waivers for people with special needs or chronic health concerns. With these waivers, healthcare providers can care for someone in their home as opposed to only providing services in long-term care facilities. Each state can choose how many and what kind of waivers they offer, but they must prove that each waiver service:

  • Costs the same or less than the same service will cost in a facility
  • Is necessary for the recipient’s health and welfare
  • Provides proper standards to meet the person’s needs, and
  • Follows a specialized plan of care focused on the recipient’s requirements. 

Under federal regulations, each state may implement home- and community-based service (HCBS) waivers that also provide non-medical services including: 

  • Personal case management organization
  • Homemaker services such as cleaning and cooking
  • Home health aides 
  • Respite care for the family members who often provide daily care
  • Personal care, and
  • Adult daycare options. 

The primary goal is to allow people with disabilities as much independence as possible along with the ability to live in their home instead of a facility.

Illinois’ Medicaid Waiver Program

Since every state offers different waivers, the benefits vary per state. You can find a  list of Illinois waivers and types at the Medicaid government website. Eligibility rules also vary for each waiver, and an applicant must meet their statelevel of care requirement.

Pending Legislation That May Affect Medicaid Waiver Services

As part of the latest COVID-19 relief proposed by the Biden Administration, the American Jobs Plan suggests $400 billion to expand access to Medicaid Home and Community Based Services (HCBS) for people with disabilities. HCBS helps people who need assistance with self-care activities such as eating and bathing, and household activities like cooking. 

Medicaid provides most HCBS and these services are usually not covered by other payers like Medicare. States can offer Medicaid HCBS to all enrollees who qualify, and Medicaid waivers to help states target specific populations that require these services.

The pending legislation is proposed in response to the growing demand for HCBS due to a large number of COVID cases in community living facilities and the need for community-based care that existed before the pandemic. The proposed funds could serve more HCBS enrollees and offer new or expanded benefits including: 

  • Granting services to people who are on waiver waiting lists
  • Creating new optional Medicaid HCBS eligibility opportunities
  • Increasing the existing participant income/asset limits
  • Offering new HCBS benefits, and 
  • Expanding the scope of current HCBS options.

The $400 billion proposed in the American Jobs Plan could increase Medicaid’s annual spending for HCBS by roughly 33% annually. 

How the New HCBS Funds Might be Used

The Money Follows the Person (MFP) program is one of the specific Medicaid proposals mentioned in the American Jobs Plan. MFP helps seniors and people with disabilities across the country move from nursing homes or assisted living facilities back into the community and their own homes. Through this program, states can fund certain services, including first months rent, household set-up costs, and staff to help recipients find appropriate community housing.

Other initiatives are being considered, including helping people with disabilities join the workforce by offering services such as attendant care or supported employment and keeping their family members employed instead of leaving a job to stay home to care for a loved one with special needs. 

If enacted, this legislation would add further federal support for HCBS and possibly improve state efforts to increase access through Medicaid. It also could be an important step toward the larger goal of eliminating Medicaids past biases to make HCBS mandatory.

Many Questions Still Remain

If the American Jobs Plan is further developed, many wonder whether the new funds will be spent federally, or passed to the states to distribute. If the money is allocated to the states, it may increase the federal matching rate or grant dollars. Also, states may be required to maintain or increase their current level of HCBS spending to qualify for the new funds. 

If you have a family member that qualifies for a Medicaid waiver in Illinois, you should be aware of the pending legislation and how it may affect your loved one’s rights and benefits. At Rubin Law, we are closely monitoring the impact these changes may have on our clients. As always, we’re happy to explain how your situation may be affected. 

Rubin Law is the only law firm in Illinois exclusively limited to providing compassionate special needs legal and future planning to guide our fellow Illinois families of children and adults with intellectual disabilities, developmental disabilities, or mental illness down the road to peace of mind. For more information, email us at or call 866-TO-RUBIN.