Elderly Waiver Rate Caps Increasing January 1

Posted on November 17, 2022 by Jeff Bostic

The customized living, 24-hour customized living, and overall case mix caps in the Elderly Waiver (EW) program increase effective Jan. 1, 2023, because they are tied to the rise in care center rates. The 24-hour customized living caps will increase by 9.69%, which is the amount of the 2022 care center increase, and the overall EW caps are going up by 9.63% due to minor rate changes in a couple of EW services.

Members should be aware that, particularly for clients near one or both of those caps, the higher cap will allow the case manager to authorize additional services they have not been able to authorize previously.

The Department of Human Services (DHS) is also changing how customized living caps are calculated by making them consistent statewide at 50% of the total EW cap for each case mix. That increases those caps of 13% to 45% depending on the case mix level and the county. DHS is also implementing a 3% rate increase for home care services on Jan. 1, 2023, because that is now authorized annually by state statute.

Unfortunately, the service rates for most EW services, including the customized living rate components and adult day services, are not increasing on Jan. 1 because the Legislature has not authorized increases. The Legislature has failed to take this vital step despite our ongoing advocacy and a DHS study that illustrated that the current rates are far short of the cost of providing these essential community services even before the impact of inflation in the last year. The Long-Term Care Imperative recently approved a legislative agenda for 2023 that prioritizes further implementation of the new EW rate system and ongoing updating of those rates. We are hopeful that the new Legislature will respond to this urgent need.