Medicaid is a crucial supply of well being and long-term care protection for low-income individuals ages 65 and older and people with disabilities. Seniors and folks with disabilities account for lower than one in 4 Medicaid enrollees however over half of Medicaid spending The Medicaid pathways during which eligibility relies on previous age or incapacity are often known as “non-MAGI” pathways as a result of they don’t use the Modified Adjusted Gross Earnings (MAGI) monetary methodology that applies to youngsters, pregnant people, mother and father, and different non-elderly adults with low incomes. Along with contemplating earnings and age or incapacity standing, non-MAGI eligibility pathways often require individuals to show that they’ve restricted financial savings and different monetary assets (e.g., property). Medicaid enrollees who use long-term providers and helps (LTSS) should additionally meet necessities associated to their purposeful wants that are usually measured when it comes to the power to carry out actions of day by day dwelling comparable to consuming and bathing. As a result of practically all non-MAGI pathways are elective, eligibility ranges range considerably throughout states.
Between March 2020 and March 2023, there was a three-year pause on disenrollments, ensuing within the largest ever variety of enrollees in Medicaid and the bottom ever uninsured price. Beginning in April 2023, states started renewing eligibility for all enrollees because the COVID-related Medicaid steady enrollment interval ended (known as the “unwinding”), leading to 23 million disenrollments as of June 2024. KFF’s latest survey of people that had misplaced protection revealed that one quarter of those that had been disenrolled remained uninsured, and plenty of reported disruptions of their entry to well being care.
Though seniors and folks with disabilities typically dwell on mounted incomes and are unlikely to expertise eligibility adjustments, extra cumbersome eligibility necessities relative to different teams may end in extra individuals shedding protection. Lack of Medicaid protection poses distinctive challenges for seniors and folks with disabilities, people who find themselves more likely to have excessive well being care spending and depend on Medicaid for protection of LTSS. Civil rights complaints alleging discrimination towards individuals with disabilities for failure to prioritize their particular wants throughout unwinding have been filed in Colorado, Texas, and Washington D.C.
On this context, KFF’s Survey of Medicaid Monetary Eligibility & Enrollment Insurance policies for Seniors & Folks with Disabilities was carried out in March 2024 by KFF and Watts Well being Coverage Consulting. The survey sheds mild on states’ eligibility, enrollment, and renewal insurance policies for seniors and folks with disabilities as of June 2024. General, 49 states and the District of Columbia (hereafter known as a state) responded to the survey, although response charges to particular questions assorted (Florida was the one state that didn’t reply). Responses had been supplemented with publicly accessible data and knowledge from KFF’s 2022 survey when accessible. The Appendix tables include detailed state-level knowledge.
Key takeaways embody:
Eligibility insurance policies. The one obligatory eligibility pathway for seniors and folks with disabilities is for individuals who obtain Supplemental Safety Earnings (SSI), which limits individuals to $943 per 30 days in earnings and not more than $2,000 in financial savings and different monetary property.
In contrast to Medicaid enrollees who qualify by MAGI pathways, most non-MAGI enrollees should doc restricted property. All non-MAGI enrollees below age 65 should additionally set up that they’ve a qualifying incapacity, excessive well being care spending, or want for LTSS.
Simply over half of states supply protection for seniors and folks with disabilities to individuals with incomes above the SSI restrict (Determine 1).
States usually tend to increase eligibility for individuals who use long-term providers and helps (LTSS). People who find themselves eligible for Medicaid LTSS should additionally show that they meet purposeful necessities for eligibility, which usually require attestation from a medical supplier about individuals’s capability to carry out the actions of day by day dwelling. Most states supply protection below the Katie Beckett pathway for kids with important disabilities (adopted by 43 states) and the Particular Earnings Rule for individuals with LTSS wants with incomes as much as 300% of SSI (adopted by 42 states).
Medicaid enrollees utilizing institutional LTSS should usually contribute practically all month-to-month earnings to the price of their care, aside from a small “private wants allowance” to cowl bills comparable to cleaning soap, toothbrushes, clothes, and discretionary spending. There are 24 states with private wants allowances as much as $50, 20 states between $50 and $100, and solely 7 states with private wants allowances larger than $100.
Enrollment insurance policies. Most states (38) now use the identical processes to find out earnings eligibility for all Medicaid enrollees no matter what pathway they’re making use of by, however the necessity to doc property when making use of for non-MAGI Medicaid might make non-MAGI functions extra onerous (Determine 1).
In states the place earnings eligibility necessities for non-MAGI pathways differ from these of MAGI pathways, non-MAGI pathways are typically extra cumbersome.
All states however California require many seniors and folks with disabilities to show that their property are under Medicaid eligibility limits, and asset eligibility processes are sometimes extra cumbersome. For instance, when self-reported ranges of earnings and property differ from digital sources, 25 states require paper documentation of earnings ranges, and 32 states require paper documentation of property. California eradicated the asset check starting this yr.
Renewal insurance policies. To arrange for and simplify the unwinding course of, states made wide-ranging adjustments to their renewal processes, a lot of which can be retained and will assist states adjust to necessities within the April 2024 ultimate eligibility rule.
All responding states reported that they solely renew eligibility yearly for non-MAGI populations and that in-person interviews are no-longer required (Determine 1).
Almost all states (47) present enrollees with 30 days to return renewal data and a 90-day reconsideration interval when data is returned following a procedural disenrollment; and 46 states have made adjustments to extend the speed of ex parte renewals for non-MAGI enrollees. (With ex parte renewals, states routinely renew eligibility utilizing digital knowledge sources.)
Enrollment and Renewal Insurance policies for Seniors and Folks with Disabilities
Inside broad federal guidelines, states have discretion when establishing Medicaid software and enrollment insurance policies, which are typically extra sophisticated for seniors and folks with disabilities. Medicaid eligibility by the MAGI pathways is mostly primarily based solely on earnings, age, and being pregnant/ household standing, however seniors and folks with disabilities making use of for Medicaid by one of many “non-MAGI” pathways should often additionally meet necessities associated to monetary property, incapacity standing, and infrequently, their want for long-term providers and helps (LTSS) or well being care spending. Past setting the eligibility standards, states make a bunch of different choices in regards to the software and enrollment course of. For instance, states resolve whether or not to confirm self-reported earnings and asset limits earlier than enrollment or to concern conditional enrollment after which confirm the earnings and asset quantities afterwards. States have discretion in find out how to reply when self-reported earnings and property differ from the quantities proven in digital knowledge sources and in what kind of documentation they require from candidates. After candidates are decided eligible, they have to periodically renew their eligibility, and states have discretion in creating renewal insurance policies.
States’ insurance policies for enrolling individuals in Medicaid and renewing their protection have been a spotlight of policymaker consideration given pressures on eligibility staff stemming from the unwinding. The unwinding of steady enrollment led to an unprecedented quantity of eligibility work that got here at a time when most states had been experiencing workforce shortages and an absence of expertise amongst newly employed employees. To assist states encountering important operational challenges and to guard eligible enrollees from inappropriate protection losses, CMS offered states with technical help and a variety of methods aimed toward streamlining the renewal course of together with permitting states to make use of part 1902(e)(14)(A) waiver authority. Some methods are broad, however some are focused particularly for non-MAGI populations. Past adjustments stemming from the unwinding, states are additionally updating enrollment and renewal processes to satisfy new necessities in a April 2024 ultimate eligibility rule, a lot of which goal to streamline non-MAGI enrollment and renewal insurance policies.
At enrollment, most states (38) use the identical processes to find out earnings eligibility for Medicaid enrollees no matter whether or not they’re making use of by MAGI or non-MAGI pathways (Determine 2). As a part of the Medicaid software, all states require candidates to report their estimated earnings after which, candidates’ self-reported earnings is in contrast with earnings from digital sources such because the Social Safety Administration and Federal Knowledge Providers hub. The place state insurance policies range is in what occurs when self-reported (or self-attested) earnings ranges differ from the quantities returned from digital knowledge sources (Desk 1). Federal guidelines specify that states should settle for self-reported values if they’re “fairly appropriate” with values from the info supply (e.g., if reported earnings and the state’s digital knowledge supply are each under, at, or above the earnings eligibility restrict). With approval from CMS, states might elect an expanded “cheap compatibility commonplace,” comparable to a share or greenback quantity. For instance, if a state elected a ten% cheap compatibility commonplace, if an applicant’s self-reported earnings is under the eligibility threshold and the info supply is above the edge, however inside 10% of the self-reported quantity, the info are thought of fairly appropriate, and the applicant is set eligible for Medicaid.
Among the many 12 states during which processes differ between MAGI and non-MAGI pathways, states usually have extra cumbersome necessities for non-MAGI candidates. For instance, 7 states reported that they’ve a “cheap compatibility commonplace” between 10% and 50% for MAGI candidates however no comparable commonplace for non-MAGI candidates; and 5 states reported that MAGI candidates might submit an affordable clarification of variations, however non-MAGI candidates should submit paper documentation when the earnings estimates differ.
In all states however California, many seniors and folks with disabilities should show that their property are under Medicaid eligibility limits, and asset eligibility processes are typically administratively extra cumbersome than earnings eligibility processes (Desk 1). As of January 1, 2024, California eradicated asset assessments for all Medicaid candidates, partly to cut back the executive burden on candidates and the state. All states should confirm earnings and asset eligibility, however they could achieve this both earlier than or after enrollment. Most states confirm earnings and asset eligibility earlier than enrollment, however 9 states conditionally enroll candidates primarily based on self-reported earnings previous to verification whereas solely 5 states conditionally enroll candidates primarily based on self-reported property. Equally, extra states have expanded the cheap compatibility requirements for earnings functions (32 states) than asset functions (6 states). Rules finalized in April 2024 make clear that cheap compatibility requirements apply to each earnings and property, which can scale back these variations in future years. When self-reported knowledge will not be appropriate with digital knowledge sources, 25 states require paper documentation of candidates’ earnings, however 32 states require paper documentation for candidates’ property. Non-MAGI people can submit paperwork by the next modes: mail (49), native workplace (49), fax (48), on-line portal (44), electronic mail (37), and cellular units (18), and 12 states permit people to submit paperwork by any of the six modes listed above.
Few states allow well being care suppliers or different entities to find out non-MAGI eligibility previous to a proper software and approval, a observe often known as “presumptive eligibility” (Desk 1). Together with Florida’s reply to the 2022 survey, there are 10 states that permit hospitals and three states permitting a distinct kind of entity to do presumptive eligibility for non-MAGI populations, together with the Division of Well being in Tennessee, Division of Public Well being in Delaware, and native well being departments in Georgia. No states reported that suppliers comparable to pharmacies, nursing services, or residence well being care suppliers may do presumptive eligibility.
Many adjustments to streamline enrollment and renewals expedite the unwinding course of and conform with new necessities within the April 2024 ultimate eligibility rule (Determine 3, Desk 2). The brand new rule prohibits states from requiring candidates or enrollees to do in-person interviews and from renewing protection extra often than as soon as per yr, two practices that had traditionally been utilized to non-MAGI candidates and enrollees. All responding states now report that they don’t require in-person interviews and that they solely renew protection for non-MAGI populations on an annual foundation. All states additionally reported adopting a number of of the next practices that will probably be required below the brand new rule in 2027.
49 states present a reconsideration interval of 90-days or longer if data is returned after a procedural disenrollment.
48 states present enrollees with no less than 30 days to return signed types and required data.
38 states ship pre-populated renewal types and Georgia sends pre-populated renewal types when requested.
To streamline the unwinding course of, 39 states reported that 1902(e)(14)(A) Medicaid waivers had helped enhance the variety of “ex parte” renewals for non-MAGI enrollees, during which states routinely renew eligibility utilizing digital knowledge sources earlier than requiring the enrollee to submit types or paperwork (Determine 4, Desk 3). Ex parte renewals scale back administrative burdens for enrollees and state companies. Previous to the unwinding, most states reported the next share of renewals being accomplished for MAGI enrollees than for non-MAGI enrollees, doubtless on account of the larger administrative necessities related to non-MAGI eligibility. The 1902(e)(14)(A) waiver possibility permits states to waive numerous federal necessities for renewal processes. When requested which waivers had been probably the most useful in rising ex parte renewals, the best variety of states (21) reported waivers to resume eligibility when no data is offered about enrollees’ property from the state’s digital system. (North Carolina reported adopting that waiver however has not but applied it.) Smaller numbers of states reported that probably the most useful waivers allowed them to resume eligibility primarily based on eligibility for the Supplemental Vitamin Help Program (16 states), renew protection with out regard to asset limits (12 states), and renew protection for enrollees with secure incomes with out checking knowledge sources (11 states). A small variety of states reported that probably the most useful waivers permitted renewing protection for individuals routinely if they’d no earnings or property in digital knowledge sources (Alaska and Indiana) or if their incomes had been under the federal poverty stage (FPL), which is $1,255 for a person in 2024 (California and Minnesota).
Almost all states reported contemplating or planning to proceed renewal insurance policies that had been applied to facilitate renewals in the course of the unwinding and practically half of states (24) reported planning to proceed greater than 5 adjustments (Determine 5, Desk 4). The commonest adjustments had been efforts to extend ex parte renewals (46 states), adopted by elevated direct outreach (40 states), new methods for enrollees to replace their contact data (30 states), and engagement with community-based organizations (30 states). Over half of states (28) engaged managed care organizations to assist with the renewal course of and 27 states enhanced on-line functionalities of their enrollment methods. Different adjustments states reported embody participating organizations apart from managed care or community-based organizations (Connecticut), implementing methods for returned mail (Minnesota), offering extra details about what’s required for renewals (Vermont), and sending textual content messages to remind enrollees of renewals (Washington and Wisconsin).
Major Medicaid Eligibility Pathways for Seniors and Folks with Disabilities
The one non-MAGI pathway that states are required to cowl is individuals receiving supplemental safety earnings (SSI), however there’s a big range of extra teams that may be lined at state possibility (Field 1). Past SSI, the principle non-MAGI pathways to full Medicaid eligibility embody state choices to increase protection to low-income individuals with disabilities; medically needy people who “spend down” by deducting incurred medical bills from their earnings; Katie Beckett youngsters with important disabilities dwelling at residence; and adults who use long-term providers and helps (LTSS). Every group has completely different guidelines about earnings and property, making eligibility advanced.
Field 1: Major Medicaid eligibility pathways primarily based on previous age and incapacity
There are numerous eligibility pathways for people who find themselves ages 65 and older or who’ve disabilities, however all of them apart from SSI are elective for states. On this survey, KFF requested states in regards to the 5 pathways that represent the most important sources of Medicaid enrollment amongst seniors and folks with disabilities.
Supplemental Safety Earnings (SSI) Enrollees. States should usually present Medicaid to individuals who obtain federal SSI advantages. That is the one pathway the place eligibility relies on previous age or incapacity that states should embody of their Medicaid packages. To be eligible for SSI, individuals should have low incomes, restricted property, and an impaired capability to work due to previous age or important incapacity. The utmost SSI federal profit price is $943 per 30 days for a person and $1,415 for a pair in 2024, which is 75 % of the federal poverty stage (FPL). The efficient SSI earnings restrict could also be considerably increased than 75% FPL in some states, resulting from state supplemental funds and/or extra earnings disregards. SSI enrollees are also topic to an asset restrict of $2,000 for a person and $3,000 for a pair.
Katie Beckett Kids with Disabilities. The “Katie Beckett” possibility permits states to increase protection to youngsters as much as age 19 who meet the SSI medical incapacity standards and qualify for an institutional stage of care however live at residence. States might goal completely different populations primarily based on the kind of institutional care that might be required (hospital, expert nursing facility, or intermediate care facility for individuals with psychological illness or mental/ developmental disabilities). Below the Katie Beckett pathway, solely the kid’s earnings and property are thought of for eligibility functions.
Particular Earnings Rule. States can elect the “particular earnings rule” pathway to cowl individuals with incomes as much as 300% of the SSI profit price ($2,829 in 2024) and purposeful wants qualifying them for an institutional stage of care. Most states restrict enrollees to $2,000 in property for a person or $3,000 for a pair and supply the pathway to individuals no matter whether or not they’re utilizing LTSS in an institutional or neighborhood setting.
Medically Needy Protection. States use medically needy pathways to increase protection to individuals who can be eligible by one other pathway however have earnings or property that exceed the restrict for that pathway. Folks might qualify by a medically needy pathway if their earnings is increased than permitted below a distinct pathway however decrease than the medically needy restrict, or in the event that they “spend down” to the medically needy restrict by deducting well being care bills from their earnings. For individuals who spend right down to eligibility, states choose a price range interval between one and 6 months throughout which the person should incur sufficient bills to lower their earnings under the restrict.
Seniors and Folks with Disabilities as much as 100% FPL. States can select to increase Medicaid to seniors and folks with disabilities whose earnings exceeds the SSI restrict however is under the federal poverty stage (FPL, $1,255 for a person in 2024). States can even select to use an asset restrict to this pathway, often $2,000 for a person.
In 2024, the commonest elective non-MAGI eligibility pathways had been these for individuals who use LTSS and required an institutional stage of care (Determine 6, Desk 5). The 2 major eligibility pathways for individuals who use LTSS embody Katie Beckett protection for kids who’ve important disabilities and require an institutional stage of care however live at residence (43 states) and the particular earnings rule, which covers different individuals who require an institutional stage of care and have incomes as much as 300% of the SSI profit price (42 states). There are 34 states providing medically needy protection and 28 states which have prolonged eligibility for seniors and folks with disabilities who’ve earnings above the SSI eligibility thresholds.
All states present Medicaid to individuals with SSI, and simply over half (28) of states increase protection for individuals with earnings above SSI limits (Determine 7 and Desk 6). The utmost SSI federal profit quantity is $943 per 30 days for a person and $1,415 for a pair in 2024, which is 75% of the federal poverty stage (FPL), however over half of states now cowl individuals with incomes larger than the SSI price, together with 18 states with protection on the FPL and 9 states with protection between 75% and 100% of the FPL. With eligibility at 138% FPL, California is the one state to supply protection to individuals with incomes larger than the FPL ($1,732 for a person). Most states set asset limits at $2,000 for a person and $3,000 for a pair, though a number of states have established increased limits, and California and Arizona reported not having asset limits.
There are two mechanisms states can use to extend eligibility ranges for seniors and disabilities: First, some states complement the federal SSI profit with extra funds, which will increase the entire SSI profit and ends in increased earnings limits for Medicaid enrollees. Second, states might undertake the 100% FPL protection group to cowl individuals with incomes larger than the SSI restrict however decrease than the poverty stage. Louisiana reported adopting the 100% FPL protection pathway however units eligibility for that pathway at SSI ranges.
When it comes to enrollment, there are three ways in which states elect to enroll SSI recipients into Medicaid. In 35 states, the Social Safety Administration determines eligibility for Medicaid when establishing SSI eligibility. There are 8 Part 209(b) states which use monetary or purposeful eligibility standards which might be extra restrictive than the federal SSI guidelines, however no extra restrictive than the principles the state had in place in 1972 when SSI was established. The remaining 7 states use SSI standards to find out eligibility however don’t auto-enroll recipients into Medicaid. When requested why they didn’t use auto-enrollment, states reported that the method is simply too cumbersome to implement or they’ve necessities past SSI eligibility comparable to an software and/or interview.
Greater than half (34) of states have medically needy pathways to Medicaid eligibility, however most earnings eligibility ranges are low—often under 50% of the FPL (Determine 8 and Desk 7). If states supply medically needy protection, they have to supply it to pregnant girls and kids, so all 34 states supply medically needy protection to pregnant girls and kids, 32 states supply it to seniors and folks with disabilities, and 21 supply it to low-income mother and father. Earnings limits for medically needy protection are low as a result of the earnings limits typically mirror earnings after cost of medical bills and since when states created their medically needy packages, most states linked earnings eligibility to the earnings limits for money help packages. Amongst states with medically needy packages, 15 states use a greenback threshold to find out earnings eligibility, 12 states use a share of the FPL, and 6 states use one other foundation. The median earnings restrict is $504 or 40% of the FPL, and plenty of states restrict enrollees to $2,000 in property.
In contrast to different Medicaid eligibility pathways, states will not be required to cowl obligatory advantages of their medically needy packages, they usually require enrollees to re-establish eligibility as often as as soon as per 30 days (Desk 7). For many Medicaid eligibility teams, there are advantages that states are required to supply to all enrollees, however states might select which advantages to cowl within the medically needy packages. Among the many 34 states that supply medically needy packages, 25 states reported overlaying nursing facility providers. In different states, nursing facility providers wouldn’t be lined and folks’s spending on nursing facility care wouldn’t rely as well being care spending for the needs of creating eligibility. Given the excessive prices of nursing facility care, the exclusion of nursing facility protection might have a major affect on individuals’s capability to qualify by this pathway, however people that want nursing facility care could also be eligible for Medicaid by one other LTSS pathway. Medically needy protection additionally requires people to periodically reestablish eligibility by incurring adequate medical and LTSS bills to cut back their countable earnings to the state’s medically needy earnings stage. The timeframe for these “price range intervals” ranges from 1 month (9 states) to 1 yr (2 states). The commonest price range interval is 6 months (12 states).
Most states undertake the Katie Beckett choice to cowl youngsters with important disabilities who dwell in the neighborhood or present protection by a comparable waiver program (Determine 9 and Desk 8). In 2024, 43 states reported providing Katie Beckett protection, with Washington presently pursuing protection by an 1115 waiver, which is able to deliver the entire variety of states with protection again to 44 as was the case in 2022. Amongst these states, 17 states supply protection by the state plan, 21 states supply protection by a waiver, and 5 states have each waiver and state plan choices. The commonest earnings restrict is $2,829 (utilized by 31 states), which equals 300% of the SSI profit price or 225% of the FPL. All states aside from Massachusetts replace earnings limits yearly. Most states restrict people to $2,000 in property however 7 states don’t have any limits (California, Hawaii, Illinois, Kansas, Minnesota, North Dakota, and Wisconsin).
Most states (42) undertake the particular earnings rule and supply Medicaid protection to individuals with incomes as much as 300% of the SSI profit price ($2,829 per 30 days for a person in 2024) for individuals who want LTSS (Desk 8). When adopting the particular earnings rule, states might decide whether or not to undertake it for individuals utilizing institutional LTSS, comparable to nursing facility care, and individually, whether or not to undertake it for individuals utilizing home- and community-based providers (HCBS), comparable to private care. In 2021, KFF estimated that over 5.6 million individuals used Medicaid LTSS, and that almost all of them obtained HCBS. Among the many 42 states that reach Medicaid to individuals who use LTSS, 41 states undertake the particular earnings rule for institutional LTSS and 41 states undertake the rule for HCBS. As in 2022, Massachusetts was the one state to report adopting the particular earnings rule for HCBS however not institutional care and New Hampshire was the one state to report adopting the rule for institutional care however not HCBS. Delaware is the one state that adopts the particular earnings rule however units earnings eligibility limits under 300% SSI, setting eligibility at 250% of the federal poverty stage as an alternative as an alternative ($2,358 in 2024). (In all states, institutionalized people are handled as single-person households after eligibility has been established.)
For Medicaid enrollees who’re eligible for Medicaid as a result of they use LTSS, most states (37) restrict the worth of candidates’ properties to the federal minimal stage ($713,000 in 2024), however all states disregard some residence fairness when calculating the house’s worth (Desk 9). In 2024, federal guidelines specified that if states place limits on candidates’ residence values, these limits should be between $713,00 and $1,071,000. There are 11 states that set the house fairness restrict on the most stage and a couple of states that use a restrict in between the federal minimal and most. These quantities are up to date yearly primarily based on adjustments in SSI profit charges and the buyer worth index. California has no residence fairness restrict on principal residence. When estimating the worth of the house, all states disregard some residence fairness for LTSS eligibility. When and the way limits on residence fairness apply, is commonly sophisticated. For instance, if the Medicaid enrollee has a partner or youngster who’s below 21, blind, or disabled dwelling within the residence, it’s exempt from residence fairness limits and doesn’t rely in direction of the restrict of individuals’s property. In different circumstances—notably, when an enrollee resides in a nursing facility and doesn’t intend to return residence—the house might as an alternative be counted as an asset for figuring out monetary eligibility.
As soon as eligible for Medicaid, people utilizing institutional care usually should contribute practically all month-to-month earnings to the price of their care, aside from a small “private wants allowance,” which was $55 within the typical state in 2024 (Determine 10, Desk 9). Private wants allowances are meant to cowl prices that Medicaid doesn’t pay for, starting from private hygiene provides comparable to cleaning soap and toothbrushes to clothes to self-care comparable to haircuts. Any discretionary spending—comparable to buying items for family members or journey—would additionally come from the private wants allowance. In 2024, the median month-to-month private wants allowance for a Medicaid enrollee residing in an establishment is $55, up from $50 in 2022. There are 24 states with private wants allowances as much as $50, 20 states between $50 and $100, and solely 7 states with private wants allowances larger than $100. Such restricted private wants allowances depart nursing facility residents with few assets for buying requirements, and usually, no earnings to cowl discretionary bills.
Private wants allowances are usually increased for people receiving HCBS in recognition that enrollees dwelling of their properties proceed to incur prices comparable to lease, electrical energy, and meals. The median month-to-month allowance for people receiving HCBS waiver providers is $2,829 in 2024, which equals 300% of the SSI profit price and was reported by 20 states. There have been 20 states that reported private wants allowances under that price and a couple of states that reported allowances above that price. (In some states, private wants allowances differ throughout the HCBS waivers. KFF requested states to report the allowance related to the waiver that had the best enrollment.)
