Oklahoma’s ADvantage Program Waiver: Qualifications and Services

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

This Oklahoma Medicaid waiver is designed to help frail elders remain living in their homes instead of in a nursing home environment.  The ADvantage Program does so by providing a variety of long term care services such as personal care and assistance, home modifications for increased safety and access and adult day care. 

 ADvantage is being expanded to allow family members to be paid caregivers and to offer assisted living services to the elderly.

Participants in the program have the option to let the state manage the care services they receive or self-directing their own care.  Self-direction, also referred to as participant direction or Cash and Counseling, is through the associated program; Consumer-Directed Personal Assistance Services & Supports (CD-PASS). Under the CD-PASS program, participants are free to choose their own personal care providers. Family members, with some exceptions, are eligible to be hired and paid to provide personal care services to the participant. Readers should be aware the CD-PASS option is being rolled out by county and is not yet be available statewide.  Current counties can be seen here.

Another option available under ADvantage, is assisted living.  Formally called the Assisted Living Service Option (ALSO).  ALSO is available to all program participants. 

 

Eligibility Guidelines

Age, functional ability, income and assets are all qualifying criteria for the ADvantage Program. Age and functional ability are related. Persons 21 and over are eligible if they are designated as disabled by the Social Security Administration. Persons 65 and over do not require full disability; instead they must have a need for the level of care provided in nursing homes.

Financially, the ADvantage Waiver requires that applicants qualify for Oklahoma's Institutional Medicaid. Medicaid in Oklahoma is also referred to as SoonerCare. The SoonerCare income limit for 2013 for a single applicant is $2,163 / month. The countable resources limit is $2,000.  If the individual is married and their spouse is not applying for Medicaid, the spouse is allowed to have higher income, ($2,931 / month in 2014) and more assets ($117,240 in 2014). 

Persons who do not qualify for Medicaid financially, might be interested in Medicaid planning assistance as these experts can usually help them to re-structure their assets and income so that they qualify.   Read more.

 

Benefits and Services

The ADvantage Waiver is intended to help the elderly remain living at home, therefore the available benefits are selected with that goal in mind. Waiver participants can be approved to receive any of the following services.   Certain unskilled services, most relevantly personal care, are available for self-direction.  

  • Adult Day Health Care
  • Assisted Living
  • Case Management
  • Disposable Medical Supplies
  • Home Modifications for Improved Access
  • Home Delivered Meals
  • Hospice Care
  • Occupational Therapy
  • Personal Assistance Services
  • Personal Care
  • Physical Therapy
  • Prescription Drugs
  • Specialized Medical Equipment
  • Speech Therapy

 

How to Apply / Learn More

The ADvantage Waiver is a SoonerCare program managed by the Oklahoma Department of Human Services. While available throughout Oklahoma, waiting lists may exist. To apply, contact your local Human Services Office or call 1-800-435-4711.  More information is available here.

There are other options available to senior citizens in Oklahoma which not have waiting lists: Adult Day Care Services and In Home Assistance Services.