Medicaid Waiver

Medicaid Waiver 2017-10-11T03:01:14+00:00

Medicaid allows certain “waiver” programs authorized under the Social Security Act. In Oklahoma, that program is called ADvantage. Its purpose is to provide a community living alternative to nursing home care when living in the community is economically feasible.

ADvantage allows Medicaid to pay for certain home and community-based services to allow Medicaid beneficiaries to live in the community and avoid having to go into an institutional setting.

The goal is to provide services at a level sufficient to keep an otherwise Medicaid eligible person in a residential care setting while receiving the care they require.

Waiver programs are not mandated by federal law in the same way as Medicaid. Rather, waiver programs are elective by states and each state has the authority to create and manage their waiver programs according to state goals, needs and budget. One trademark of waiver programs is flexibility and significantly greater involvement by the benefit recipient and their family in directing services and selecting providers as compared to traditional Medicaid long-term care benefits.

The State of Oklahoma receives cost savings through ADvantage because it provides an applicant with care, usually at home, for less than the cost of traditional Medicaid in a nursing home. That makes it a win-win since the vast majority of people prefer to remain in a community setting. For people needing substantial assistance, yet desiring to remain at home or some other community setting, ADvantage can be an excellent option.

Services Eligible for ADvantage

Unlike traditional Medicaid, ADvantage provides payment to help cover the cost of many different benefits including:

  • In-home Skilled Nursing Care
  • Physical and Respiratory Therapy
  • Personal Care
  • In-home Respite
  • Hospice
  • Specialized Medical Equipment and Supplies
  • Home Modifications
  • Prescription Drugs
  • Assisted Living Services

The eligibility criteria for ADvantage, including the income and asset limits, are very similar to regular Medicaid eligibility. To learn more about the ADvantage Waiver Program and how to plan for eligibility, contact us or call (405) 435-9700.