How to Work with Medicaid for Home Modifications

If your loved one has limited mobility, they will primarily benefit from the right kind of home modifications. Even the most straightforward home improvements, such as grab bars in the bathroom, improve the sense of safety, comfort, and dignity for people with disabilities. Unfortunately, making these home modifications can be much more expensive than you can afford. But don’t worry; government programs can help finance these home modifications. Every state usually has a Medicaid program to help foot home modification costs for people with disabilities. Some home modifications Medicaid can cover include the installation of wheelchair ramps, grab bars in the bathroom, and brighter lighting solutions, among others.

The idea behind these home modifications is to make the home more livable to foster independence. While this may seem straightforward, Medicaid has specific rules about who can financially and functionally qualify for the program. With that in mind, this article will discuss how you can work with Medicaid for home modifications.

Medicaid's Role in Home Modifications

Medicaid plays a critical role in providing financial assistance for home modifications aimed at improving accessibility and safety for individuals with disabilities. This support is part of Medicaid's broader effort to ensure that those with disabilities can live more independently and safely in their homes. Typically covered modifications include wheelchair ramps, grab bars in bathrooms, improved lighting solutions, and other modifications that enhance mobility and reduce the risk of injuries in the home.

Eligibility and Application Process

To qualify for Medicaid support for home modifications, an individual must meet certain financial and medical criteria, which can vary by state. The process generally involves:

• Verification of Disability - You must provide documentation from a healthcare provider to confirm that the modifications are medically necessary due to your disability.
• Income and Asset Tests - Most Medicaid programs require meeting specific financial criteria.
• Application Submission - Submit an application to your state’s Medicaid agency.
• Assessment by a Professional - Often, an occupational therapist will assess your home and recommend specific modifications.
• Approval - The Medicaid agency will review the recommendations and approve the funding if all criteria are met.

The Funding Process

• Step 1: A family member contacts the Medicaid Agency in their state and submits their application for the home modification process.
• Step 2. If the application for home modification is approved, the Medicaid Agency assigns a Case Manager.
• Step 3. The Medicaid Agency contacts an Occupational Therapist to provide the appropriate home evaluation of the disability. The OT then recommends specific home modifications that need to be covered under the Medicaid waivers for home modifications.
• Step 4. The Occupational Therapist submits a recommendation summary to the Case Manager. The CM can provide the family member with a comprehensive list of approved contractors, or they can contact the contractors on behalf of the family.
• Step 5. Since Medicaid is a competitive bid process, the family should have at least 2-3 bids from different contractors for the project. These bid estimates are forwarded to the Case Manager.
• Step 6. The CM will choose a specific contractor’s estimates and send them for approval on the specified amount.
• Step 7: The chosen contractor is provided with a PAR (Prior Authorization Request) to serve as a green light to commence the home modification process.

The Medicaid home modification process takes 6 and 9 months to a year before the project begins. Also, note that you are not guaranteed to get funding from your Medicaid Home Modification application.

Waiver Amounts and Covered Disabilities

The amount you receive for your Medicaid waiver depends on whether you are an adult or a child. Generally, the Medicaid waiver amount for children is $10,000 at an interval of 5 years until they turn 18. As soon as the child turns 18, they are transferred to an adult waiver which offers waivers of $14,000 lifetime maximum cap.

Medicaid home modification program covers a wide range of disabilities including;

• Brain injury
• Multiple sclerosis
• Cerebral Palsy
• HIV/AIDS
• Epilepsy
• ALS
• Autism
• Nursing Facility Care
• Developmental Disability
• Hospital-Level Care
• Geriatric
• Amputee
• Intellectual Disability
• Among other disabilities
  

Types of Qualifying Home Modifications

Medicaid programs cater to home and environmental accessibility modifications. That said, some of the home modifications that qualify for Medicaid include:

• Wheelchair Ramps for improving accessibility for people with disabilities and reducing the risks of falling.
• Lighting adaptations for better overall lighting to reduce the risks of falls. Lighting adaptations also include accessible sockets and light switches as well.
• Widening of the doorways in order to accommodate wheelchairs as well as other mobility aids for people with limited mobility
• Shower modifications to accommodate roll-in wheelchairs. These shower modifications may also include hands-free controls, seat installations, and cube-less showers.
• Medical dispensers help your loved one track their medications, ensuring a single dose is missed.
• Grab bars and handrails to reduce the risk of falls and injuries, especially in bathrooms and staircases.
• Personal Emergency Response Systems to help your loved ones notify someone in case of an accident.
• Stair/Wheelchair lifts help people with limited mobility go up and down the stairs without any risk of falling.
• Accessible handles like lever-style handles make it easier to open and close doors and cabinets.
• Bidets and toilet modifications help people with limited mobility get up and down better and clean themselves after using the toilet.

Navigating the Process

Navigating the Medicaid process for home modifications can be complex, but staying organized and informed can help.

Maintain thorough documentation of all communications and paperwork. Keeping a log of dates, names, and summaries of conversations can be beneficial if you encounter delays or disputes.

Familiarize yourself with your state’s specific Medicaid rules regarding home modifications. Knowing these guidelines can help you effectively advocate for the necessary services.

Follow up regularly on your application status and be prepared to provide additional information or clarification as needed.

FAQs

Will Medicaid pay for a walk-in shower?

Yes, Medicaid can cover the cost of a walk-in shower if it is deemed medically necessary due to your disability. You will need approval based on an assessment by a healthcare provider or an occupational therapist.

How can I get a free home modification?

Free home modifications may be available through Medicaid if you meet the eligibility criteria, or through state-specific programs and grants dedicated to individuals with disabilities. Research local and state resources, or contact a Medicaid advisor to understand what financial aid is available in your area.

Does Medicaid cover vehicle modifications?

Medicaid coverage for vehicle modifications varies by state and typically requires the modifications to be medically necessary. Check with your state’s Medicaid program to see if such accommodations are covered and the process for approval.

Are there grants to make a home handicap accessible?

Yes, several grants are available for making homes handicapped accessible, provided by both governmental agencies and private organizations. These grants are designed to help individuals with disabilities enhance their living spaces for better accessibility and safety.

If you need assistance navigating the Medicaid process for home modifications, contact us at (855) 202-8762 for expert guidance and support. Our experienced team is ready to help you understand your eligibility, complete your application, and ensure you get the necessary modifications to make your home safe and accessible. Don't hesitate—reach out today to take the first step towards a more independent and comfortable living environment for your loved one.