Alternatives to Waiver Programs
Alissa Gorman, Esq.
Low-income individuals with disabilities may be eligible to receive in-home personal care services, which would allow them to live independently in the community instead of an institutional setting. Many of these services are provided to individuals through Home and Community Based Services, or “waiver” programs. Waiver programs are available only to individuals that meet strict financial and medical eligibility requirements. However, there are several non-Medical Assistance programs that provide services similar to waiver programs, where individuals with disabilities can receive personal care services in their homes without meeting the strict financial and medical eligibility requirements of waiver programs.
The Options program provides the same services as the Aging Waiver, which include adult daily living services, home delivered meals, home health services, non-medical transportation services, personal care services, respite services, counseling services, and many other services. Individuals who are 60 years or older, have resources over the $8,000.00 Medical Assistance waiver limit and monthly income over the $2,130.00 waiver limit, and that do not require skilled nursing care services are eligible for the program. A violation of the Medical Assistance waiver income limit does not disqualify the individual for the in-home services; if his or her monthly income exceeds 125% of the federal poverty limit (“FPL”) ($1,196.00 for a one person household), the program requires cost-sharing to obtain the services. If an individual is eligible for both the Aging Waiver and the Options program, the individual must enroll in the Aging Waiver. The maximum amount of services an individual may obtain in 2013 is $714.60 per month.
The ACT 150 Program provides personal assistance services similar to the Attendant Care waiver, such as bathing, dressing, cleaning, cooking, and shopping. Similar to the Options program, there are no income or resource requirements; however, if an individual’s income is more than 125% of the FPL, they will be required to contribute to the cost of services. To qualify for the Act 150 Program, an individual must be between the ages of 18 – 59, capable of hiring, firing and supervising their workers, capable of managing their own financial and legal affairs, and cannot require skilled nursing facility level of care.
If an individual is over the age of 18, needs assistance with activities of daily living, and is unable to live independently, he may be eligible for Domiciliary Care or “Dom Care.” Individuals in the Dom Care program live with a care provider in the care provider’s home. This program is only available for individuals with disabilities who do not have another relative that is able to provide the care. No more than three Dom Care residents may live in the home. If an individual qualifies for Dom Care and also receives Supplemental Security Income (SSI), the individual may also receive a state supplement towards the cost of Dom Care and a personal needs allowance or may qualify for the Aging Waiver. Funding and eligibility for Dom Care is determined by each county’s Area Agency on Aging (AAA).
The Caregiver Support Program provides support and respite care for a primary caregiver who provides in-home services to an individual with chronic dementia. A care provider with an income below 200% of the FPL ($1,915.00 for 1 person) may receive home chore services, advice and counseling, a small stipend for out of pocket costs (not to exceed $200 per month), a one time home modification up to $2,000.00, and respite services. For caregivers with income between 200% of the FPL but under 380% ($3,639 for 1 person), the care provider is required to contribute to the cost of the services. If the caregiver’s monthly income is over 380% of the FPL, the caregiver is not eligible for the program.
Older Adult Daily Living Centers (otherwise known as Adult Day Care) are for individuals age 60+ years or adults of any age with dementia-related diseases and Parkinson’s disease. The Centers provide a safe, supervised environment in which qualified adults may receive meals, nursing care, physical therapy, speech therapy, medical treatment, and laboratory service. The centers are typically located in a senior center or a church and are licensed by the Pennsylvania Department on Aging. The AAA determines an individual’s funding and eligibility for the center.
The Options Program, Older Adult Daily Living Center, ACT 150 Program, Domiciliary Care, and Caregiver Support Program are not funded by Medical Assistance, and therefore, funding for these programs comes from other state sources. Since these programs are not an entitlement, individuals might be put on a waiting list before they receive the services. Individuals that have not yet qualified for Medical Assistance funded long-term care due to excess resources may be eligible for one or more of these programs while they spend down their assets. Should want more information on these programs, please contact our office to schedule an appointment.