Medicaid Home Modification Funding Guide

A disabled man with an amputated leg sits in his wheelchair holding a Medicaid Home Modification Funding Guide

Medicaid Home Modification Funding Guide

For over 20 years, Accessible Systems has helped families navigate the Medicaid Home Modification Funding process. The majority of our clients, from children to adults, have disabilities. About half of the Medicaid projects have entailed making bathrooms accessible and the other half have been the installation of adaptive equipment like wheelchair ramps, stairlifts, ceiling lifts, automatic door openers, and grab bars and other handholds for fall prevention. It is our goal to provide the very best solutions possible for each individual’s situation, and we trust you will find value in this Medicaid Home Modification Funding Guide.

Does Medicaid Pay for Home Modifications?

Basic Medicaid services do not cover home accessibility. Thankfully, for the last 27 years, Medicaid has provided a Home and Community Based Waiver Program. This waiver program is only available to people enrolled in Medicaid and it provides an alternative to nursing home and assisted living facilities. The goal is to support Medicaid recipients and allow them to stay in their own home.

What is the Medicaid Home Modifications Funding Process?

What is the Medicaid Home Modifications Funding Process?

Check Off Where am I at in the process? 
_____ 1 Family member contacts the appropriate Medicaid Agency in their state and associated county and submits an application for approval or denial to go through the home modification process.
_____ 2 IF the family is approved, a Case Manager (CM) from the Medicaid Agency will be assigned.
_____ 3 Most of the Medicaid agencies will contact a certified home modification Occupational Therapist (OT) that is required to provide a home evaluation of the disability eligibility and will recommend specific home modifications that will be covered under the Medicaid Home Modification Waivers.
_____ 4 The OT submits their Survey to the CM with a recommendation summary. The CM either provides the family with a list of approved contractors OR the CM will reach out to the list of contractors on behalf of the family.
_____ 5 The Medicaid Home Modification Process is a “competitive bid process,” meaning that the family is required to have 2 or 3 different contractors provide estimates for the same project.  These estimates are sent to the CM.
_____ 6 The Medicaid Home Modification Process is a “competitive bid process”, the client is required to have 2 or 3 different contractors provide estimates for the same project.  These estimates are then sent to the case manager
_____ 7 The chosen contractors estimate will then be sent to the state for approval for the amount specified on the contractors estimate.
_____ 8 The state provides the chosen contractor a Prior Authorization Request (PAR) serving as the green light for the contractor to begin the project.

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How Long Does the Medicaid Home Modifications Funding Process Take?

This process can take up to 6-9 months on average and can take up to one year, BEFORE the project actually begins.

This Medicaid guide does not guarantee that the client will receive funding, but it will connect the OT or family to the correct Medicaid agency that will help to start the Medicaid Home Modification Application Process.

What are the Disabilities Covered by Medicaid for Home Modification Funding?

Disabilities covered by Medicaid for home modification funding include:

  • Cerebral Palsy
  • Spinal Cord Injury
  • Brain Injury
  • HIV/AIDS
  • Multiple Sclerosis
  • Nursing Facility Care
  • Hospital Level Care
  • Developmental Disability
  • Intellectual Disability (ICF-IID)
  • ALS
  • Geriatric
  • Amputee
  • Epilepsy
  • Autism
  • Other disabilities

What Barriers are Covered by Medicaid for Home Modifications Funding?

  • Bedroom
  • Bathroom
  • Stairway
  • Garage Access
  • Front Door Access
  • Back Door Access
  • Other

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What are the Waiver Types?

While the waivers mentioned here are specific to Colorado, the waivers in other states should be pretty similar. They may be called by another name, so it’s best to contact your state’s Medicaid Agency or look on their website for the accurate local information near you.

ADULT WAIVERS

  • Brain Injury (BI)
  • Community Mental Health Supports Waiver (CMHS)
  • Developmental Disabilities Waiver (DD)
  • Elderly, Blind and Disabled Waiver (EBD)
  • Spinal Cord Injury Waiver (SCI)
  • Support Living Services Waiver (SLS)

CHILDRENS WAIVERS

  • Children’s Extensive Support Waiver (CES)
  • Children’s Home and Community Based Services Waiver (CHCBS)
  • Children’s Habilitation Residential Program Waiver (CHRP)
  • Children with Life-Limiting Illness Waiver (CLLI)

What is the Medicaid Home Modifications Waiver Benefit Amount?

Generally, children’s Medicaid waivers are for $10,000 every 5 years until the child turns 18 years of age at which point the child will then be transferred over to an adult waiver. Adult Medicaid waivers have a $14,000 one-time lifetime cap.

What Types of Home Modifications Qualify for Medicaid?

  • Ceiling Lifts
  • Wheelchair Lifts (aka Vertical Platform Lifts or VPL’s)
  • Stairlifts
  • Incline Platform Lifts
  • Barrier-Free Showers and Bathroom Modifications
  • Installation of or Building of a Wheelchair Ramp
  • Installation of Sensory Equipment
  • Railings and Grab Bars
  • Automatic Door Openers
  • Door Widenings
  • Flooring Replacement
  • Window Safety

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