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How to Work with Medicaid for Home Modifications

home modification info

If your loved one has limited mobility, they will benefit significantly 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 some of these home modifications could be much more expensive than expected.

But don’t worry, there are government programs that can help finance these home modifications. Every state usually has a Medicaid program to help foot home modifications 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 making the home more livable to foster independence. While this may seem pretty 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. 

What is the Funding Process for Medicaid Home Modifications? 

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. 

How Long Will the Home Modification Process Take? 

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. 

What is Medicaid’s Waiver Amount for Home Modifications? 

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.  

What Disabilities Does Medicaid Cover for Home Modification? 

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

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

What Kind of Home Modifications Qualify for Medicaid? 

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.

While it might seem like a daunting task, once you start the process there’s a chance that you and your loved one might receive the proper assistance needed to make their home safer. Improving their wellness comes with taking the first steps. If you need assistance getting these modifications this is where Rosarium Health comes in. Our team is equipped to work within this process for both Medicaid and private insurance. If you're ready to take those first steps, reach out! Also, if you happen to be at the 2023 Hybrid Home and Community-Based Services (HCBS) Conference on the 27th our team will be present to answer any questions you have.

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