Pennsylvania Department of Aging Medicaid Waiver

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 Medicaid Waiver provides home and community based services to seniors who require nursing facility care but elect to live in their own homes or in other community living arrangements and receive care in those locations. It is also referred to as the PA Council of Aging Waiver, the PDA Waiver or the Home and Community-Based Waiver for Individuals Aged 60 and Over.

The program's objective is not just to reduce nursing home admissions, but to help seniors function independently in their homes.  As such services beyond personal care are covered.  Support is available to family members caring for loved ones such as adult day care and respite care.   The program also pays for home medical equipment and minor home modifications to improve home access (wheelchair ramps, stair glides) and home safety (walk-in bathtubs, safety bars). 

 PA Seniors are eligible to receive free quotes for bathroom safety improvement in the form of walk-in tubs to replace showers.  Get a quote here.

Under the PDA Waiver, certain goods, supports and services can be participant directed or self-directed. This means the individual chooses from whom they purchase goods or care services. Pennsylvania also has a more robust program which allows the individual even greater control of their care providers called the Services My Way Program.

 

Eligibility Guidelines

In addition to living in PA, residents must be at least 60 years old and require the level of care typically provided in a nursing home. They also must qualify financially for Medicaid in Pennsylvania, which is sometimes called "Medical Assistance" or abbreviated MA.  Financial eligibility is determined at the county level but the following information is sufficiently accurate for planning purposes. 

PA Medicaid Eligibility Requirements for 2014
The income limit for an individual applying for a PA Medicaid waiver is $2,163 / month. If one spouse is applying for Medicaid and the other is not, joint income can be shifted to help the applicant qualify.  The maximum monthly income a non-applicant spouse can have is $2,931.

The asset limit for the PDA waiver is $8,000. Resources in excess of that amount will need to be spent down or re-allocated into exempt (non-countable) assets. In the situation previously described, where one spouse of a married couple is applying, resources in excess of $8,000, up to a maximum of $117,240 can be allocated to the non-applicant spouse. This is referred to as the Community Spouse Resource Allowance.

Applicants Exceeding these Limits
PA has a Medically Needy Medicaid program that enables residents with unusually high care costs to qualify for the program.

Alternatively, Medicaid planning professionals can work with a family to arrange their assets and income into annuities and trusts so that they meet the eligibility requirements. For example, by pre-funding a funeral using an irrevocable funeral trust, one can reduce their countable assets by up to $15,000.   Learn more about Medicaid planning.

 

Benefits and Services

The services provided under this waiver are determined on a needs basis. Individuals can be approved for any of the following and there is no limit on how many of these can be received by any single beneficiary.  

  • Adult Daily Living Services (Adult Day Care)
  • Attendant Care (Personal Care)
  • Community Transition Services (Moving Assistance)
  • Companion Services (Escort)
  • Counseling
  • Environmental Accessibility Modifications (Home and / or Vehicle)
  • Financial Management Services
  • Home Health Services
  • Home Medical Equipment and Supplies
  • Meal Delivery (Hot or Prepared)
  • Non-Medical Transportation
  • Personal Emergency Response (PER) System
  • Respite Care Services (Temporary Caregiver Relief)

 

How to Apply / Learn More

 Waiting lists may exist for the PDA Waiver in some Pennsylvania counties.

While previously only available in certain areas of the state, the PDA Waiver is now available statewide in all 67 counties. However, this waiver is not an entitlement. This means that even though one meets all the eligibility requirements, it does not necessary mean they will immediately be able to receive services.   Waiting lists can exist.  However, they are managed at the county level therefore in some areas there may be immediate availability and in other areas a wait may be required. 

One can learn more about the program on the following website. To apply individuals should contact their local County Assistance Office.

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