Eligibility Guidelines

To qualify for a MA-Waiver program, the services must:

  • Be necessary to protect your health and safety
  • Help develop or maintain skills you need in your daily life
  • Best meet your desires, interests, and needs (after considering all available options)
  • Help you avoid institutionalization or help you function with greater independence in the community
  • Not be paid for by any other source, including private health coverage, Medicare, standard Medical Assistance (MA), education services, or Vocational Rehabilitation. If you can access the same service offered by a MA-Waiver program elsewhere, you have to access it elsewhere

Who Can Enroll?

The number of people who can enroll in a MA-Waiver program depends upon legislative action and how much funding is available. In some years, there are plenty of slots available for all people who need MA-Waiver services; in some years there are not enough available slots.

Check with your county human services agency for information on program availability in your area.

Eligibility Criteria
You must meet all of the following criteria to qualify for a MA-Waiver program:
  • You must qualify for disability-based MA or for MA-EPD. You cannot access MA-Waiver services through MinnesotaCare or any other Minnesota public health care program.
  • You must be certified disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
    • Note: If you’re applying for the Developmental Disabilities (DD) Waiver, you only need to have a documented diagnosis of a developmental disability. This is determined during a MnCHOICES assessment by your county human services agency.
  • You can be any age when you enroll in the DD Waiver program, however the developmental disability must have been determined prior to age 22. You must be under age 65 when you enroll in the CAC, CADI, or BI Waiver programs. If you’re on a MA-Waiver program when you turn 65, you can remain on it past age 65.
  • You must get a MnCHOICES assessment from your county human services agency. This assessment will help you decide which services you need. It will also help decide if living in the community, as opposed to an institution, is in your best interest.
  • You must be able to make an informed choice about the fact that you want MA-Waiver services rather than institutional care. If you're unable to make that choice, an authorized representative can make it for you
  • You must have a plan of care that ensure your health and safety (often referred to as a Community Support Plan). This plan should help you identify and access the supports you need to live in the community
  • You must need supports and services beyond those provided under standard MA or MA-EPD
  • You must live in the community, not an institution. You can live in your own home, with family, or in other community settings like foster care homes or assisted living centers

In addition to the criteria above, each MA-Waiver program has its own specific eligibility requirements which are discussed on the ensuing pages in this section.

Application

The application process for each of the four MA-Waiver programs described in this section is the same.

  • Start by reviewing the eligibility criteria for each waiver program to see which one you might qualify for.
  • If you are already on disability-based Medical Assistance (MA) or on Medical Assistance for Employed Persons with Disabilities (MA-EPD), you can apply for a MA-Waiver program at your county human services agency. You will need to fill out the appropriate paperwork and schedule a MnCHOICES assessment. Eligibility for all MA-Waiver programs is ultimately determined during the assessment process
  • If you are not already on disability-based MA or MA-EPD, you can also apply for any waiver program at your county human services agency. You will need to schedule an assessment/screening and fill out the MHCP Long-Term Care and Waiver Services Application and any other necessary paperwork.

Remember that there may be waiting lists for the waiver program you’re interested in. Be sure to apply as soon as you think you meet the eligibility criteria. The length of waiting lists may vary from program to program and county to county.

If you have questions about applying for a MA-Waiver program, contact your county human service agency or Chat with a Hub expert.

Maintaining Eligibility

The most important thing to remember about maintaining eligibility for MA-Waiver programs is this: You must remain eligible for disability-based Medical Assistance (MA) or for Medical Assistance for Employed Persons with Disabilities (MA-EPD) to maintain eligibility for your MA-Waiver program. If you lose disability-based eligibility for MA or MA-EPD, you'll no longer qualify for your waiver program either.

You must remain eligible for disability-based Medical Assistance (MA) or for Medical Assistance for Employed Persons with Disabilities (MA-EPD) to maintain eligibility for your MA-Waiver program.

Asset Limits

Both disability-based MA and MA-EPD restrict the assets that you’re allowed to own. Disability-based MA has an asset limit of $3,000 for individuals and $6,000 for a couple. Your home, the car you drive to work, and a number of other items do not count towards that total. Click here for a listing of all assets that are exempt under standard MA.

Note: If you are getting disability-based MA and are under 21, you do not have an asset limit. If you are on MA via SSI's 1619b provision, the asset limit is $2,000 for individuals ($3,000 for a couple).

If you’re on MA-EPD, the asset limit is $20,000. As with disability-based MA, a number of asset exclusions apply to MA-EPD, including your home and the car you drive to work. MA-EPD also excludes other assets not excluded by standard MA like retirement accounts and your spouse’s assets. For a complete listing of MA-EPD asset exclusions, click here.

Income Limits

You have to meet the income limits for disability-based MA in order to remain eligible for MA-Waiver programs. The Income limits for MA vary depending upon which type of MA you're using. This list does not include income-based MA, because having that type of MA does not let you get the benefits provided by MA-Waiver programs.

  • Disability-Based Medical Assistance (100% FPG): One way you can qualify for MA is to have a disability and have total countable income below 100% of the Federal Poverty Guidelines (FPG). That’s $1,041 per month for individuals and $1,409 for a family of two.
  • Medical Assistance with a spenddown: If your countable monthly income is above 100% of FPG, you can pay a monthly spenddown to maintain your disability-based MA coverage. A spenddown is the amount of money you have to pay for health care expenses each month before MA starts to pay for the rest of your health care bills.
  • SSI 1619(b): If you’re on MA through Social Security’s 1619(b) provision, you will keep your MA coverage as long as your annual earned income is below $53,658.
  • Medical Assistance for Employed Persons with Disabilities (MA-EPD): MA-EPD has no upper income limit though you must be earning more than $65 per month to qualify for the program. Your MA-EPD premium will rise as your income rises, but you’re not at risk of losing MA-EPD eligibility if your income increases.

If you have questions about working and maintaining access to MA, MA-EPD, or MA-Waiver services, Chat with a Hub expert. You can also read the DB101 articles about disability-based MA and MA-EPD.

Other Tips on Maintaining Eligibility

Maintaining your disability-based MA or MA-EPD coverage is essential to maintaining your eligibility for your waiver program.

Here are a few other things you should do to be sure you keep your MA-Waiver services:

  • Complete and return all renewal forms and verifications
  • Participate in any medical and other assessments, as needed
  • Understand how changes in your income or benefits, including Social Security benefits, will affect your eligibility for MA or MA-EPD

Appeals

You may appeal any decision that is made regarding a Minnesota public health care program, including MA-Waiver services, by contacting your county human service agency or writing to the Minnesota Department of Human Services at:

Minnesota Department of Human Services
Appeals and Regulations
P.O. Box 64941
St. Paul, MN 55164-0941

If you have questions about filing an appeal, Chat with a Hub expert.