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Receive Payment as a Caregiver: Cash and Counseling Program
| Definition | Qualifications | Costs |
| Pros & Cons | Benefit Types & Limits | How to Apply |
| Overview of the Cash and Counseling Program | ||
Note: The Cash & Counseling Program is changing its name to the National Resource Center for Participant-Directed Services.
It should be noted that this program is still in development. Rules and processes are determined at the state level and are subject to change. By 2011, the number of participating states is expected to increase from 15 to 35.
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For Medicaid eligible seniors, the process begins with an assessment in the home to determine the senior’s home care needs; this includes interviews with caregivers and possibly the senior’s physicians. A determination of how many monthly care hours are required is made. The benefit amount is calculated using that determination and cost of care for that geographic area. This amount can be increased or decreased as the senior’s needs change.
Seniors are considered to be “employers” and they decide how to allocate the funds, payments can go to a spouse or the adult child who is providing them with care. Most programs have a provision that allows surrogate decision makers to help the senior with the selection of care provider and management of funds. To avoid conflicts of interest, usually the surrogate decision maker and the individual being paid for caregiving cannot be one in the same.
Many state programs require that financial management companies be used to make sure applicable payroll taxes are filed (remember the senior is considered “an employer”). An exception to this is if payments are less than the limit at which payroll taxes are due.
Skilled Nursing and Assisted Living
The Cash & Counseling program is for care provided in the home, therefore it is not relevant to skilled nursing or assisted living.
In addition, each participating state has its own name for these programs. For examples in Arkansas it is called “IndependentChoices”, in Florida “Consumer-Directed Care Plus” and in New Mexico, “Mi Via”.
The income thresholds for Medicaid eligibility are determined at the state level but all of them use one of two methods:
- Income Cap States use the federal income cap which is 3 x SSI payment standard. For 2010, this limit was $2,022 a month. If one’s income is below this amount, then one qualifies. If it exceeds that amount, it is possible one could still qualify, but will need to work with a legal professional to set up an Income Cap Trust/Miller Trust.
- Non-Income Cap States looks at the applicant’s income and the cost of care. If an applicant cannot afford the cost of care, he or she will qualify.
| Income Cap States | Non-Income Cap States | ||
|---|---|---|---|
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For couples, where one spouse requires care in a facility and the other is healthy enough to remain at home, the spouse living at home is known as the “community spouse” and is entitled to a certain amount of income. The community spouse's income consists of income solely in his or her name plus half of any income that is in the joint name of both spouses.
Medicaid / Cash and Counseling Asset Limits
Medicaid applicants' resources are a major factor in eligibility. Resources
might also be referred to as their "assets" or "countable assets." State limits
range from $1,000 to $8,000, but most are $2,000. There are a considerable
number of exceptions made when determining what qualifies as a resource. For
example, the Medicaid applicant's home can be a "non-countable" asset. Others
are:
- Clothing, furniture, and jewelry
- One motor vehicle
- Prepaid funeral plans
- Assets that are considered "inaccessible" for one reason or another
There are some additional requirements determined by states for homes to be
counted exempt. The applicant must live there or intend on returning to the
home. It also must be in the same state in which the applicant is applying for
Medicaid. His or her equity in the home must be value at less than $500,000,
unless the spouse resides there.
For couples, the "community spouse" is entitled to a certain amount of
resources, half of the couple's resources up to $109,560 in 2010. (That amount
may be lower in some states.)
Working with a Professional to be Financially Eligible for Medicaid
As mentioned previously, the financial eligibility rules for Medicaid are very
complex. There are approaches and strategies that help seniors gain
eligibility. It is recommended that seniors consult with Medicaid experts prior
to application. Case Managers from the local Area Agency on Aging office may be
able to help. Private Geriatric care managers can help as well. Working with a
Medicaid Planner ensures the greatest possibility of acceptance while at the
same time helping families to preserve as much of their assets as possible.
| Arkansas | Iowa | Pennsylvania |
| Florida | Kentucky | Rhode Island |
| New Jersey | Michigan | Vermont |
| Alabama | Minnesota | Washington |
| Illinois | New Mexico | West Virginia |
The money can also be used to purchase items related to the activities of daily living; a cleaning service, meal preparation, laundry service and transportation for medical appointments are acceptable services.
