Page Reviewed / Updated - Apr. 2015
The Personal Choice Program provides for consumer directed care; also known as the cash and counseling model. Instead of care, nursing home qualified participants receive cash and are able to retain their own personal care providers. Individuals must have a need for nursing home level care and can live at home or in the community.
Given the flexibility to choose their own personal care providers and the very personal nature of personal care, many program participants prefer to receive care from persons with whom they are comfortable and familiar. The Personal Choice Program excels in this capacity as certain family members are eligible to be hired as paid caregivers. In this situation, the care recipient is considered an employer and must manage their caregiver or employee. The caregiver receives payments and must pay taxes on the wages they receive.
The Personal Choice program takes into consideration both the financial status and the functional ability of applicants when determining eligibility.
Functional Ability - applicants, at a minimum, must require the level of care provided in nursing homes. An assessment by qualified medical professionals is the norm in determining this qualification.
Financial Status - applicants must be financially qualified for Rhode Island Medicaid, also referred to as the Medical Assistance Program. Both income and assets are taken into consideration. In 2015, unmarried or widowed applicants are limited to $4,000 in countable assets. Countable assets do not include the home, vehicle, and life insurance policies with a benefit of less than $4000.
There are two levels of income qualification, applicants can be Medically Needy or Categorically Needy. Categorically Needy applicants have income sufficiently low that they are eligible regardless of their medical expenses. In 2015, state residents with income below 100% of the Federal Poverty Level ($11,770 / yr) are Categorically Needy. Medically Needy individuals may have income in excess of this amount but their medical expenses are factored into the calculation. If they cannot afford their recurring care costs with their income, they become eligible as Medically Needy recipients. This is referred to in RI as the 'Flex Test.'
It is possible to qualify for this Medicaid HCBS waiver a third way. Under this method, the applicant has to show wages and net income that total less than $1,961. When participants qualify in this way, they will be asked to contribute a modest co-pay for their care services.
A Medicaid planner or a specialist with knowledge of the Rhode Island rules can be of great assistance when one's assets or income are over the limits to appropriately convert them to compliant forms. Applying in this way is a complicated procedure and requires expertise to perform without error. However, for many families, it is their only option to care for a loved one. Learn more.
Each participant in the Personal Choice program is assessed and found eligible for a different array of services. These might include:
This program is available in all Rhode Island counties. A Fact Sheet can be downloaded here. To apply, one can call 401-725-1966 or 401-349-5760 or visit their local Department of Human Services office.