The Personal Care Assistance (PCA) Medicaid Waiver, administered by the Department of Social Services, pays for the costs of a personal care attendant to assist individuals between ages 18 and 64 with a physical disability with their Activities of Daily Living (ADLs).
The intent of the program is to assist individuals with disabilities to accomplish ADLs, achieve a greater sense of independence and to provide an alternative to living in an institution.
It is important to understand that the individual on the PCA Medicaid Waiver is the employer of the personal care attendant. They assume several responsibilities as an employer including the hiring, training and, if necessary, firing of the personal care attendant. The individual should also define job responsibilities with the employee and determine scheduling and paying.
After approval for the PCA Medicaid Waiver is confirmed, the individual has 90 days to hire a personal care attendant. Wages are negotiated between the PCA Medicaid Waiver participant, who is the employer, and the personal care attendant up to a maximum rate. Payment is made on the behalf of the employer by a fiscal agency, who is responsible for all tax matters.
To be eligible for the PCA Waiver, individuals must:
Be between ages 18 and 64
Have a long-term health condition that requires hands on care with at least two ADLs
Meet financial eligibility requirements
Be able to supervise the personal care attendant or have a conservator who can do so
Not have community supports available to live independently
Unmarried applicants are not permitted to have more than $2,250 in monthly income and up to $1,600 in assets. The DSS will perform an assessment to determine program eligibility if the applicant and their spouse have total combined assets greater than $1,600. A spouse can retain joint assets valued up to $123,600.
An owner-occupied home, primary vehicle and some personal effects are not considered countable assets. All savings, stocks and additional property are counted as assets.
Individuals who qualify for Medicaid may also meet the financial requirements for the PCA Waiver. Under the Med-Connect program, employed individuals can have an income up to $75,000 per year and up to $10,000 in assets. Some individuals may pay a monthly premium for this coverage.
Med-Connect applicants may also meet the financial eligibility rules for the PCA Medicaid Waiver if the individual qualifies for Medicaid through this coverage group. Working individuals can have income up to $75,000 per year and up to $10,000 in assets. Some individuals may pay a monthly premium for this coverage. In general, an eligible person, who is employed or becomes employed, can qualify for MED-Connect without the use of spend-down while earning more income than is allowed under other Medicaid coverage groups.
Types of services and supports that can be used for Personal Care Assistance (PCA) Waiver
Services offered by the personal care attendant can include any which enable the individual to carry out Activities of Daily Living such as:
PCAs may also help with shopping, paying bills and transporting participants to medical appointments. They cannot help with medical tasks such as administering medicine or injections.
In addition to the services of the PCA, you may be offered additional supports, such as: adult family living, case management and support brokers.
There is a waiting list for applicants interested in the PCA Waiver.
The process starts by either calling or applying online. Callers should be prepared with information about the kind of help the applicant needs, health conditions and financial information. A nurse or social worker will take the information and determine if the applicant appears to be eligible.
There are a maximum number of slots for the PCA Waiver. Available slots are filled in the order the referrals are received provided all eligibility criteria are met. When a space becomes available, a referral will be made for a care manager to come to the home. The care manager will do an assessment of home and community-based service needs, explain how the program works and bring all necessary forms to be completed.
The applicant and the care manager will decide what services are needed and preferred. Applicants have 90 days to select providers once eligibility is determined.
Contact the state Department of Social Services at1-800-445-5394or go online on theDepartment's website.