Are you a senior who is experiencing the physical and/or mental deterioration that comes along with the natural aging process? If so, it may be getting difficult – even unsafe – for you to care for yourself without help. Understandably, however, you do not want to leave your home and move to a long-term care facility. By the same token, you don’t like the idea of someone you don’t know caring for you. As the Oklahoma City Medicaid lawyers at Parman & Easterday explain, there are two Medicaid Waiver programs that may allow a family member to be compensated for providing for your care.
What Is a Medicaid Waiver?
“Medicaid Waivers,” which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services, are programs that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under traditional Medicaid rules. Unlike the traditional Medicaid program, services or benefits provided through a waiver are only good for a designated period of time. They are often renewed, but there is no guarantee that a waiver will be renewed. These waiver programs allow people who would otherwise receive care in a long-term care (LTC) facility to receive that care in the community through an assisted living facility, a community based care program, or even by family caregivers.
The Oklahoma Personal Care Program
The Oklahoma Personal Care Program, also referred to as “State Plan Personal Care,” provides disabled and elderly residents with the funds to retain a personal care assistant to help them manage their Activities of Daily Living (ADLs) in their own home or the home of a family member. Assistance with ADLs includes helping an eligible applicant do such things as get dressed, use the bathroom, and prepare meals. Personal Care Program participants can select home care agencies, neighbors, friends, and even some non-immediate family members to provide their personal care, but cannot select spouses or legal guardians to provide care.
To be eligible, you must be a resident of Oklahoma and require assistance to complete your activities of daily living. You cannot be so severely incapacitated that you require skilled nursing level assistance or the level of care provided in an Intermediate Care Facility. You must also meet current income and asset requirements for Medicaid. For 2019, a senior may be eligible for Medicaid if monthly countable income is no greater than $1,041. If you are married and you are both applying, your joint countable monthly income cannot exceed $1,409. In addition, if you are applying as an individual you cannot have more than $2,000 worth of countable assets. If you are applying with your spouse, your countable assets cannot exceed $3,000. Certain assets are exempt, such as your family home up to $585,000, a vehicle, household items, personal goods, and burial plots.
The ADvantage Program
This Oklahoma Medicaid waiver is designed to help frail elders remain in their homes or the home of a family member, instead of in a nursing home environment. Seniors participating in the ADvantage Program can receive a number of long term care services, such as personal care and assistance, home modifications for increased safety and access, and adult day care.
One option under this waiver is referred to as the “Personal Assistance Services & Supports” (CD-PASS). Under the CD-PASS program option, participants are free to choose their own personal care providers. Family members are eligible to be hired and paid to provide personal care services. With this program, spouses and legal guardians can be paid to provide care under certain conditions. Another option is assisted living, formally referred to as the “Assisted Living Service Option” (ALSO).
You must be a resident of Oklahoma, 65 or older, and be in need of the level of care provided in nursing homes. In addition, you must meet the income and asset requirements for Oklahoma’s Institutional Medicaid. As of 2019, the income limit for long term care services (institutional Medicaid) for a single applicant is $2,313 per month and the countable resources limit is $2,000. Like the Oklahoma Personal Care Program, certain assets are exempt. If you are married and your spouse (referred to as the “community spouse”) is not applying for Medicaid, the spousal impoverishment rules apply to ensure your spouse is not left without resources. Although the spousal impoverishment rules are complex, your spouse may be entitled to some of your monthly income and is entitled to keep a significant amount of assets.
ADvantage Waiver participants can be approved to receive any of the following services.
- Adult Day Health Care / Adult Day Care
- Assisted Living – Assistance with laundry, preparing meals, housecleaning, mobility, hygiene, etc.
- Case Management
- Consumer Directed Personal Assistance Services / Supports
- Disposable Medical Supplies
- Home Modifications for Improved Access – Ramps, lifts, roll-in showers, widening of doorways, etc.
- Home Delivered Meals
- Hospice Care
- Occupational Therapy
- Personal Care – Aid in activities of daily living, such as bathing and dressing
- Physical Therapy
- Prescription Drugs
- Specialized Medical Equipment
- Speech Therapy
- Respite Care
- Nursing / Skilled Nursing
- Personal Emergency Response System (PERS)
- Restorative and Supportive Assistance – For individuals with a chronic condition that is stable, such as a need for an external catheter
- Transition Services from Institution
- Transportation – Medical and Non-Medical
Contact Oklahoma City Medicaid Lawyers
For additional information, please join us for an upcoming FREE seminar. If you have additional questions or concerns about the Medicaid program, contact the experienced Oklahoma City Medicaid lawyers at Parman & Easterday by calling 405-843-6100 or 913-385-9400 to schedule your appointment today.