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Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration

Mary A., Age 79, Winston-Salem, North Carolina

Medicaid HCBS help senior with physical functional limitations continue to live independently in her own apartment.

Mary lives alone in a subsidized apartment building for senior citizens. She has diabetes, atrial fibrillation, and chronic obstructive pulmonary disease and was hospitalized for four days in February 2013 due to congestive heart failure. She had surgery for breast cancer in 2010, and continues to have follow-up tests. She sometimes has to use oxygen during the day because she gets out of breath when she “tries to do too much,” and she uses oxygen connected to a continuous positive airway pressure machine at night to keep her airway open. She also takes “a whole list” of medications and has frequent doctor appointments. Mary is dually eligible for Medicaid and Medicare and receives Social Security benefits and food stamps.

I almost gave up and learned to do without while I was waiting for waiver services and unable to do things for myself.”
-Mary, age 79

Mary currently receives certified nursing assistant (CNA) services for an hour and 45 minutes a day, five days a week, and she recently learned that she will start receiving additional Medicaid home and community-based waiver services in two to three weeks. Presently, the CNA comes in the afternoons to help Mary with bathing and dressing. If there is any extra time, the CNA will help make her bed if she was unable to do so in the morning and fix her something to eat, but Mary says there is not much time for cooking because the CNA is there such a short time.

Mary needs help cleaning her apartment because she can no longer do any heavy work or lifting. She used to pay someone to help with cleaning, but she can no longer afford it. It is difficult for her to reach up to get a can down from the top shelf in her kitchen, and she also needs help grocery shopping. She says that the CNA used to be able to take her out for an “errand day” once a week, but CNAs are no longer permitted to do so. It is hard for Mary to find someone to take her shopping; when she does, she needs to pay the person about $20 for gas, and she doesn’t have much more than that to spend on her groceries. All of her money goes to rent, utilities, and food, and she can hardly afford anything extra like haircuts.

Mary says that she does not fully understand the Medicaid HCBS waiver program. She was on the waiting list for one year and was “about to give up.” Mary does not want to live in an assisted living facility or a nursing home and says that receiving Medicaid home and community-based wavier services will “make a whole lot of difference” in her life.

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