Medicaid Aged and Disabled Waiver Environmental Modifications - What is Allowed and Not Allowed?
One of the first questions we get from both Case Managers and their clients is, what is allowed under the guidelines of the Medicaid Aged and Disabled (A&D) Waiver for Environmental Modifications? A very good question and not the easiest to answer.
In the Koremen LLC blog, we are determined to keep things simple, but like most things in life, simple doesn't cover all the nuances that can occur when looking into an individual's needs.
You can download our one-sheet that gives a good detail of information on what is and what is not allowed under the A&D Waiver for Environmental Modifications. Or you can bookmark this page for reference when you are wanting a refresh on the basics. Below is a summarized list and by no means is meant to be the end-all when speaking to clients. If you ever have a question about what could be allowed, give us a call! We would be happy to help you through the process of determining what might be the best option for your client.
Another good thing to remember, just because one item wasn't allowed in the past, that does not mean it is a definite to be denied in the future. Some items don't fall neatly into any one of the defined categories. In the end, a human will determine whether or not to approve an item for your client and based on the rationale and explanation from the Case Manager, could have an impact on the decision.
Allowed:
Adaptive Door Openers and Locks
Bathroom Modification - Limited to one existing bathroom
Environmental Control Units
Environmental Safety Devices
Fence - Limited to 200 linear feet
Ramp - Limited to one per individual household
Stair Lift
Single-Room Air Conditioners
Single-Room Air Purifiers
Widen Doorway
Windows - Replacement of glass with Plexiglass or other shatterproof material
Maintenance - Limited to $500 annually
NOT ALLOWED:
Adaptations or Improvements that are Not of Direct Medical or Remedial Benefit to the Individual
Central heating and air conditioning
Routine home maintenance
Installation of standard home fixtures
Structural repair
Garage doors, elevators, and ceiling tracks
Driveways, decks, patios, sidewalks, etc.
Replacement of carpeting and flooring
and more
Modifications that Create Living Space or Facilities Where They Did Not Previously Exist
Modifications That Duplicate Existing Accessibility
Modifications That Will Add Square Footage to the Home
Individuals living in Foster Homes, Group Homes, Assisted Living Facilities, or Homes for Special Services Are Not Eligible
Individuals Living in a Provider-Owned Residence Are Not Eligible
Completion of, or Modifications to, New Construction, or Significant Remodeling or Reconstruction Are Excluded
Services to Participants Receiving Adult Family Care or Assisted Living
*Koremen LLC is not responsible for changes to the Medicaid rules and guidelines. This document is for reference and training purposes only. Please refer to the Indiana State Medicaid office for the most up-to-date guidelines available.
